June 25, 2018
Dense Breasts: Newer Exams

Dense Breasts: Newer Exams

by Berkeley Wellness  

For women who have dense breasts, there are three newer screening options to consider. Learn more about tomosynthesis, digital mammography and automated breast ultrasound.

Tomosynthesis. This 3D mammography imaging technique, approved by the Food and Drug Association (FDA) in 2011, is done following a regular mammogram. It produces dozens of razor-thin visual slices, which reduces the problem of tissue overlap that obscures breast masses in regular mammography, so the masses are better delineated.

Studies have shown that the combination of mammography and tomosynthesis significantly improves cancer detection, as well as reduces the recall rate (when women are called back for additional mammography imaging because the results are unclear). But it’s not known if the test reduces false positives, and it exposes women to additional radiation.

Though some doctors think tomosynthesis will become the new standard for supplemental screening for women with dense breasts, there is too little evidence to recommend it at this time. Insurance usually does not cover it because it’s still considered investigational.

Digital mammography. This may be better than conventional film mammography for dense breasts because the images, stored on a computer, can be adjusted to better see “hidden” tumors. There are few studies comparing digital to film mammography, but a large clinical study in the New England Journal of Medicine in 2005 found that the digital technology improved cancer detection by 11 percent in women with dense breasts, compared to film exams.

And an observational study in the Annals of Internal Medicine in 2011 found that digital mammography had higher sensitivity in women with extremely dense breasts. It concluded, however, that the accuracy of a mammogram depends on the expertise of the radiologist who reads it “at least as much as whether the screening modality is digital or film-screen.”

Many mammography centers now offer digital imaging. If yours doesn’t, talk to your doctor about whether you should switch to one that does.

Automated breast ultrasound (ABUS): In a standard breast ultrasound, a doctor or technician moves a hand-held device (called a transducer) over each breast and takes images of selected areas that are viewed on a computer screen. This can be time-consuming and, because the results are highly dependent on the skill of the person doing the test, some lesions can be missed.

Several automated ultrasound systems have thus been developed in recent years, including the somo-v, which the FDA approved in 2012 specifically for use in women with dense breasts. It scans the entire breast in just one minute, producing images that are sent to a workstation where the doctor reviews the results.

A study in Clinical Imaging in May found that ABUS detected 12 cancers per 1,000 women with dense breasts, compared to 5 per 1,000 women by mammography alone—but there are no studies yet comparing ABUS to regular ultrasound. Both regular and automated breast ultrasound use harmless sound waves.