Adjunct screening using 3D tomosynthesis and ultrasound to women with NORMAL 2D mammographic findings significantly detects invasive cancer. The multi-site ASTOUND trail from Italy compared the benefit of 3D and Ultrasound as an adjunct to women with NORMAL 2D mammography results. Twenty four cancers were found (23 invasive). 3D detected an additional 13 cancers, ultrasound detected 23. Out of the 13 invasive cancers NOT seen on 3D, eight were in women with heterogeneously dense breasts, BIRADS C. The number of false positives and recall rates were similar in both technologies. The incremental cancer detection rate for tomosynthesis and ultrasound differed by 3.1 cancers per 1000, favoring ultrasound. Thirty-two percent of the cancers missed on 2D mammography were in women with lymph nodes metastasis, an indicator of poorer survival outcomes.
"Our findings could be taken to suggest that tomosynthesis is detecting Breast Cancer that would have been otherwise masked on 2D, but seems less than capable than ultrasound at finding cancers that are entirely masked by mammography-dense tissue," reported the authors.
Take Away from this study: If you have dense breast tissue and are getting 2D or 3D mammography as your breast screening, be sure to discuss with your health care providers the addition of adjunct ultrasound, which in the ASTOUND study, showed an increased cancer detection rate over 2D and 3D alone. Remember: The sole purpose of breast cancer screening is,in the unlikely event that you are diagnosed with breast cancer, it is found at an early stage which convey better survival outcomes and more treatment options.
The abstract of the ASTOUND study from the Journal of Clinical Oncology, March 2016, can be found HERE.
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Breast density is one of the strongest predictors of the failure of mammography screening to detect cancer.
Two-thirds of pre-menopausal women and 1/4 of post menopausal women have dense breast tissue.
Adding more sensitive tests to mammography significantly increase detection of invasive cancers that are small and node negative.
Cancer turns up five times more often in women with extremely dense breasts than those with the most fatty tissue.
While a mammogram detects 98% of cancers in women with fatty breasts, it finds only 48% in women with the densest breasts.
A woman at average risk and a woman at high risk have an EQUAL chance of having their cancer masked by mammogram.
Women with dense breasts who had breast cancer have a four times higher risk of recurrence than women with less-dense breasts.
A substantial proportion of Breast Cancer can be attributed to high breast density alone.
There are too many women who are unaware of their breast density, believe their “Happy Gram” when it reports no significant findings and are at risk of receiving a later stage cancer diagnosis.