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Tomosynthesis: Is It Reaching a Tipping Point?

3-D mammography superior to traditional imaging for both dense-breasted and nondense-breasted women, JAMA study finds

Innovations in Cancer - Summer 2016 - View Full PDF


Director, Breast Cancer Imaging, UH Seidman Cancer Center, Associate Professor of Radiology, Case Western Reserve University School of Medicine

Tomosynthesis first grabbed headlines two years ago. Writing in JAMA, researchers from 13 breast centers reported results of a large study of breast imaging exams, which included more than 280,000 digital mammograms and more than 170,000 digital mammograms with supplemental 3-D tomosynthesis.

“The bottom line was that with the addition of tomosynthesis, our detection of breast cancers improved substantially, while our recall rate decreased,” says Donna Plecha, MD, Director of Breast Cancer Imaging at University Hospitals Seidman Cancer Center and one of the study’s authors. “We were able to show a 41-percent relative increase in the invasive cancer detection rate for combined tomosynthesis and digital mammography, compared with digital mammography alone. In this study, we also saw a 15-percent relative decrease in call-backs using tomosynthesis, compared with 2-D digital mammography alone.”

Now, new findings support the apparent superiority of tomosynthesis.Reporting again in JAMA, researchers reviewed the same data as used in the 2014 study. But this time they considered women’s breast density as a factor.

“Currently, 24 states have laws mandating that women be notified about the implications of breast density,” says Dr. Plecha, who is also an author of the new JAMA study. “However, it’s not known which if any additional modalities should be recommended for women with dense breasts.”

Results of the new study show that adding tomosynthesis to traditional digital mammography increased invasive cancer detection and reduced recall rates for all women, regardless of breast density.

“People may think that tomosynthesis is only for dense-breasted women, and that’s not the case,” Dr. Plecha says. “This large study shows that it’s good for dense and nondense breasts. That’s the bottom line.”

Specifically, study results show that improvements with tomosynthesis were largest for women with heterogeneously dense breasts and those with nondense breasts of scattered fibroglandular densities.

“These two groups make up about 82 percent of all women,” Dr. Plecha says. “Everyone benefits from tomosynthesis, but these groups benefit more than others.”

“Tomosynthesis makes us better,” she adds. “We’re not only finding more cancers – we found 48 percent more invasive cancers in the dense-breasted women and 30
percent in the nondense women. We’ve also reduced the recall rate 14 percent and 13 percent. No other supplemental screening exam does both.”

For more information about the advantages tomosynthesis may provide to your patients, please contact Dr. Plecha at