References Breast tomosynthesis is an X-ray imaging method in which an X-ray tube moves in an arc, acquiring a series of views that are post-processed to create images showing thin typically 1 mm slices of breast tissue. By minimizing the obscuring presence of overlying structures seen in digital mammography, tomosynthesis can reveal the characteristic margins of a tumor more clearly Figure 1.
The upshot is that many women continue to hear and read confusing and sometimes contradictory claims, leaving many critical questions undecided: When should I start screening, at 40, or after 50, or even younger? Should I screen annually or every two years biennially?
At what age should Dan kopans tomosynthesis stop screening? And what are the harms of screening?
These are among the many concerns of screening-eligible women seeking some clarity within the chaos of dueling guidelines and conflicting advice. Although we have a reasonable consensus that mammographic screening has significant benefits, the central question becomes: This I take up below, but I add two overlooked questions to this central one: A Guided Tour of the Benefits So to begin with the central question, are the benefits of mammographic screening greater than the potential harms?
Certainly, a significant reduction in mortality from breast cancer is considered the primary benefit. But notice even here Dan kopans tomosynthesis much of the debate over mammographic screening is framed far too narrowly, solely around whether survival is ultimately affected.
But there are potential benefits beyond just reduction of mortality, and these include: Ignoring these very real benefits has compromised the debate and yet advantages like these, even independent of any reduced deaths from breast cancer, are very real and important to women.
The Harms, in Perspective Now what of the claimed harms of mammographic screening? The most cited is overdiagnosis, but the definition of overdiagnosis is somewhat elastic across authors and studies.
But at its heart, the occurrence of overdiagnosis boils down to the case of someone being diagnosed with a disease here, breast cancer that will not go on to cause them harm. Regardless of the definition chosen, the claim is that the principle real harm stemming from overdiagnosis is overtreatment, that is, the treatment of cancers not significantly progressing non-progressive or highly slow-growing indolent and so unlikely if left untreated to cause symptoms or shorten life.
But here we should not become — as many partisans in the debate have — excessively focused on only the potential harms of overdiagnosis. We must also acknowledge the real harms of underdiagnosis, which includes a progressive decline in survival for each annual mammography screening a woman omits: Still, the question remains, what is the degree of overdiagnosis caused by mammographic screening?
But what of other claimed harms like negative psychological effects like anxiety experienced from any false positive results received? Although we can grant these may not be trivial, more recent robust data suggests that the magnitude of such anxiety is small and that in any case it appears largely transient, with little potential for longer-term consequences.
Moreover, whether there is any clinically relevant level of harm from such angst remains undemonstrated.
But multiple studies have found the risk of radiation-induced breast cancer to be reassuringly extremely low, where the total lifetime risk from screening every year for 40 years age 40 — 80 ranges between only 0.
In addition, other studies have found that patients exposed to mammographic radiation did not in fact have a significantly higher risk of developing other malignancies thyroid and hematological cancers.
Therefore women should not be discouraged from gaining the benefits of regular screening due to fear of radiation-induced breast or other secondary cancers. Lessons Learned Therefore, balancing the countervailing substantial benefits we have already described above, we are left with the conclusion that the balance sheet remains positive for mammographic screening, with benefits outweighing any claimed harms.
And although still intensely debated, data suggests that the weight of the robust evidence does not support an age 50 start point on the low end, but rather argues for benefits of screening for women in their forties, as well as in the elderly, past the arbitrary upper end cutoff of But as always every woman, and every case, is different — for example some women may have high risk factors, or dense breasts — so women should assure a candid discussion with their health professionals to weigh all special and individual factors in order to make the most informed decision.
A Healthy Splash of Reality: What Women Really Think A number of recent studies have found that women overwhelmingly elect annual mammographic screening, and beginning at no later than 40, with additional data decisively confirming that even when informed of potential harms, women show regret-avoidance behavior in preferring the risk of overtreatment to the risk of undertreatment.Legacy digital mammography podcasts and newer.
Breast Cancer Specialist and Medical Imaging Adviser. “We’re on the verge of a new era in mammography, with the arrival of digital breast tomosynthesis D 3(D B T), Harvard Radiology Professor Dan Kopans`s invention. Dec 12, · Dan kopans tomosynthesis No essay received a score of one on essay topic i the majors during that night of crying i understood my mother for the first time–i they usually had a very sentimental theme, and i was very emotional when it came to animal suffering.
4 Stamatia Destounis, Role of Digital Breast Tomosynthesis in Screening and Diagnostic Breast Imaging, Seminars in Ultrasound, CT and MRI, , 39, 1, 35CrossRef 5 Mohammad Eghtedari, Catherine Tsai, Julie Robles, Sarah L.
Blair, Haydee Ojeda-Fournier, Tomosynthesis in Breast Cancer Imaging, Surgical Oncology Clinics of North America. Mar 09, · If Dan Kopans thought it was important, who was I to argue?
Way back, I used to have lunch with him—I am sure he does not remember me, as I was an insignificant member of the lunch group, a Fellow from another division, graced with his presence because my Chief was his friend.
Dr. Kopans is the inventor of the latest advance in Breast Imaging known as Digital Breast Tomosynthesis which is replacing conventional mammography with more three-dimensional information that reduces recall rates while increasing the detection of small cancers.