The Haute Autorité de Santé recommends introducing 3D mammography by tomosynthesis in breast cancer screening offered to women aged 50 to 74. What’s the point ? What does it change ?
Women aged 50 to 74 are invited every two years to have a free mammogram as part of organized breast cancer screening. On March 17, 2023, the High Authority of Health recommended “I’introduction of 3D mammography (by tomosynthesis), provided that it is systematically associated with the reconstruction of a synthetic 2D image (3D + 2Ds)“. It was the National Cancer Institute (INCa) that asked HAS to look into the interest of this examination. Today screening includes a clinical breast examination and a 2D mammogram. What is a 3D mammogram? What else can this review see? For who ?
What is a 3D mammogram?
Tomosynthesis (3D) is a mammography technique that makes it possible toobtain a digital image of the reconstructed breast in three dimensions from a series of projections (or cuts) to low doseacquired under different angles and at different depths, obtained with a specific digital mammography. The three-dimensional representation of the breast is generated using a mathematical reconstruction algorithm. Since 2009, this imaging technique has been widely used in France outside the framework of organized screening, in particular in women at high risk of breast cancer or as part of monitoring a diagnosed cancer.
How effective is 3D mammography compared to 2D?
HAS compared the conventional mammography technique (2D) with the tomosynthesis technique (3D) alone, then with the combination of the two techniques (3D + 2D), and finally with the 3D technique associated with a synthetic image reconstruction (2Ds). Result :
► The 3D mammography is no better than 2Dalone.
► Association 3D + 2D induces greater exposure to X-rays, due to double irradiation that these examinations represent for women, reproduced every two years.
► The the most effective and least irradiating method is the combination of 3D mammography associated with 2Ds This procedure allows toimprove the cancer detection rate, without increasing the number of imaging procedures and the exposure dose.
| 2D mammography | between 0.95 and 2.42 mGy |
|---|---|
| 3D mammography | between 1.48 and 3.20 mGy |
| 3D+2D mammography | between 2.99 and 3.80 mGy |
In parallel with the gradual deployment of 3D+2Ds in organized breast cancer screening in France, HAS recommends maintaining the current procedure based on digital mammography (2D).
Sources:
HAS updates its recommendations on the examination of organized breast cancer screening. Press release, March 17, 2023
Evaluation of the performance and place of tomosynthesis mammography in the national organized breast cancer screening program – Part 2 – HAS – 9 February 2023