Over half a century after the introduction of modern-day mammography, the
screening controversy seems stronger than ever. Heated debates are centered
on determining the effects of mammograms on breast cancer mortality, largely
based on data that is decades old.
As I watch these debates, I can't help but feel that we have lost our
way. Somewhere along the line, the focus has deviated from what is paramount
— saving women from breast cancer.
Rather than looking to the data from decades past, we should be looking
forward and determining how to make good screening technology even better
and more accessible.
That is what Hoag Hospital and other breast centers around the country
have done in adopting breast tomosynthesis (3D mammography). If traditional
mammograms are the gold standard in breast cancer detection, tomosynthesis
Traditional 2D mammograms depict all the complexities of breast tissue
in a single flat image. The limitations of 2D mammography are largely
related to the fact that normal dense fibroglandular breast tissue and
breast cancer both appear white on mammograms.
This is admittedly a gross oversimplification of mammographic interpretation,
but the principle holds true. Dense breast tissue may not only conceal
some breast cancers, resulting in false-negative results, it can also
simulate signs of cancer, resulting in anxiety-producing false positives
(when a mammogram indicates cancer is present, though it is not). About
1 in 10 women will be recalled from her 2D screening mammogram for additional
imaging evaluation. The addition of tomosynthesis reduces this rate by
up to 37%.
Tomosynthesis is a breakthrough technology that allows specially trained
radiologists to examine breast tissue layer by layer. Tomosynthesis reveals
fine details and helps deliver a clearer image. The result is improved
detection of cancer (40% more invasive cancers) and a decrease in false-positive results.
This decrease in false positives is a key differentiating factor between
tomosynthesis and other supplemental screening tools like breast ultrasound
and MRI, in which the benefit of increased cancer detection must be weighed
against the risk of increased false positives and unnecessary biopsies.
As the data continues to emerge, it is clear that tomosynthesis is a superior
technology. And it is something that every woman should be able to access
— not just those with dense breasts or those with an increased breast
To this end, Hoag has now placed these $500,000 machines in all seven of
our breast imaging facilities throughout Orange County, making it one
of the largest providers of tomosynthesis in the West, and ensuring that
women can access superior 3D mammograms no matter where they live.
Through remote connections, our specially trained breast radiologists read
all the images acquired at our breast imaging facilities, whether they
are in Irvine, Costa Mesa, Aliso Viejo or Huntington Beach. As the first
breast center in California to offer tomosynthesis four years ago, Hoag's
breast program is one of the most experienced in performing and interpreting
these highly specialized exams, and we have seen first-hand how beneficial
this technology is in detecting breast cancer early and saving lives.
Mammograms do save lives. It is time to stop arguing about how many lives
they save and start working toward a future in which all women have access
to the best, most accurate imaging possible.
Dr. January Lopez is the director of breast imaging at the Hoag Breast Center.