Introduction
Mammograms can assist to save lives by detecting breast cancer early when it is still treatable. Research shows that regular breast cancer screening minimizes mortality resulting from breast cancer, and mammograms remain the best methods to screen for cancer of the breast. For this reason, it has become part of the list of a must do measures of preventive health care for women of 40 years and above. However, the traditional mammography has had some limitations: women describe it as being quite painful and zero fun, and also it can lead to inaccurate results which may lead to overdiagnosis, which might pose some health challenges to women due to excessive exposure to radiation. Even though the pain and discomfort of traditional mammography do not last longer and might not be considered a serious issue, it is, however, having grave health consequences. According to Mazzo (2017), a recent survey done by the agency of market research Kadence International of 10,000 women documented that physical discomfort fear was the chief reason for avoidance of a mammogram for women who have not done it before.
According to Breast Cancer Surveillance Consortium, mammograms are the best technique for breast cancer screening, accounting for correct identification of close to 87 percent of women who suffer from breast cancer, and so, it is troubling that most women are avoiding it because of the mentioned shortcomings. But thanks to the new technology, the 3D mammography also called tomosynthesis, which has been found to reduce the shortcomings of the traditional mammography significantly. The U.S. Food and Drug Administration approved the new technology in 2011, and medical literature indicates that it reduces pain, decreases false negative and positive results, thus decreasing overdiagnosis. On this background, this paper focuses to discuss mammograms regarding its limitations and the new technology to improve the shortcomings. The first part will cover an overview of what a mammogram is and research/literature showing its flaws. The second section will discuss the new technology while the third part will address the future needs or expectations. Finally, a concluding paragraph concerning the discussion observation.
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Mammogram and research/literature showing its shortcomings
Centers for Disease Control and Prevention (CDC, 2006) defines a mammogram as a low-dose x-ray image of the breast. In that context, mammography refers to a specialized type of medical breast imaging which applies x-rays of low dose to detect cancer early and diagnose it before experiencing its symptoms. As such, Radiological Society of North America (RSNA, 2018) defines mammogram as the mammography exam. In connection to that, it is done when a woman stands right in front a mammography machine, and one of the woman’s breast is placed on a transparent plastic plate and firmly, but gently pressed from another paddle which is above the breast. The plate then compresses the breast and maintain it still, which assists to produce a better image of a mammogram. The pressure is felt for a few seconds and does not hurt the breast. The same process is repeated with the second breast. Then the machine’s plates are tilted for side viewing of each breast. When the process is over, a woman will have undergone two different x-rays of each breast, amounting to four x-rays (CDC, 2006).
Mammograms are used for two primary reasons: diagnosis and screening. Screening mammograms are applied to check women who have not shown any symptoms or signs of breast cancer, and it comprises of two x-rays for every breast. Its major goal is to aid in early detection of cancer, thus, enhances the chance for successful treatment (CDC, 2006). On the other hand, diagnostic mammograms are used at the time when a woman has signs of breast symptoms or after an irregular mammogram. During a mammogram for diagnostic, various pictures are taken to examine the breast carefully. In many cases, special images enlarge a small region of the breast, making it easier to study. At times, a woman has to undergo a diagnostic mammogram shortly after taking her screening mammogram because this will help study abnormalities found on the first mammogram (CDC, 2006).
Various research has documented the importance of mammography in women. According to Duffy (2005) screen-film (traditional) mammography remains the best tool for breast cancer, because of the vast consensus which shows that it saves lives through early detection of the cancer of breast hence higher chances fruitful treatment. As a result, this has reduced the mortality rate of women resulting from breast cancer. Duffy (2005) adds that many recent data review by numerous independent organizations, including the Global Mammography Summit (June 2012), the International Agency for Research on Cancer of the World Health Organization (March 2014), and the U.S. Preventive Health Task Force (September 2012), brought to an extensive agreement concerning the utility of screening mammography. From the review, breast cancer mortality is believed to have reduced by approximately 20 to 30 percent, and perhaps as high as 50 percent due to mammography screening use (Duffy, 2005).
However, even though screen-film mammography saves, it has some limitations. Firstly, some women fear it and cite as a quite painful and no fun process due to the pressing of the breast during screening. As a result, most of the women have been avoiding mammography, an essential preventive healthcare care measure, because of the fear of pain (Mazzo, 2017). Secondly, according to Duffy (2005), there still exist approximately 400 men and 40,000 women who die annually of the cancer of the breast in the US. The high breast cancer death rate is perhaps because the sensitivity of screening mammography or its ability to detect cancer when it is in the breast is not perfect, ranging from 83 to 95 percent. This difference means that 5-17 percent of women who have cancer of the breast does not have their diagnosis done through mammography, but due to other tests or palpations. Additionally, many breast cancers are very advanced to cure when they are found. The sensitivity is even lower in women who have radiographically dense breasts that appears opaque in on mammography, and this is especially common for younger women (Duffy, 2005). This point is supported by research that was conducted by The Oslo II which enrolled 25263 women who were randomly examined under digital and film mammography for the screening of breast cancer. Cancer detection rate across the whole population that was examined, and for ages 50 to 69 years group of women was higher for digital than for film with results showing the overall detections rates as 0.59 percent for digital and 0.41 percent for film, and for the age group detection rates as 0.83 percent for digital and 0.54 percent for film. These results mean that the screen-film mammography cancer detection is lower compared to digital mammography (Pisano, Zuley, Baum, & Marques, 2017).
