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BreastScreen VIC trial results - 3D mammos have significantly higher cancer detection rate than 2D

Emma17Emma17 Member Posts: 33
edited October 2019 in General discussion
Published online today in The Medical Journal of Australia:


While the study discussion reverts to the usual issues about false positives, overscreening, etc. that litter any discussion about technology beyond 2D mammograms in the Australian screening program (BreastScreen), it is indisputable that 3D mammograms (tomosynthesis) have a significantly higher cancer detection rate than 2D mammograms.

This is critically important for all women and especially those with dense breast tissue who are within the BreastScreen catchment age range of 40-74.  Women age 40 and older are eligible for free mammograms through BreastScreen. 

This BCNA forum is replete with stories of women across the BreastScreen age spectrum (including many aged 50+) who were unaware they have dense breast tissue, and which BreastScreen (except in WA) purposely does not advise about despite it being evident to the reading radiologists.  Dense breast tissue obscured their cancer and caused a delayed diagnosis and sometimes more intensive treatment.

@arpie You are a vocal and articulate advocate about this issue and I wanted to bring this article to your attention ASAP.

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Comments

  • AfraserAfraser MelbourneMember Posts: 3,070
    My breast surgeon has an in house 3D mammogram machine so it’s a one stop shop for me. I don’t have dense tissue but the 3D readings make me comfortable about not having an ultrasound, as I used to feel much more confident about the ultrasound result than the old 2D mammograms. If many people are relying on Breastscreen (as they are encouraged to do) then 3D equipment should be rolling out now. 
  • Annie CAnnie C Member Posts: 725


    @Emma17
    @arpie

    The following I "lifted" from BreastScreenWA online information on breast screening. 


    12. Tomosynthesis / 3D Mammography

    "What is 3D Mammography?

    Three-dimensional mammography (also called digital breast tomosynthesis) uses special computer software to create a 3D image of the breast using x-rays (mammograms) taken at different angles. A standard mammogram creates a two-dimensional (2D) image of the breast.

    Is 3D Mammography better than 2D Mammography in screening for breast cancer?

    Currently there is no evidence that 3D Mammography is superior in reducing death from breast cancer compared to standard 2D Mammography.

    Does BreastScreen WA use 3D Mammography for screening?

    BreastScreen WA uses 2D Mammography in screening because there is no evidence that 3D Mammography is superior in reducing mortality from breast cancer.

    BreastScreen Australia, is actively reviewing the published medical evidence on 3D Mammography, and future decisions on breast cancer screening technology will be based on the best robust medical evidence as that evidence emerges."


    Note that BreastScreen WA cites that 3D screening shows no evidence in being superior in reducing mortality from breast cancer.

    Well, not sure about other women, but I want my tumours found long before the mortality stage. 

    Surely we should be given the latest technology to discover tumours  at a much earlier and smaller size.





  • arpiearpie Mid North Coast, NSWMember Posts: 4,008
    Quote: ....  Is 3D Mammography better than 2D Mammography in screening for breast cancer?

    Currently there is no evidence that 3D Mammography is superior in reducing death from breast cancer compared to standard 2D Mammography.

    Does BreastScreen WA use 3D Mammography for screening?

    BreastScreen WA uses 2D Mammography in screening because there is no evidence that 3D Mammography is superior in reducing mortality from breast cancer.

    BreastScreen Australia, is actively reviewing the published medical evidence on 3D Mammography, and future decisions on breast cancer screening technology will be based on the best robust medical evidence as that evidence emerges."...... Unquote


    oh dear, @Annie C - that is a tad disconcerting isn't it!  They obviously haven't read the latest report even tho they say they do (above, many thanks to @Emma17 - we have ears & eyes everywhere!!   ;)  ) as published in the Medical Journal of Australia!!   

    Hopefully they will review it soon & change their mindset.

    If not, perhaps an email to them, enlightening them to the fact, may be in order?

    But then, will they even 'believe it'?  The info that @JJ70 sent was also from reputable researchers & medical boffins - and BSNSW didn't believe it or refer it back to BSAustralia!!

    And the really sad thing is that, after 5 years, if we are sent BACK to Breastscreen for 2 yearly scans ...... they'll probably still only have the 2D machines operating - so would have no confidence in the procedure at all!   :(   

    I know I'll be opting to stay with the ones I trust!

  • Annie CAnnie C Member Posts: 725
    @arpie

    I am very certain that I will not be staying with BreastScreen WA  as I have discovered that in WA, albeit in Perth, there are imaging services offering 3D mammograms with bulk billing for seniors with a doctor's referral. Well that is easy to get and it is necessary for me to travel to Perth for current followup care. 

    I now know that my last mammogram in August this year (year 2) was a 2D!

    I am now seriously considering of leaving the public hospital system and finding a private breast specialist who bulk bills and who will support my decision in requesting 3D mammograms. Can't be too hard. 

