Film mammography still the foundation

An IOM report stresses the need for more study into new technology and the nature of breast cancer.

By Victoria Stagg Elliott, AMNews staff. April 2, 2001.

X-ray film mammography should continue to be considered the "gold standard" of breast cancer screening because new technologies have yet to demonstrate superiority to the decades-old favorite. The new technologies, however, including digital, ultrasound or computer-aided detection, have promise and demand further study, according to a March report from the Institute of Medicine and the National Research Council of the National Academy of Sciences.

"To date, no quantum leap has been made," said Joyce C. Lashof, MD, chair of the Committee on Technologies for the Early Detection of Breast Cancer, which authored the report. "At the same time, many of the newer tools offer certain advantages and deserve to be studied further."

In addition, the report calls for more research into the natural progression of the disease as a possible solution to overdiagnosis and overtreatment. Screening mammography has a high false-positive rate, and many breast lesions biopsied turn out not to be malignant. And, although the early detection rate has increased, mortality from the disease has declined only 2% a year for the past decade. Some believe that more mammography may not make any more impact on those numbers.

"As the imaging technology has improved over the past 30 years, we've found an increasing number of cancers, and we know a number of these would not be fatal if left untreated," said Craig Henderson, MD, adjunct professor of medicine at the University of California in San Francisco and a member of the committee. [...]