Does digital mammography find DCIS sooner?

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Question from Sindee: Does digital mammography detect DCIS earlier than conventional X-ray mammography?
Answers - Cecilia M. Brennecke, M.D. X-ray mammography is the cornerstone screening method when it comes to finding cancer early. Digital mammography produces an X-ray image using digital technology, which is more like a TV monitor. The standard way of producing an X-ray image uses film, which is more like a movie. Film produces an image that is a little bit sharper than a digital image. Digital is still new, and companies that make the equipment want radiologists to buy it. When General Electric came out with the first digital equipment, the company did a lot of advertising, particularly during the Olympics, making all sorts of claims such as digital is the only way to go. A lot of people who were watching believed what they were hearing from GE.

However there's a study that's currently underway in which each woman who signs up has a mammogram with film followed by a digital mammogram. Both mammograms are done during the same visit and compared. The study is showing that there are fewer recalls with the digital method, but that the image quality is a little better with the film. (Editor's Note: A 'recall' is when you are called back into the office following a screening mammogram because the radiologist found an abnormality on the mammogram that requires further evaluation.) A key benefit of the digital method is that we can manipulate the image after it has been obtained. We look at the image on a computer monitor, and we can make it larger or smaller, brighter or dimmer. We can also magnify specific areas. With a film image, on the other hand, once the technologist has taken the image and processed it, it can't be changed. If it's too dark or light, that's it.

The bottom line is that although there are some manipulations we can make with a digital image, at this point digital is no better than film and it's considerably more expensive. Digital equipment is about 10 times the cost of film equipment, and at this point there's no proven benefit to the patient. I think it will eventually be the only way to have a mammogram, but the equipment and monitors still need to be improved. Unfortunately, when we buy new equipment, health care costs go up, so we have to be very cautious about how we develop and use new equipment. We have to be sure it's worth the cost, because the cost is in some way passed on to patients. Screening has to be low in cost in order to be effective. You can't charge a lot of money and expect women to be able to pay for a test every year.

On Wednesday, July 16, 2003, our Ask-the-Expert Online Conference was called Breast Cancer Screening. Cecilia M. Brennecke, M.D. and Marisa Weiss, M.D. answered your questions about mammograms, ultrasound, MRI, breast self-exams, physical exams by a doctor, and other topics related to breast cancer screening.

The materials presented in these conferences do not necessarily reflect the views of Breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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