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Breast Cancer Statistics
ACS Estimates for 2014
Most common cancer among American women
232,670 new cases of breast cancer diagnosed in women
2nd. Leading cause of cancer death in women, exceeded only by lung cancer
40,000 women will die from breast cancer
5-Year Relative Survival by Stage at Diagnosis
www.seer.cancer.gov
SEER 18 2004-2010, All Races, Females by SEER Summary Stage 2000
Limitations of 2D Mammography
20% of cancers will be missed
Sensitivity decreases significantly with increased breast density
Approximately 10% will be recalled for additional work up
75-80% of all breast biopsies will result in benign results
2D versus 3D Mammography
Enhanced lesion detection – borders of lesion better defined
Increased cancer detection rate
Reduces false positive recalls
Precise lesion localization
Technique: 2D and 3D images obtained with
one compression
X-ray tube sweeps through a 15deg
arc acquiring 15 low dose
projections (~4secs)
Mathematical reconstruction
generates 1mm slices through the
breast
Radiation dose: ~2X the dose of a
mammogram
Still very low, below MQSA
requirements
C-view (synthesized 2D)
2D will no longer be needed
Dose reduction
Hologic
Limitations of DBT
Takes longer to read
Cannot be read on demand or STAT
Increased radiation
Radiation dose: ~2X the dose of a mammogram
Still very low, below MQSA requirements
No CPT code
Massive storage requirements
IT Storage Requirements for 20,000
Mammograms
2D Storage for standard 4 View Mammogram = 1.74 Terabytes/year
3D Storage for standard 4 View Mammogram = 10 Terabytes/year
Oslo Norway DBT
Screening Trial
Prospective Trial : November 22,2010 to December 31,2011
4 Arms: 2D, 2D +CAD, 2D+3D, synthesized 2D+3D
12,621 sequentially recruited women
Exams interpreted with mammography alone and compared with
mammography + DBT
Oslo Norway DBT
Screening Trial
Results:
Cancer Detection Rate of Invasive Cancer +DCIS
27% increase (p=.001)
40% Increase detection of invasive cancers
Increase observed across all breast densities
2D Mammography alone: 6.1 cancers/1000 exams
2D + Tomosynthesis : 8 cancers/1000 exams
Oslo Norway DBT
Screening Trial
Results:
False Positives ( Recalls from screening exams)
Mammography alone : 61.1/1000 exams
Mammography + Tomosynthesis : 53.1/1000
15% Decrease
JAMA
Retrospective Trial : March 2010 – December 2012
454,850 examinations
13 sites (academic and nonacademic)
Compared mammography interpretation performance 1 year prior to
tomosynthesis implementation to performance following
tomosynthesis implementation
JAMA
Results:
454,850 examinations
281,187 2D exams
173,663 2D+3D exams
Recall Rate: 15%
Cancer Detection Rate: 41% (invasive cancers)
DCIS detection rate : no change
The Breast Density Legislation
Effective August 1, 2014, a new law by the Minnesota State Legislature
requires all Minnesota mammography facilities to report breast density to
patients with dense breasts. This law was enacted for three reasons:
1. Dense breasts slightly decrease the ability of mammography to find
breast cancer.
2. Dense breasts slightly increase the risk of breast cancer.
3. Patients may want to know about supplemental screening tests.
Supplemental Screening Options
Breast MRI
Expensive
Requires IV contrast
Recommended for select hi risk population (>20% lifetime risk of breast cancer)
Screening US
Slightly increased cancer detection but has high false positives
Operator dependent, time consuming
Digital Breast Tomosynthesis
Only mammography has been shown to decrease mortality rates.
Summary Digital Breast Tomosynthesis
Build on the success of the the
screening mammogram
Increased Sensitivity AND
Specificity
Right sizing breast imaging
Replace 2D MammographyAllina website