Feds test whether 3-D mam­mo­grams bet­ter than X-rays

The Detroit News - - Front Page - BY LAU­RAN NEER­GAARD As­so­ci­ated Press

Washington — A bet­ter mam­mo­gram? In­creas­ingly, women are asked if they want a 3-D mam­mo­gram in­stead of the reg­u­lar Xray — 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 al­ready 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 pose 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 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 con- fu­sion sur­round­ing best screen­ing prac­tices.

Who needs mam­mo­gram?

That de­pends on whom you ask. Guide­lines vary for women at av­er­age risk of breast cancer. (Those at in­creased risk, be­cause of fam­ily his­tory or ge­net­ics, al­ready get dif­fer­ent ad­vice.)

The Amer­i­can Col­lege of Ra­di­ol­ogy rec­om­mends an­nual mam­mo­grams start­ing at age 40.

The Amer­i­can Cancer So­ci­ety urges an­nual checks start­ing at 45 and switch­ing to ev­ery other year at 55, though it says women 40-44 still can opt for a mam­mo­gram.

And the U.S. Pre­ven­tive Ser­vices Task Force, a gov­ern­ment ad­vi­sory group, rec­om­mends start­ing at age 50, with mam­mo­grams ev­ery other year. It, too, says 40-some­things can choose ear­lier screen­ing.

Stan­dard mam­mo­grams take X-rays from two sides of the breast. With to­mosyn­the­sis, ad­di­tional X-rays are taken at dif­fer­ent an­gles — not truly three-di­men­sional but a com­puter com­piles them into a 3-D-like im­age. Ap­proved by the Food and Drug Ad­min­is­tra­tion in 2011, they’re not yet the stan­dard of care in part be­cause of ques­tions that the new study aims to an­swer.

How to de­cide?

Un­der­stand that mam­mo­grams come with pros and cons, and weigh them, said Dr. Otis Braw­ley, the Amer­i­can Cancer So­ci­ety’s chief med­i­cal of­fi­cer.

Con­sider: For ev­ery 1,000 women screened ev­ery other year un­til their 70s, start­ing at 40 in­stead of 50 would pre­vent one ad­di­tional death — but cre­ate 576 more false alarms and 58 ex­tra un­needed biop­sies, the task force es­ti­mated.


Dr. Tova Koenigs­berg at The Mon­te­fiore Ein­stein Cen­ter for Cancer Care in New York shows an ex­am­ple of a tra­di­tional mam­mo­gram scan. Of­fi­cials are be­gin­ning to com­pare tra­di­tional tests with 3-D ver­sions.

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