Thomas Jefferson University Hospital - Digital Mammography Improving Breast Cancer Care

Digital Mammography Improving Breast Cancer Care

The mammogram is changing for the better, say experts trained in breast imaging.

New computer-driven technologies should make the yearly exam more accurate and easier on patients than ever before.

Computer-based digital mammography is already available at about 10 percent of diagnostic centers in the country, including Jefferson-Honickman Breast Imaging at Thomas Jefferson University Hospital in Philadelphia.

While film-less mammography does not feel any different to women while they are being screened, physicians are discovering that there are benefits for particular patients.

Dense breast tissue easier to image
A study of more than 40,000 women published last fall found that compared with standard mammograms, computer-based digital “pictures” were more beneficial for over half the women. Jefferson-Honickman Breast Imaging participated in this study, which is called the American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial.

The findings note that younger women with dense breast tissue, those under 50, and those who are pre-menopausal would benefit most from digital mammograms.

So would women with calcifications in their breasts, which are very common, adds Annina N. Wilkes, MD, Interim Director of Jefferson-Honickman Breast Imaging.

“Digital mammography enables us to see calcifications much clearer than does film-screen mammography,” says Dr. Wilkes, who is also Clinical Assistant Professor of Radiology, Jefferson Medical College at Thomas Jefferson University. “The images have more contrast so we can see smaller details and evaluate them much better.”

Many physicians have concluded since the study that dense breast tissue in all groups is better evaluated with the help of digital mammography. Dr. Wilkes believes that digital is better than film-based mammography for everyone.

Annina N. Wilkes, MD

On the horizon
Other technologies for mammography are on the horizon – for example, Cone Beam Breast Computed Tomography (CBBCT), which takes a number of pictures of the breast from various angles and then merges them into one three-dimensional image. Some researchers believe CBBCT promises to equal or surpass digital mammography in detecting breast cancer.

The first phase of a pilot study to see how well the CBBCT scanner could image the breast involved 20 volunteers who had had normal mammograms, as well as a group of women who had had abnormalities detected during a physical exam or who had had suspicious mammograms. The CBBCT proved itself at least as good as conventional mammogram in imaging the breast.

The pilot study will continue until 60 participants have been imaged, and a larger trial is planned for next year.

“Any new technology that is being developed holds promise,” says Dr. Wilkes. “But thousands of patients will have to be screened and studied in order to come to some meaningful conclusion. For now, I’m very, very happy with the improvement in quality that digital mammography provides over film-screen mammography.”

Digital mammography is catching on
Digital mammography does have drawbacks – at least for now. There are so many options for setting up and reading the computer images that physicians are somewhat slower at determining their results.“Within two or three years, as physicians become more comfortable with the idiosyncrasies of a particular digital mammography system, they’ll also be able to use it more efficiently,” says Dr. Wilkes, acknowledging the learning curve necessary for physicians to master the new technology. She compares some physicians’ trepidation toward digital mammography to that which photographers felt toward digital photography in its early years: “Photographers were skeptical about whether its quality was worth the trouble of learning how to use it. But in time, they became comfortable with it, found it easy to use and realized how superior to film it is.”

Regardless of technology, Dr. Wilkes recommends that women over 40 should have a screening mammogram every year. Women who are at higher-than-average risk of breast cancer should seek expert medical advice about whether they should begin screening before age 40 and the frequency of screening.

Digital mammography at Jefferson
The Division of Breast Imaging in the Department of Radiology at Thomas Jefferson University Hospital performs approximately 40,000 breast imaging procedures – including mammograms, sonograms, needle-guided biopsies of non-palpable lesions, stereotactic or ultrasound-guided core biopsies, and breast MRI examinations – yearly, making it one of the most active services of its kind in the country.

All diagnostic breast-imaging studies are performed at Jefferson-Honickman Breast Imaging, at 1100 Walnut Street. Annual screening mammography for patients is performed at the Mammography Screening Center, at 909 Walnut Street. Jefferson-Honickman Breast Imaging has four state-of-the-art digital mammographic units and performs digital mammography exclusively. The Mammography Screening Center currently has one digital unit and one conventional unit. (The Mammography Screening Center will eventually relocate to 1100 Walnut Street and become “all digital” as well, says Dr. Wilkes). Jefferson-Honickman Breast Imaging also contains a stereotactic core biopsy unit with digital imaging capability and three high-resolution breast ultrasound units.

For more information about or an appointment at Jefferson-Honickman Breast Imaging or the Mammography Screening Center, call 1-800-JEFF-NOW or make an appointment online.