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BreastScreen Australia information on breast tomosynthesis

BreastScreen Australia information on breast tomosynthesis Top

1. What is breast tomosynthesis?

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Breast tomosynthesis (3D mammography) is a new digital mammography technology that is in the testing and clinical evaluation stages for its possible benefits in screening and assessment. 
 
Currently, BreastScreen Australia uses two-view (2D) digital mammography as the primary test to screen women for breast cancer.

2. What are the benefits of 3D mammography/breast tomosynthesis?

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3D mammography (or breast tomosynthesis) gives a series of images to identify tissue at different depths within the breast. This gives clinical confidence to reach a diagnosis earlier meaning a woman may go through fewer invasive tests to reach a firm diagnosis.
 
It is important to note that the benefits of tomosynthesis have only been trialled in an Australian setting for the assessment of women recalled for further tests after their initial screening.
 
The results provide good reason to believe that tomosynthesis can give a definitive result earlier in the assessment of breast cancers and reduces the risk of missing cancers.

3. Why doesn’t BreastScreen Australia use breast tomosynthesis in the routine screening process?

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There is evidence that tomosynthesis may be of benefit in an assessment settingThere is currently insufficient evidence for the benefit of tomosynthesis as the screening test for population screening of well women. 
 
We do not yet have a clear picture of the benefits and costs of using tomosynthesis for population screening generally within the BreastScreen Australia service. 
 
The results of further Australian clinical trials are needed before the technology could be considered for routine population screening. 
 
A Victorian study is currently underway to further understand the costs and benefits associated with implementation of tomosynthesis in breast cancer assessment.
 
At this time, 2D mammography remains the only proven technology for screening healthy women aged 50-74 years for breast cancer in Australia.

4. Are women getting a second rate service with 2D mammography now that 3D mammography/tomosynthesis is a proven technology?

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Women should continue to feel confident that having a free mammogram every two years with BreastScreen as recommended, will give them the best chance of detecting and surviving breast cancer.
 
BreastScreen Australia notes research from a Lund University major screening study in Sweden that tomosynthesis detects 40% more breast cancers than traditional two-view (2D) mammography in a screening population.
 
The results look promising, however the study has also raised important considerations such as a reported increase in recall rates, meaning healthy women with non-cancerous conditions were recalled for further testing. 
 
Any potential increase in radiation dosage and further testing to healthy women in Australia needs further exploration to ensure the benefits for women far outweigh the harms.
 
We do not yet have a clear picture of the benefits, harms and costs of using tomosynthesis for population screening generally in the BreastScreen Australia service.
 
Currently, 2D mammography remains the only proven technology for screening healthy women aged 50-74 years for breast cancer in Australia.

5. Haven’t some states and territories already licensed the use of tomosynthesis as part of BreastScreen Australia services?

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Jurisdictions are gathering evidence on tomosynthesis for breast screening but BreastScreen Australia will make a national decision on its use for screening in the BreastScreen program. 
 
The next step is to understand the impact of introducing tomosynthesis as the only form of breast screening technology, instead of as an adjunct to the existing 2D mammography.

6. Have other countries rolled out tomosynthesis for population screening?

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Australia is aware of one other country that has recently begun the use of tomosynthesis for population screening. 
 
However, population screening programs differ between countries and we need to be confident that it is appropriate in an Australian population screening setting. 
 
The results of further Australian clinical trials are needed before the technology could be recommended for routine population screening.

7. What kind of radiation does tomosynthesis deliver?

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The radiation exposure is safely below the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) guidelines. However, the radiation dose with tomosynthesis may be higher compared to 2D mammography; the evidence remains unclear.1, 2  A higher radiation dose will occur when using 2D mammography and tomosynthesis in conjunction. This risk needs to be weighed carefully against the potential benefits to healthy people with no signs or symptoms of breast cancer who undergo population screening.
 
1 Dance DR, Strudley CJ, Young KC, et al. Comparison of breast doses for digital tomosynthesis estimated from patient exposures and using PMMA breast phantoms. In: Maidment AD, Bakic PR, Gavenonis S (eds) Proceedings of the 11th international conference on breast imaging (IWDM 2012). Berlin: Springer; 2012, 316321.
 
2 Skaane P, Bandos A & Gullien R. Comparison of Digital Mammography Alone and Digital Mammography Plus Tomosynthesis in a Population-based Screening Program. Radiology: Published online before print & January 2013.