Adding tomosynthesis to digital mammography screening may increase the breast cancer detection rate in women with dense and nondense breast tissue, according to a study published in JAMA.

“Breast density is associated with reduced mammographic sensitivity and specificity, and increased tumor size and worsened prognosis are associated with increased breast density,” said Elizabeth A. Rafferty, MD, Director of Breast Imaging and Medical Director for Women’s Health Imaging at Andover Medical Center in Massachusetts. “However, which, if any, additional testing should be recommended for women with dense breasts is not known.”

The study included data from 13 institutions; screening performance metrics for digital mammography were reported for 12 months and from 3 to 22 months after the introduction of tomosynthesis. Four subgroups of breast density were used for reporting: entirely fat and scattered fibroglandular densities were considered nondense tissue patterns, while heterogeneously dense and extremely dense were considered dense tissue patterns.

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The researchers performed 452,320 examinations; 278,906 were digital mammography and 173,414 were digital mammography plus tomosynthesis. Overall, 2,157 cancers were diagnosed. Dr Rafferty and colleagues found that the combination of tomosynthesis and digital mammography screening was linked to an increased rate of cancer detection and reduction in recall rate in women with dense and nondense breasts.

“These combined gains were largest for women with heterogeneously dense breasts, potentially addressing limitations in cancer detection seen with digital mammography alone in this group, but were not significant in women with extremely dense breasts,” Dr Rafferty concluded.


  1. Rafferty EA, Durand MA, Conant EF, et al. Breast cancer screening using tomosynthesis and digital mamamography in dense and nondense breasts. JAMA. 2016; doi: 10.1001/jama.2016.1708