3-D, 2-D mammograms being studied in diverse populations

Are 3-D mammograms better than standard 2-D imaging for catching advanced breast cancers?

A clinical trial is recruiting thousands of volunteers — including a large number of Black women, who face higher breast cancer death rates — to try to find out.

People like Carole Stovall, a psychologist in Washington, have signed up for the study to help answer the question.

“We all need a mammogram anyway, so why not do it with a study that allows the scientists to understand more and move closer to finding better treatments and ways of maybe even preventing it?” Stovall said.

The underrepresentation of women and minorities in medical research has long been an issue with a range of health problems including Alzheimer’s disease, strokes and COVID-19. Trials that lack diversity lead to gaps in understanding of how new treatments might work for various people.

“Until we get more Black women into clinical trials, we can’t change the science. And we need better science for Black bodies,” said Ricki Fairley, a breast cancer survivor and advocate who has been working on the issue.

Black women are 40% more likely to die of breast cancer than white women and tend to be diagnosed with it younger. But it’s not clear whether 3-D mammography is better for them, said Dr. Worta McCaskillStevens of the National Cancer Institute.

“Are there populations for whom this might be important to have early diagnosis?” she asked. “Or is it harmful” — perhaps leading to too many false alarms or unnecessary follow-up tests and treatments?

McCaskill-Stevens, who is Black, leads the Cancer Institute’s efforts to boost research among minority and rural communities — and has joined the study herself.

The 3-D technique has been around for a decade, but there’s never been conclusive evidence that it’s better than 2-D at detecting advanced cancers. The newer technique combines multiple pictures taken from different angles to create 3-Dlike images of the breasts. Both 3-D and 2-D screenings compress the breast and use low doses of radiation.

Studies have suggested that 3-D finds more cancers than 2-D, but catching more cancers doesn’t necessarily save lives — some cancers missed by standard screening may not progress or require treatment. But past studies did not assign subjects to a screening method randomly, which is the gold standard for research.

The idea “that if it’s new, it’s shiny, then it’s better,” isn’t always true, McCaskillStevens said. “Until we have the evidence to support that, then we need well-designed, randomized trials.”

The trial’s goal is to study 128,000 women, and it has enrolled nearly 93,000 to date. The National Cancer Institute-funded study is running in Canada, South Korea, Peru, Argentina, Italy and 32 U.S. states, soon to be joined by Thailand.

“We added more international sites to enhance the trial’s diversity, particularly for Hispanic and Asian women,” said Dr. Etta Pisano, the study’s leader.

Latinos make up 42% of the study’s current participants. As recruiting continues, enrolling Black women and other women of color will “absolutely” continue to be a priority, Pisano said.

The women are randomly assigned to have either 2-D or 3-D mammograms and will be followed for several years. The number of advanced cancers detected by the two methods will be compared.

At the U.S. sites, 21% of participants are Black — far higher than the 9% seen in typical cancer treatment studies, McCaskill-Stevens said.

The University of North Carolina has signed up more Black women for the study than any other site. Nearly a quarter of the nearly 3,000 women enrolled at UNC’s two locations are Black.

“Women in North Carolina want to take part in something that’s bigger than them,” said Dr. Cherie Kuzmiak, who is leading the UNC arm of the study. “They want this active role in helping determine the future of healthcare for women.”

In the nation’s capital, word of mouth has helped with recruiting.

A chance encounter persuaded Stovall to join the research. While waiting for a hair appointment at her salon, she met Georgetown University cancer researcher Lucile Adams-Campbell. The two, both Black, started chatting.

“She explained how important it was to get women of color into the program,” said Stovall, who jumped at the chance to catch up on her mammograms after the pandemic delayed screening for thousands.

Stovall, 72, also had a personal reason to join the research. Her sister recently completed treatment for triple-negative breast cancer, an aggressive type that affects Black women at higher rates than white women.

Women ages 45 to 74 without a personal history of breast cancer are eligible for the study, which launched in 2017. Many women also are providing blood and cheek swab samples for a database that will be mined for insights.

“It’s a dream that people had since the beginning of screening that we wouldn’t fit everybody into the same box,” Pisano said, adding that the findings could “reduce disparities if we’re successful, assuming people have access to care.”

Stovall had a brief scare when a traditional 2-D mammogram showed something suspicious. But a biopsy ruled out cancer.

“I was extremely relieved,” she said. “Everybody I know has heard from me about the need for them to go get a mammogram.”