Why Add Tomosynthesis for Screening Dense Breasts?

For women with dense breasts, adding tomosynthesis to biennial digital mammography is a cost-effective way to improve cancer detections, researchers report in the journal Radiology.

Researchers found that if priced appropriately, using tomosynthesis screenings for women between 50 and 74 years of age provided improved specificity saving lives and reducing false-positive results. The screening process for tomosynthesis, similar to mammography, relies on ionizing radiation but also allows for three-dimensional reconstruction of the breast tissue, giving radiologists the option to view the images as sequential slices through the breast.

Key Point:

- Adding tomosynthesis to digital mammography for women with dense breasts could be a cost-effective way to ensure fewer false-positive screening results and avoid unnecessary follow-up procedures.

The biennial protocol could be an effective alternative to using MRI in women with dense breasts, said study author Christoph I. Lee, MD, assistant professor in the Department of Radiology Health Services at the University of Washington

"Screening MRI is the most sensitive breast imaging test, but is also more expensive, requires intravenous contrast injection and is currently reserved for screening women at high risk for breast cancer," Lee said in a news release. "Digital breast tomosynthesis, in contrast to MRI, may offer operational and ease-of-use advantages since it is an integrated part of newer generation mammography units."

The study found that the incremental cost per quality-adjusted life-year gained by adding tomosynthesis to digital mammography screening was $53,893. The addition of tomosynthesis led to an additional 0.5 deaths being averted and the avoidance of 405 false-positive results per 1,000 women after 12 rounds of screening.

The researchers suggested that a cost of up to $226 for the combined screening would be cost-effective. That’s compared with a price of $139 for digital mammography alone. Combined screening was less than $100,000 per quality-adjusted life-year gained, the authors reported.

"The decrease in false-positive results after adding tomosynthesis is a major contributor to the cost-effectiveness of combined screening," Lee said. "Our study suggests that adding tomosynthesis at the time of mammography screening has the potential to decrease the number of unnecessary diagnostic work-ups and invasive procedures that result from false-positive findings."