Screening Mammography and Treatment Advances Linked to Decreased Breast Cancer Mortality Over 30 Years

Q & A with chief of Duke’s Division of Breast Imaging

side view of breast cancer

A combination of screening mammography and advances in breast cancer treatment over the last 30 years has saved between 380,000 and 615,000 lives, according to findings from a study published in February 2019 in Cancer.

Jay A. Baker, MD, chief of Duke’s Division of Breast Imaging and co-author of the study, discusses the significance of these findings and shares new technologies Duke is implementing and exploring to improve screening and diagnostics.

Question: What was the basis for the research in this study?

Baker: We looked at what the mortality rate for cancer “should have been” in the absence of the screening and early detection methods we have today to estimate the number of breast cancer deaths averted by screening mammography and improved treatment since 1989. In other words, we asked “if we were using the same practices as we did in the 1970s, what would the mortality rate be today?” We found that approximately a half-million breast cancer deaths have been averted through the use of mammography screening and improved treatment in women ages 40 to 84 years.

Question: What are some of the latest advances in screening and diagnostics for Duke patients?

Baker: Breast tomosynthesis is now standard across the Duke University Health System. We’ve replaced all of our mammography equipment with 3-D systems so there’s no longer a decision to make between 2-D and 3-D—it’s 3-D all the way. It’s also important to note that at Duke, 100 percent of imaging is read by fellowship-trained specialists in breast imaging.

Question: Why is tomosynthesis preferable to other screening methods?

Baker: It’s preferable because the research is clear that breast tomosynthesis is the rare “win-win” when it comes to imaging: it improves sensitivity, finds more cancers, and finds smaller cancers than is possible with 2-D. And although these scans take radiologists longer to read, the improvement in patient outcomes is a huge win.

We’re also finding fewer “false alarms” with tomosynthesis so fewer women are undergoing biopsies for benign lesions. In fact, some recent research indicates that 3-D mammograms find 15% to 35% more breast cancers, and result in up to 15% to 35% fewer false positive results. Data also show 3-D mammography does a better job at finding breast cancer in dense breast tissue. Because of all of this evidence, Duke made a significant investment in installing the new equipment and bringing this improved diagnostic technique to all of our patients.

Question: What other technologies are being explored at Duke to improve screening and early detection?

Baker: One technology we’ve studied and will be implementing soon is abbreviated breast MRI for women at intermediate risk for developing cancer. It’s a shorter version of the breast MRI protocol we use for screening women who are at high risk. It’s just 10 minutes on the table for the patient, it’s less expensive than the longer protocol, and data has shown that we catch just as many cancers using this modified version.

We’re also leading randomized controlled trials on how to make needle biopsy procedures more comfortable for patients. Needle biopsies are well accepted now, but we believe we can improve the patient experience. For example, the lidocaine we use to numb the breast can sting. For years, clinicians argued whether adding sodium bicarbonate to the lidocaine would decrease the discomfort, but no one knew with certainty whether it helped so many did not use bicarb due to the time and expense of the extra step. So, Duke performed and published a double-blind controlled trial, and to our delight, we found that bicarbonate does indeed help make the lidocaine injection more comfortable. Now we use it 100% of the time, and our findings have improved this procedure in practices across the country.