Furthermore, there certain false alarms with screen-film mammography. Researches approximate screening specificity of traditional mammography, or its ability to identify whether a woman does not have cancer of the breast when she has a negative test, to be 90 to 98 percent. In the US, positive mammogram screening rates tend to be 5 to 10 percent compared to Europe, and this indicate that 100 US women and 10 Europe women return for additional tests for those diagnosed with breast cancer. These false positives may be as a result of three lesions types: architectural distortions, masses, and calcifications, and they lead to anxiety and morbidity to some patients as well as costing a lot of money to a health care system that is already stressed. The dense tissues which cause false positives are most common in women at the ages below 50. In fact, two studies have proposed that women who get screened have a chance of 50 percent for abnormal examination over a period of 10 years (Duffy, 2005).
This point is supported by a study, Digital Mammographic Imaging Screening Trial (DMIST) funded by the National Cancer Institute under the sponsorships of the American College of Radiology Imaging Network, registered 49528 women at 33 organizations in Canada and the US, with 42760 evaluable cases. Women underwent both film and digital mammography. The results documented that for the entire women population, there was no substantial difference in accuracy of diagnostic, as measured by AUC between film and digital mammography for the screening of breast cancer (Pisano, Zuley, Baum, & Marques, 2017). However, for women under the age of 50, women with dense breasts, peri- and premenopausal women, digital mammography was statistically substantially better, even after multiple comparisons accounts. Similarly, the sensitivity measurement, Positive Predictive Value 1 (PPV1), and specificity across the whole study also indicated no differences between film and digital mammography. But for women under the age of 50, digital mammography sensitivity was superior to film mammography, 0.78 versus 0.51 (p=0.002) (Pisano, Zuley, Baum, & Marques, 2017).
Even with the limitations of film mammography, still lies an improvement chance for screening and diagnosis of breast chance. That is the new/digital technology called the 3D mammography with a smart curve or tomosynthesis.
The new mammography technology and how it works to improve on the issues with film mammography
3D mammography is an advanced form of imaging where numerous breast images from various angles are constructed and captured into a three-dimensional image set. This system uses low-dose x-rays and advanced computer imaging to change the breast images of digital into a stack of very thin breast layers. It has been approved by the Food and Drug Administration (FDA) and gained extensive research evidence indicating that it reduces pain, enhances the detection of breast cancer while reducing the rate of results of false-positives. In overall, the 3D mammography with smart curve helps to address the limitations of film mammography and gives a more accurate valuation of breast health (UCLA, 2015).
It addresses these limitations in three steps. First, the smart curve system helps to reduce pain caused by compression of the breast during screening because in it integrated with a MammoPad cushion which gives a comfortable surface between the image receptor and the patient, assisting the patient to relax the pectoral muscle. This enables the radiologist to position the breast in a better way and to obtain correctly more of the chest wall, hence improving the accuracy of image and saving time (Tangorra, 2015). Secondly, according to UCLA (2015), tomosynthesis improves breast cancer detection by 40 percent. During 3D mammography, the breast is compressed and placed similarly as conventional mammography.
During the scan of a four-second, the system moves across the breast in a small curve to obtain many images of very low-dose from numerous angles. The images are then processed into a breast image of three-dimensions composed of 1mm-thick slices (UCLA, 2015). The radiologists can then scroll through layer by layer of the breast, eliminating superimposed fibroglandular tissue and illuminating breast cancer that would otherwise be hidden (UCLA, 2015). Additionally, with 3D mammography, fewer patients (15 percent) are instructed to return for additional assessment. Because of the major cause of false-positive results in the breast tissue that overlaps at various depths in the breast which appears like a mass or abnormality on film mammography, digital breast tomosynthesis reduces this overlapping chance (UCLA, 2015). By viewing the tissue layer by layer, the radiologist is capable of determining that the area of worry is just a superimposed tissue of the breast and not fundamental mass, hence preventing pointless return visits. Moreover, if the 3D mammography identifies an abnormality, the likelihood of approving a real finding after additional assessments is very high (UCLA, 2015). Also, 3D mammography contains less exposure to radiation, and it has been approved by the FDA to comply with the radiation exposure requirement since it uses low-dose x-rays similar to conventional 2D mammography.
