Research highlights need for more investment in 3D screening


Dr Lim


With one in nine women now developing breast cancer at some time in their life, detecting the disease early and protecting future generations, especially through research, is more important than ever. Of course, breast screening is the most effective and efficient way of spotting warning signs; however, traditional mammograms are not without their flaws.

For instance, such screening can miss key indicators of the disease or, equally, can misinterpret images as signalling cancer when this isn’t the case, leading to unnecessary recalls and causing increased anxiety levels in patients.

It was this issue that inspired us to lead research into digital breast tomosynthesis (DBT), which is a new mammography technique that can give greater accuracy and potentially lower false positive (‘false alarm’) rates. DBT takes 3D X-rays of the breast tissue, giving a clearer view of the structure of the breast than standard (2D) mammography.

With a study we called FHTomo, which was led by consultant academic breast radiologist Dr Anthony Maxwell, we wanted to find out whether using DBT in addition to conventional 2D mammography would reduce the number of women recalled for more testing and, therefore, prevent unnecessary upset and stress.

Younger women have denser breasts which often makes interpretation of their mammograms difficult. The FHTomo study involved women aged 40 to 49 attending for screening at the Nightingale Centre and King’s College Hospital in London. They were split into two groups: the first received DBT and a conventional 2D mammogram at their initial appointment and then just a 2D mammogram a year later, while the second group received a 2D mammogram first and then DBT and a 2D mammogram at the second appointment. This allowed researchers to look at the impact, if any, of DBT on recall rates.

Interestingly, results showed that the introduction of DBT did not lead to a reduction in the need for further testing in women that had previously been screened. However, such findings do not mean that this screening method should be discounted. Instead, the results highlight the need for more investment in DBT research and training, and in particular to establish whether DBT is cost-effective when screening women for the first time.

While conventional mammography is essential when detecting and diagnosing cancer, DBT can support such a method and, following further studies with more participants, we’re confident that DBT will, in time, form an integral part of the UK breast screening programme.