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La investigación con tomo y mammo conduce a 405 pocos positivos falsos por 1.000 mujeres

por Lauren Dubinsky, Senior Reporter | October 29, 2014
Dr. Christoph I. Lee
Using both digital mammography and tomosynthesis to screen women with dense breasts has been shown to be a cost-effective approach to improving breast cancer detection compared with screening with only mammography, according to a new study published online in the journal Radiology.

Dr. Christoph I. Lee, assistant professor in the departments of radiology health services at the University of Washington, and his fellow researchers used a breast cancer simulation model to evaluate how cost-effective screening with tomosynthesis and mammography is for women between ages 50 and 74 with dense breasts.

For the model, the team used existing data and metrics from the National Cancer Institute's Breast Cancer Surveillance Consortium, Medicare reimbursement rates, and medical literature on European trials.

They found that the cost per quality-adjusted life year (QALY) gained by supplementing digital mammography with tomosynthesis was $53,893. If the QALY gained is less than $100,000 then it is considered to be cost-effective. It also resulted in .5 less deaths and 405 fewer false positives per 1,000 women after 12 screening rounds.

Now that 19 states have passed breast density reporting legislation that requires physicians to inform their patients about their breast density, research like this is very crucial. "More and more patients are going to be asking for supplemental screening beyond mammography and it's important for policymakers, payors, physicians and patients to know what the best options are for supplemental screening among women with dense breasts," Lee told DOTmed News.

Ultrasound is currently being promoted for supplemental screening but studies have shown that even though ultrasound can improve cancer detection, it also comes along with more false positives. But Lee has shown that tomosynthesis can increase cancer detection and also decrease false positive results.

Mammography is still the only modality that has been proven to decrease mortality from breast cancer and that's because randomized control trials at the population level were conducted. Ultrasound, MR, and tomosynthesis have yet to be proven to decrease mortality as well because those types of trials take several years and a lot of resources and money.

However, tomosynthesis may one day be involved in a trial like that. "There is a lot of talk and a lot of hope right now, and a lot of stakeholders are talking with the National Cancer Institute about funding such a trial," said Lee. "Whether or not that is going to happen is still to be seen but there is a lot of hope that the NCI and other potential funders would be able to sponsor such a study."

Going forward, Lee and his team will continue to collect more population-based screening information in the U.S.

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