Digital mammography breast cancer screening of the future
Digital mammography improves early detection of breast cancer. Dutch researchers led by Adriana Bluekens from Radboud University in Nijmegen compared early breast cancer detection with "digital screening mammography" to conventional X-ray film mammography.
In their study, the Dutch scientists came to the conclusion that aggressive breast cancer tumors based on digital mammography are better recognized than before. In addition, the originally feared increase in false positive diagnoses did not occur, Bluekens and colleagues report in the journal "Radiology". The improved early detection of breast cancer also increases the chances of a successful treatment of the tumors.
More than a million breast cancer screenings evaluated As part of their study, the researchers at the “National Expert and Training Center for Breast Cancer Screening” in Nijmegen evaluated 1,198,493 screening tests from 2003 to 2007. Of the almost 1.2 million breast cancer screenings, a total of 12.7 percent were carried out using digital technology, the rest based on conventional X-ray film technology. 18,896 patients were followed up on the basis of the first finding. The proportion of follow-up examinations ordered for digital mammography was around twice as high as for conventional screening examinations. A total of 6,410 women were diagnosed with breast cancer using the mammograms. On the basis of the X-ray film, evidence was found in 5.6 out of 1,000 women during the initial examination, and in 5.2 out of 1,000 patients, the subsequent tests confirmed the breast cancer diagnosis. The detection rate per 1,000 women in digital mammography was 6.8 for the first examination and 6.1 for the subsequent examinations, according to Bluekens and colleagues.
No overdiagnosis through digital mammography As the Dutch researchers report, early detection of breast cancer not only has the goal of "discovering tumors as such", but must also enable an evaluation of the associated breast cancer risk. Because not every tissue change in the breast has to develop into breast cancer. For example, the procedures should only identify potentially aggressive early forms, "anything else would be overdiagnosed," write Adriana Bluekens and colleagues. Although a certain proportion of overdiagnoses cannot be ruled out with either breast cancer screening technique, the digital procedure has no disadvantages in this regard. With both methods approximately the same number of slowly growing and thus harmless early forms of breast cancer were discovered. Contrary to previous concerns, the rate of false positive diagnoses does not increase due to the switch to digital mammography. With both screening methods, the proportion of diagnoses of rather harmless ductal carcinomas in situ (DCIS) was around three percent. "This result suggests that digital mammography overdiagnoses do not increase in early detection of breast cancer," concludes the Dutch researchers.
Aggressive early forms of breast cancer reliably detected With the aggressive forms of ductal carcinoma in situ, the detection rate based on digital technology was significantly better than with conventional mammography, Bluekens and colleagues report. The rapidly growing, potentially invasive tumors were identified much more frequently. The invasive carcinomas could be detected particularly reliably on the basis of digital mammography if they were associated with so-called microcalcifications (microscopic lime deposits in the tissue). Overall, "digital mammography found significantly more tumors than conventional mammography," according to the Dutch scientists.
Breast cancer screening saves lives The study by the Dutch research team shows that there is still room for improvement in the area of breast cancer screening. The future belongs to digital technology. However, the conventional method has already helped numerous women. Because the earlier breast cancer is detected, the better the chances of successful treatment. In this country, women between the ages of 50 and 69 are therefore invited to the mammography examination every two years. Your health insurance covers the costs. While the corresponding breast cancer screening program in Germany has only been running since 2006, it has been in the Netherlands for over twenty years. The Netherlands are also leaders in the introduction of digital technology for breast cancer screening. (fp)
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