Breast cancer is the leading cancer among women, and while mammography is well suited to detect lesions in the majority of females undergoing preventive screening, the emergence of breast density as a factor that limits the value of mammography has ushered in a host of secondary screening options.

In 2017 we saw research highlighting several of these options, new modalities entering the market and new evidence in the ongoing debate over how often women should be undergoing breast cancer screening.

Here are the most high impact breast imaging stories of the year:

1) Tomo may be less expensive than 2-D mammo

Breast tomosynthesis, or 3-D mammography, has been stirring interest in women's health for years — but one of the most common drawbacks you hear about concerns the cost associated with it. According to MD Buyline, the average price for a full-field digital mammography system and digital breast tomosynthesis system are $273,940 and $462,010, respectively.

But despite the significantly higher initial investment, tomosynthesis has been shown to be less expensive in the long term. A study presented at the San Antonio Breast Cancer Symposium in mid-December found that’s the case when diagnosis-related costs are taken into consideration. The researchers found that tomosynthesis was a more effective screening method because it had a lower false positive rate and higher true negative rate.

Dr. Emily Conant of the Hospital of the University of Pennsylvania believes that the future of breast cancer screening will involve a combination of synthesized 2-D mammograms and tomosynthesis, which would eliminate the need for a 2-D digital mammography system.

A study published in Radiology last year showed that there is no significant difference in cancer detection for synthesized 2-D mammography and tomosynthesis versus digital mammography and tomosynthesis.

2) New evidence in the debate over screening guidelines

The odds seem to be against the USPSTF when it comes to breast cancer screening guidelines. The agency recommends against routine screening of women aged 40 to 49, but HHS’ Health Resources and Services Administration ruled in January 2017 that private insurers must cover regular mammograms for women aged 40 and up.

The American College of Radiology further undermined the USPSTF guidelines with a new study that was published in May. It found that delaying screening from age 40 to ages 45 or 50, or increasing the interval between screening, would not reduce the rate of overdiagnosis.


That research puts to bed the assumption that many overdiagnosis cases are due to cancers disappearing on their own.

"Physicians caring for women need to recognize invasive breast cancer for what it is — lethal," Dr. Debra Monticciolo, chair of the ACR Breast Imaging Commission, told HCB News at the time.



3) Hologic calls foul on Fujifilm tomo option

On the business side of things, we saw two of the leading breast imaging OEMs enter a legal dispute earlier this year.

In early July, Hologic sued Fujifilm Medical Systems for infringing five patents issued to its Selenia Dimensions digital breast tomosynthesis system. The company claims that the digital breast tomosynthesis option for Fujifilm’s ASPIRE Cristalle digital mammography system is in patent violation.

When the DBT option received FDA approval in January 2017, Fujifilm stated that it combines its hexagonal close pattern detector design, advanced image processing and image acquisition workflow. Issues arose when it was on display at the National Consortium of Breast Centers conference in March and the Society of Breast Imaging Symposium in April.

Hologic is asking Fujifilm to put an end to the infringement and pay monetary damages.

4) Automated breast ultrasound doubles cancer detection

Mammography isn’t cutting it when it comes to high breast density, so researchers and system developers are on a quest to find the best supplemental screening tool for this patient population.

NorthShore University Health System in Chicago seems to be onto something. The health system doubled its cancer detection rate by performing 40 automated breast ultrasound exams per day for 15 months.


GE Healthcare’s Invenia ABUS, which was used for the study, is currently the only ABUS system approved for use as screening adjunct to mammography. Over 200 facilities globally have installed the system — more than 120 of which are in the U.S.

Sankar Suryanarayanan, general manager of the ABUS business at GE, explained that a large-scale clinical trial that demonstrates the performance of ABUS on the population is needed for guidelines to change.


5) Molecular breast imaging finds cancer that mammography misses

So we’ve established that ABUS is great for improving cancer detection, but what about molecular breast imaging? A retrospective study published in the August issue of the American Journal of Roentgenology found that MBI can also spot cancers that mammography misses.



After undergoing a mammogram, 1,696 women with dense breasts received supplemental screening with Gamma Medica’s LumaGEM MBI system. MBI detected 13 malignancies that were hidden by mammography.

In May, Henry Ford Health System in Michigan launched a supplementary breast cancer screening program with LumaGEM. This is the first supplemental MBI program in the state, so the radiologists were trained at Mayo Clinic in Minnesota.

“Despite providing the best mammogram we can, we know that sensitivity is not 100 percent,” Dr. Patricia Miller, director of Henry Ford’s Breast Imaging Center, told HCB News at the time. “For women with dense breast tissue, it’s a much more sensitive exam. Adding this as an adjunct, it provides great peace of mind.”