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.

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