The High Authority for Health has recommended introducing 3D mammography by tomosynthesis in breast cancer screening, but doctors believe that it is still too early.
The edition Pink October 2023 is thrown. The opportunity to remind women aged 50 to 74 that they can get tested for free for breast cancer. This screening which is based, among other things, on carrying out a mammogram could evolve according to the recommendations made by the High Authority of Health in March. The authority wishes in fact “L’introduction of 3D mammography (by tomosynthesis), provided that it is systematically associated with the reconstruction of a synthetic 2D image (3D + 2Ds)” to detect possible breast cancer. This is the National Cancer Institute (INCa) who asked the HAS to look into the interest of this examination. Today, screening includes a clinical breast exam and a 2D mammogram. What is a 3D mammogram? What else can this exam see? For who ?
What is a 3D mammogram?
Tomosynthesis (3D) is a mammography technique that allowsobtain a digital image of the breast reconstructed in three dimensions from a series of projections (or sections) to low doseacquired under different angles and at different depths, obtained with a specific digital mammograph. 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, notably 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 classic mammography technique (2D) to the tomosynthesis technique (3D) alone, then to the combination of the two techniques (3D + 2D), and finally to the 3D technique associated with a synthetic image reconstruction (2Ds). Result :
► The 3D mammography is not more efficient than 2Dalone.
► The 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 you 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).
It is “too early” to recommend it according to Gustave Roussy
On the site RoseUpdedicated to women suffering from breast cancer, Professor Corinne Balleyguier, radiologist and head of the Diagnostic Imaging department at Gustave Roussy confirms that the interest of 3D mammography “more sensitive and more specific” but believes that it is “too early” to recommend it. The Women’s Imaging Society, the French Society of Senology and Breast Pathology, the French Society of Radiology and the National Council of the Profession have written to the HAS to modify its text. “We ask that the Tomosynthesis is recommended as a complement to mammography, not as a replacement. In any case, not until all manufacturers comply with the standards.”