    I will be proactive in my breast care and decide what is best for me.
  • JJ70JJ70 FremantleMember Posts: 983
    There need to be more trials before the country invests MEGA $$ on changing to Tomo for population screening. I have that from the 'horse's mouth'. Perhaps this new publication will go towards that. As you can imagine, spending millions of tax payer's money needs to be invested wisely. The 5 week waiting period at the moment  in WA - from a suspect mammo result to further assessment is unacceptable. BSWA needs funding to create at least one or two more clinics.

    Having said that Dr Liz Wylie (BSWA Medical Director) has indicated that Tomo is likely to be rolled out across the states after the evidence is secured. this will take some time. It is not only the machines that are mosre costly, but they will require more people power, namely the radiologists who read the images. If you can imagine a 2D image - being read as a 'flat' image (4 to look at for each woman), then TOMO is MULTIPLE - each 'slice' of the image (x 4 images) needs to be looked at.
    We have great standards at BS in terms of double reads. Every woman's images are read by two radiologists. If ONE radiolofgist doesn't like the look of t=something, whilst the other clears it, a third radiologist is brought in.

    I will copy and pasts the journal link and a query about the website statement to BSWA and see what reply I get.

    Jo xx
  • kmakmkmakm MelbourneMember Posts: 7,930
    I shall tell my story again.

    When I went for my mammogram in late 2017 I was asked if I'd like tp participate in the trial of 3D mammogram machines. I was happy to do so and was randomly assigned a 2D machine (which I recognised as I'd had a mammogram before).

    The 2D machine did pick up my tumour. However when I returned for the call back scan I was taken straight to the 3D machine.

    That pretty much answered the question right there.

    It's going to come down to money as always. And I wouldn't be surprised if there was some politics going on about which we are unaware.
  • JJ70JJ70 FremantleMember Posts: 983

    Straight from the top ladies...............and promptly!

    Dear Jodi

    I believe that

    1)      Yes tomosynthesis/ 3D mammography does detect more low grade cancers that conventional 2D Digital Mammography 

    2)      However there is still no evidence that there is any reduction in breast cancer mortality,

    I have read the article

    We are a long way away from having evidence that Tomosynthesis , is a cost effective screening modality

     

    Liz

    So, if you look at BreastScreen Australia's aims - reduction of mortality rates from BC is pretty much it.

    Tomo is yet to prove that it is more effective in reducing this rate. It does (as Liz states) pick up more cancers that are smaller and lower grade.

    TOMO will happen.....it will take time.


  • arpiearpie Mid North Coast, NSWMember Posts: 4,008
    Interesting @JJ70

    Hmmm, So if the cancers are being detected sooner & smaller & treated earlier with less invasive treatments - that is a good thing, surely and eventually less costly?

    Even if the 3Ds were aimed more at those with Dense Breast Tissue or 'ambiguous results' like @kmakm's .....

    I wait with baited breath!
  • JJ70JJ70 FremantleMember Posts: 983
    Yes all good points @arpie. Definitely 3D for less invasive treatments and yes, you would think that over time it would save $$, not to mention the lower impact on each individual and collectively too. It is just the initial outlay. ATM they are focusing on saving lives - until TOMO results show that. it is better at that than 2D........

    Now ,who of us would prefer a tomo scan rather than a 2D ? My hand is definitely up!!
    Image result for hands up gif
  • Annie CAnnie C Member Posts: 725
    Mine too. 
     Having been diagnosed once, I would definitely prefer a tomo scan. 

    I would venture a guess that every already diagnosed breast cancer survivor would prefer a tomo.

  • arpiearpie Mid North Coast, NSWMember Posts: 4,008
    Hmmm - So if 3D Tomosynthesis actually PREVENTS mortality/deaths by discovering the tumours early, with less invasive surgery & treatments - how do they actually decide that mortality has been decreased? (Unless it is because they continue NOT treating women early & not improving their longevity .....)  It sort of sounds like 'damned if you do, damned if you don't?'  Also - 'how long is a piece of string'?  Altho you know it is 'long enough' (ie good enough!) if it does the job & that is to improve longevity ie living! 

    Using 3D & ultrasound to confirm earlier lesions - which would automatically show increased longevity/saving lives by the dropping numbers of mortality/death!  

    Is it that hard to understand?  

    Having been missed once (probably twice given how quickly after the MG my turmours were found by my GP) .... I am definitely on the 3D band wagon .... and would recommend that everyone demand to know the  status of their Mammogram machine before booking in!
  • kmakmkmakm MelbourneMember Posts: 7,930
    Those are weasel words. We are constantly being told that early detection saves lives. The logic is faulty.

    I simply don't understand why they can't come out and say something like "With better detection we stand a greater chance of saving lives and reducing the severity of breast cancer treatments. We recognise that this would also reduce the strain on those diagnosed and their loved ones, as well as ultimately saving money. Unfortunately in a health system that has severe financial constraints it will be some time before we can provide tomosynthesis at all sites. We will continue to look at further studies of this technology with great interest, and in the hope of building an even more compelling case to achieve full funding for provision of 3D mammography to all of Australia."

    It makes me want to tear out my hair with frustration.
  • arpiearpie Mid North Coast, NSWMember Posts: 4,008
    Absolutely, @kmakm - well said!

    It's been doing my head in all afternoon!!
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