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U. researchers gauge effectiveness of 3-D, 2-D mammograms

Many women, doctors turn to three-dimensional imaging over conventional option

With the emergence of new technologies such as three-dimensional mammographies, many women and doctors are inclined to turn away from conventional two-dimensional mammographies and instead lean toward these more recently developed options. But a new study conducted by University researchers seeks to determine which type of breast cancer screening is actually more effective.

This study is a multi-center joint collaboration involving the ECOG-ACRIN Cancer Research Group, the National Cancer Institute and Brown University’s Center for Statistical Sciences, said Constantine Gatsonis, professor of biostatistics and director of the Center for Statistical Sciences, who is leading the trial. The University’s center handles all of the statistical work, which includes design and data analysis throughout the trial.

“This study, as big and expensive as it is, will really help guide patient care,” said Ilana Gareen, associate professor of epidemiology at the Center for Statistical Sciences. “It’s a head-to-head comparison of two competing interventions.”

This trial could be crucial if it determines which of the two screenings is better, because the newer 3-D technology has currently not been completely accepted by all hospitals and insurances, Gareen said. The downsides of the new technology include a heavier price tag and more radiation. At the end of the day, researchers say it all comes down to which technology has better diagnostic rates.

“It’s really important to do these head-to-head studies so that we get answers to questions of medical practice,” Gareen said. “Someone may develop a machine and truly believe it’s the best thing, but if you haven’t compared, then how do you know?”

One of the main aims of the study is to simply find the quickest and most efficient pathway toward diagnosis, Gareen said. Doctors often do not have all of the information available to them to help make that important decision, she added.

All breast imaging centers participating in the trial have both 3-D breast cancer screenings, known as tomosynthesis, and 2-D screenings, known as conventional, said Jean Cormack, biostatistician at the center. These sites throughout the United States will screen the women involved in the trial through a standard mammogram process, and the data analysis will then occur at Brown.

As the data comes in, the statisticians look at “quality, completeness and mistakes — some of which databases are able to capture but others that we need to look at more closely,” Gatsonis said. In addition to the images that are collected and archived, University researchers will also analyze clinical data, biospecimen data and molecular data from biopsies and specimens given with consent. Much of this bulk analysis will occur three years into the trial, with researchers looking for specifics such as correlations with the imaging features or mutations in the genes.

But finding out whether or not tomosynthesis leads to reduced advanced cancers is only one of the study’s main goals.

“We’re also going to look at how much healthcare is needed in order to receive the diagnosis of either 2-D or 3-D,” Gareen said. “Once you find an abnormality, you become a patient, and it could change the ability to get health insurance because it becomes a pre-existing condition.”


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