The Who, What, Where, When and Sometimes, Why.

3D Mammography (Breast Tomosynthesis) for Breast Cancer Screening

This summary table contains detailed information about research studies. Summary tables are a useful way to look at the science behind many breast cancer guidelines and recommendations. However, to get the most out of the tables, it’s important to understand some key concepts. Learn how to read a research table.

Introduction: A 3-dimensional (3D) mammography machine takes multiple 2-dimensional (2D) digital images of the breast. Computer software combines the 2D images into a 3D image (called breast tomosynthesis).

Some studies have shown 3D mammography may find a few more breast cancers than 2D mammography [1-5]. Whether 3D mammography is better than standard 2D mammography for breast cancer screening is still under study [1-5].

Learn more about 3D mammography.

Learn about breast cancer screening recommendations for women at average risk.

Study measures (sensitivity and specificity)

The main goal of any cancer screening test is to correctly identify everyone who has cancer (called the sensitivity of the test). For example, a sensitivity of 90 percent means 90 percent of people tested who truly have cancer are correctly identified as having cancer.

An ideal cancer screening test would also be able to correctly identify all the people who don’t have cancer as not having it (called the specificity of the test). For example, a specificity of 90 percent means 90 percent of the people who don’t have cancer are correctly identified as not having cancer.

When sensitivity is high, the test picks up even the slightest abnormal finding. Very few cases are missed, but the test will mistake some people as having cancer when they don’t (called a false positive result).

When specificity is high, there are few false positive results, but more cases of true cancer are missed.

No screening test has perfect sensitivity and perfect specificity. There’s always a trade-off between the two. That is, when a test gains sensitivity, it loses some specificity.

Learn more about the quality of screening tests.

Study selection criteria: Clinical trials with at least 100 cases of invasive breast cancer cases.

Table note: The studies below compare sensitivity and specificity for screening with 2D digital mammography plus 3D digital mammography vs. screening with 2D digital mammography alone.

There are no data comparing survival among women who had 2D digital mammography versus those who had 3D digital mammography (alone or in combination with 2D digital mammography).

StudyStudy Population
(number of participants)
SensitivitySpecificity
2D Digital Mammography
Alone
2D Digital Mammography
Plus 3D Digital Mammography
2D Digital Mammography
Alone
2D Digital Mammography
Plus 3D Digital Mammography
Clinical trials
Oslo Tomosynthesis
Screening Trial [6]
24,301
(302 invasive breast cancer cases)*
76%81%NS96%98%Sig

 

NS = No statistically significant difference between the 2 groups

Sig = Statistically significant difference between the 2 groups

* Included an additional 76 cases of ductal carcinoma in situ (DCIS)

References

  1. Skaane P, Bandos AI, Gullien R, et al. Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology. 267(1):47-56, 2013.
  2. Friedewald SM, Rafferty EA, Rose SL, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 311(24):2499-2507, 2014.
  3. Bernardi D, Macaskill P, Pellegrini M, et al. Breast cancer screening with tomosynthesis (3D mammography) with acquired or synthetic 2D mammography compared with 2D mammography alone (STORM-2): a population-based prospective study. Lancet Oncol. 17(8):1105-13, 2016.
  4. Siu AL on behalf of the U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 164(4):279-96, 2016.
  5. Melnikow J, Fenton JJ, Whitlock EP, et al. Supplemental screening for breast cancer in women with dense breasts: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 164(4):268-78, 2016.
  6. Skaane P, Sebuødegård S, Bandos AI, et al. Performance of breast cancer screening using digital breast tomosynthesis: results from the prospective population-based Oslo Tomosynthesis Screening Trial. Breast Cancer Res Treat. 169(3):489-496, 2018.

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