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Mammography Still the 'Gold Standard' for Breast Cancer

Is Mammography still the best?
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WebMD Feature

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 resonance imaging.

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.

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