Mammography Still the 'Gold Standard' for Breast Cancer
Is Mammography still the best?
March 8, 2001 (Washington) -- Despite its flaws, traditional
mammography remains the best way of finding a deadly breast cancer. That's the
primary conclusion of an expert panel that reviewed 17 other detection systems,
including computer-aided approaches like digital mammography.
"With all of its limitations, film mammography remains the
gold standard against which new imaging technologies will be measured,"
says Joyce Lashof, MD, of the School of Public Health at the University of
California at Berkeley. "But screening mammography cannot eliminate all
deaths from breast cancer, because it does not detect all cancers."
Lashof chaired a panel of experts that reviewed mammograms, the
standard breast X-rays, as well as some of the newer and highly touted imaging
techniques designed to reveal breast cancer.
"To date, no quantum leap has been made in this area. At
the same time, many of the newer tools offer certain advantages and deserve to
be studied further," Lashof says.
The analysis, done by the Institute of Medicine (IOM), an arm
of the National Academy of Sciences, points toward several different tools
including digital, or computer-enhanced, mammograms, ultrasound, and magnetic
In its report titled, "Mammography and Beyond, Developing
Technologies in the Early Detection of Breast Cancer," the panel notes
that, "The immense burden of breast cancer, combined with the inherent
limitations of mammography ... have been the driving forces behind the enormous
efforts ... for the early detection of breast cancer."
It's estimated that more than 180,000 new cases of breast
cancer will be diagnosed in the U.S. every year, and more than 40,000 women
will die from the disease. While the report notes that the death rate is
declining slightly, at least in part due to early detection through
mammography, there is considerable room for improvement.
Most of the suspicious findings that are detected via
mammography turn out to be benign. That can lead to unnecessary or
overtreatment. And even in women with the disease, screening drops the death
rate by no more than 40% in those aged 50 to 70.
Barnett Kramer, MD, MPH, director of the Office of Medical
Applications Research at the National Institutes of Health, tells WebMD that
the IOM mammography report is on target in that it's the only screen that's
been shown to lower the death rate.
"The hopeful part is that there are other technologies
emerging that haven't been proved to the extent that standard mammography has,
but they're certainly worthy of continued study and may replace
mammography," says Kramer, who's also the senior medical scientist at the
National Cancer Institute (NCI).
Among the existing alternatives is digital mammography. It uses
equipment similar to the old machines, except that the images can be displayed
and manipulated on a computer. Backers of the high-tech device point out that
the greater detail in the image may reduce the need for additional screenings
in some cases and that new software could more clearly reveal potentially
worrisome changes in the breast like calcifications.