Recent findings presented at the Radiological Society of North America (RSNA) conference have put into perspective the limitations of two-dimensional (2D) mammography in detecting breast cancer. The study, led by Dr. Matthew Covington, highlighted that 2D mammography might miss a significant portion—up to 59 percent—of detectable breast cancer cases. This revelation raises critical questions about the reliance on traditional mammogram techniques for breast cancer screening.
Dr. Covington’s study scrutinized an extensive sample of 40,538,610 screening mammograms performed in 2023, utilizing data from the Mammography Quality Standards Act (MQSA). Additionally, the study accounted for a prevalence of 43 percent of dense breast tissue as noted by the Breast Cancer Surveillance Consortium (BCSC) and considered an estimated 17,431,602 supplemental screening exams conducted within the same timeframe.
In his research, Dr. Covington identified 469,437 cases of detectable breast cancer across the 2023 population subjected to screening. The study aimed to compare the effectiveness of different screening methods: 2D mammography, digital breast tomosynthesis (DBT), ultrasound, molecular breast imaging (MBI), contrast-enhanced mammography (CEM), and magnetic resonance imaging (MRI).
The detection capabilities of these methodologies were quantified using cancer detection rates (CDR) and incremental cancer detection rates (ICDR). For 2D mammography, the BCSC provided a CDR of 4.7 per 1,000 cases. In contrast, the ICDR values for the other modalities varied: DBT at 1.7 per 1,000, ultrasound at 2.7 per 1,000, MBI at 8.1 per 1,000, CEM at 10.7 per 1,000, and MRI leading with a rate of 16 per 1,000.
The results were striking. Of the total cases, 2D mammography could successfully diagnose only approximately 190,531, accounting for just 41 percent of the total breaches in the detected population. This statistic underscores the potential pitfalls of relying solely on this conventional method.
Dr. Covington, serving as an assistant professor in the Department of Radiology and Imaging Sciences at the University of Utah, remarked on the insufficiency of 2D mammography, notably in cases involving dense breast tissue. He stressed that “less than half of all detectable cancers within the screening population” might be identified through this method alone.
Exploring other modalities, the study projected that MRI holds the highest potential for detecting breast cancer, especially in women with dense breasts. MRI was noted to be the leading supplemental screening tool, followed closely by CEM, which could potentially reveal 80 percent, or 377,049 of the 469,437 cases, and MBI, with an estimated detection rate of 71 percent.
In terms of supplemental screening, DBT and ultrasound were found to be less efficacious. DBT was found to be capable of identifying approximately 47 percent, while ultrasound could detect about 51 percent of breast cancer cases, according to the study.
Dr. Covington emphasized the importance of evaluating the effectiveness of various screening approaches for breast cancer. He believes that a deeper understanding of these methods, including specific tactics for those with dense breast tissue, could guide future screening strategies and improve detection rates significantly.
This comprehensive study brings to light the critical need to explore and implement more effective breast cancer screening methods, particularly for those populations identified as having dense breast tissue, thus ensuring a thorough and accurate diagnostic process.
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