By: Elaine Gottlieb for Fibroids1For most women, one mammogram a year is enough. Being called back for a follow-up test just adds to the anxiety. In the future more women may be spared this stress, as digital mammography, which a new study found requires fewer callbacks than conventional mammography, becomes more widespread.
What is digital mammography?
Like film mammography, digital mammography uses x-rays to create an image of the breast. But the image is stored and recorded in digital form while a conventional mammogram is printed as a hardcopy. Doctors can view and manipulate digital images on a computer screen – zoom in, magnify and optimize – for a clearer view of breast tissue.
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Is digital mammography right for you?
Speak with your doctor or gynecologist – they can discuss the pros and cons of digital mammography and whether it is important for your health needs.
Contact your mammography facility – technologists can provide more information about mammography and the type of tests available.
Contact digital mammography manufacturers – they may be able to tell you if there’s a facility in your area. Manufacturers include General Electric Medical Systems, Fischer Imaging and Lorad/Hologic. GE Healthcare has a referral service for its units; find out more here.
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“In my experience, digital mammography images dense breast tissue somewhat better than standard mammography,” said Dr. Elisabeth Frost, staff radiologist at Brigham and Women’s Hospital in Boston, where the study was conducted. Just as breasts come in many shapes and sizes, they also vary in tissue patterns. Dense breasts are more glandular with less fat; as women age, the breast tends to become fattier.“With digital, you can increase contrast and brightness and improve the ability to detect subtle differences in the tissue,” said Dr. Janet Baum, director of Breast Imaging at Beth Israel Imaging Center, Boston and Associate Professor of Radiology at Harvard Medical School. But, she cautions, even with digital mammograms, there are still instances when a second image is needed.
When are follow-up mammograms needed?
When an image isn’t of adequate quality or an area of the breast requires closer scrutiny or a different view, patients are called back for a follow-up mammogram. Some conditions that warrant a second look are masses in the breast or areas with calcifications (calcium deposits in tissues that can be associated with cancer or fibrocystic changes).
Getting a second mammogram is not a reason for alarm. Out of 1,000 screening patients, approximately 4 - 8 are diagnosed with cancer. “It’s important that women know that most findings that require a second test turn out not to be cancer. So, if they are called back, they should not be overly concerned,” reported Dr. Frost.
Digital reduces callbacks
The study, led by Dr. Sughra Raza of Brigham and Women’s Hospital in Boston, compared conventional and digital mammograms taken at the hospital’s screening center and evaluated by the same radiologists. Of the 6,189 conventional film screen mammograms, 274 patients were called back, for a 4.4 percent call back rate. For the digital mammograms, there were 261 callbacks out of 6,792 screenings, for a 3.2 percent call back rate. At Brigham and Women’s, this would translate to 160 fewer women a year needing follow-up mammograms.
While these particular findings are preliminary and have not been published, they do support other studies conducted in the U.S. and Europe which reported lower callback rates with digital mammography.
However, digital imaging has not yet been shown to aid cancer detection. Results of a major National Cancer Institute study comparing cancer detection rates of digital and traditional mammograms based on a sample of nearly 50,000 women are expected soon.
The benefits of digital tests
Fewer callbacks do spare patients the anxiety of a second test, time away from work and the possible costs of childcare or medical coverage. In addition, digital mammograms offer these benefits:
• Faster results for shorter appointments – the image appears in ten seconds so the technologist can check it for quality right away and not keep the patient waiting.
• More efficient access – digital mammograms can be easily transmitted to other sites for viewing or printing.
• Cost savings – digital mammography eliminates the need for facilities to store, process and handle film, which saves time and money and helps offset the higher cost of digital systems.
When you have a digital mammogram, you won’t notice any difference. The machine and process are the same, with breasts positioned and compressed on a metal surface for optimum viewing.
Is digital for you?
Both digital and film mammography are useful tools for breast cancer screening. Neither Dr. Baum nor Dr. Frost advise patients to request one type or another at the present time. Whichever test you take, it is important to bring prior mammograms for comparison if you switch to a new facility for any reason, advises Dr. Frost, so the radiologist can track changes.
It is likely that most larger facilities will switch to digital mammography just as digital x-rays have replaced film x-rays, if it is shown to be at least as accurate as film mammography, according to Dr. Baum.
