3-D mam­mo­grams: An im­prove­ment?

The Denver Post - - NEWS - By Lau­ran Neer­gaard

WASHINGTON» A bet­ter mam­mo­gram? In­creas­ingly women are asked if they want a 3-D mam­mo­gram in­stead of the reg­u­lar X-ray — and now U.S. health of­fi­cials are start­ing a huge study to tell if the newer, some­times pricier choice re­ally im­proves screen­ing for breast cancer.

It’s the lat­est dilemma in a field that vexes women with con­flict­ing guide­lines on when to get checked: Start­ing at age 40, 45 or 50? An­nu­ally or ev­ery other year?

The is­sue: Mam­mo­grams can save lives if they catch ag­gres­sive breast can­cers early. But they also can harm through fre­quent false alarms and by spot­ting tu­mors that grow so slowly they never would have posed a threat — over­diag­no­sis that means some women un­dergo un­needed treat­ment.

That trade-off is a key ques­tion as doc­tors be­gin re­cruit­ing 165,000 women na­tion­ally to com­pare po­ten­tially more ben­e­fi­cial 3-D mam­mo­grams — known sci­en­tif­i­cally as “to­mosyn­the­sis” — with stan­dard two-di­men­sional dig­i­tal mam­mog­ra­phy.

The 3-D mam­mo­grams have been mar­keted as be­ing able to find more can­cers. “But the idea isn’t so much find­ing more can­cers as find­ing the can­cers that are go­ing to be life-threat­en­ing,” said Dr. Worta McCaskill-Stevens of the Na­tional Cancer In­sti­tute, which is fund­ing the new re­search to tell whether the 3-D scans truly pin­point the tu­mors that mat­ter most.

It’s one of the largest ran­dom­ized tri­als of mam­mog­ra­phy in decades, and sci­en­tists de­signed the re­search to do more than an­swer that key 3-D ques­tion. They hope the find­ings also, even­tu­ally, will help clear some of the con­fu­sion sur­round­ing best screen­ing prac­tices.

“The most im­por­tant thing about this study is that it’s mov­ing us to in­di­vid­u­al­ized screen­ing as op­posed to what we have now, which is one-size-fits-all screen­ing,” pre­dicted study chair Dr. Etta Pisano, a ra­di­ol­o­gist at Bos­ton’s Beth Is­rael Dea­coness Med­i­cal Cen­ter.

“We are go­ing to have a much bet­ter un­der­stand­ing of how to screen women so that we do the least amount of harm.”

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