Various research has indicated the benefits of using 3D mammography. According to the research “Tomosynthesis in Breast Cancer Visualization as a Function of Mammographic Density,” 3D mammography was useful for envisioning breast cancers that are noncalcified in heterogeneously and scattered dense breasts with close to 70 percent of these categories cancers density observed only with tomosynthesis (Tangorra, 2015). Patients with extremely dense and fatty breasts had cancers viewed well with 2-D mammography and tomosynthesis. Also, Hologic carried a multi-center clinical test that compared tomosynthesis plus 2-D mammography (combo mode) to 2-D mammography alone. Results indicated that addition of digital mammography to tomosynthesis enhanced the accuracy of diagnosis and decreased recall rates for cases of non-cancer (Tangorra, 2015).
Future needs/expectations
According to Park, Franken, Garg, Fajardo, and Niklason (2017), during the preliminary developmental stages of the 3D mammography, many questions arose. One of the questions was “what is the optimal reconstructed section thickness.” Thinner sections provide better resolution but also leads to a massive number of reconstructed images (Park, Franken, Garg, Fajardo, & Niklason, 2017). A faster process of reconstruction id essential is vital if 3D breast tomosynthesis is to give visual guidance for interventional procedures (Park, Franken, Garg, Fajardo, & Niklason, 2017). Additionally, other problems need to be solved like the minimization or the avoidance of scatter radiation and reconstruction induced artifacts. Despite these many issues yet to be solved, 3D mammography clenches promise for future applications in contrast to film mammography (Park, Franken, Garg, Fajardo, & Niklason, 2017). However, currently, the only reconstruction planes found in tomosynthesis are those parallel to the detector; reconstruction in other planes explicit to the needs of the patient could be achieved in the future. The ability to improve 3D data image of the entire lesion may assist to reduce the required number of images during diagnostic mammography, with a resultant minimization of in radiation amount to which the patient is exposed (Park, Franken, Garg, Fajardo, & Niklason, 2017). Additionally, some new advanced technology is expected to come shortly either to enhance 3D mammography or used in conjunction with it. This will occur as a result of extensive research and innovation to improve any weaknesses noticed in the digital/3D mammography.
Conclusion
From the discussion it is evident that mammography helps to save lives of many women through early detection and diagnosis of cancer, thus, enhances the chances of successful treatment. However, film mammography has some shortcomings that have led to women avoiding this essential preventive health care and also it sometimes lead to inaccurate results (false positive results). As such, these false positive results cause anxiety and morbidity in some patients because of repeated screening that is associated with the danger of exposure to radiation which may cause cancer. But thanks to the new technology, 3D mammography or tomography. Research indicates that this new technology is capable of improving some of the shortcomings of the film mammography such as reducing pain, enhances the detection of breast cancer while reducing the rate of results of false-positives. Additionally, 3D mammography has been approved by the US Food and Drug Administration (FDA) to be working under low-dose x-rays as required by the policy.
While the new technology has a lot of benefits as mentioned above, it also comes with some challenges. One challenge being that 3D mammography is quite expensive compared to the film mammography, and this has made its implementation in most of the US hospitals difficult. The expensiveness is associated with the advancement of the computer which it uses that may be costly to install. Therefore, the government should aid in the adoption of this technology to help save lives of American people from breast cancer.
References
Centers for Disease Control and Prevention (CDC) (2006). Mammograms & Breast Health: An Information Guide for Women. Retrieved April 12, 2018 from http://www.pacificcancer.org/cancer-information/cancer-downloads/breast/cdc_mammogram_brochure.pdf
Duffy, S. W. (2005). Some current issues in breast cancer screening. Journal of medical screening , 12 (3), 128-133.
Mazzo, L. (2017). This New Mammogram Technology Will (Finally!) Make Screenings Less Painful. Shape. Retrieved April 12, 2018 from https://www.shape.com/lifestyle/mind-and-body/new-curved-mammogram-technology-will-make-screenings-less-painful
Pisano, E. D., Zuley, M., Baum, J. K., & Marques, H. S. (2017). Issues to consider in converting to digital mammography. Radiologic Clinics , 45 (5), 813-830.
Park, J. M., Franken Jr, E. A., Garg, M., Fajardo, L. L., & Niklason, L. T. (2017). Breast tomosynthesis: present considerations and future applications. Radiographics , 27 (suppl_1), S231-S240.
Radiological Society of North America (RSNA) (2018). Mammography. Retrieved April 12, 2018 from https://www.radiologyinfo.org/en/pdf/mammo.pdf
Tangoria, L. (2015). Emerging Technologies: New Mammography Modalities. Imaging technology news. Retrieved April 12, 2018 from https://www.itnonline.com/article/emerging-technologies-new-mammography-modalities
UCLA health (2015). Advanced 3D mammography leads to more accurate breast cancer detection. Retrieved April 12, 2018 from http://radiology.ucla.edu/workfiles/forpatients/CU201510_3DTomosynthesis.pdf
