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Trial seeks better breast cancer screening
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Dr. Howard Zaren with St. Joseph’s/ Candler is excited. And he wants others to be excited, too.

Zaren is the medical director for the Nancy N. and J.C. Lewis Cancer and Research Pavilion and the principal investigator in a trial comparing 2-D and 3-D mammography to hopefully learn the best ways to find breast cancer in women who have no symptoms.

The Tomosynthesis Mammographic Imaging Screening Trial (TMIST) is the first randomized trial to compare the two types of digital mammography for breast cancer screening, 2-D and 3-D, also known as tomosynthesis. Even though both are FDA-approved and in use, no one knows whether the newer 3-D technology tops conventional mammography at early detection of aggressive breast cancers.

Zaren explained that when breast cancer is found in women, 60 percent of the time is from an abnormal mammogram, while roughly 40 percent is from breast self-exams or physician exams.

“So screening is really important since 60 percent of patients will find (cancer) from an abnormal screening process,” Zaren said during a phone interview. “That’s pretty impressive, right?”

And the idea of improving that statistic is what he finds so exciting.

“I can’t look you in the eyeball, but I want you to be excited about this because that’s a big deal.”

Zaren said there hasn’t been a breast cancer screening trial since the 1980s despite how much technology has changed over the last three decades, so there’s a need for newer technology in the screening process.

2-D mammography takes pictures from two sides of the breast to create a flat image. 3-D mammography, or tomosynthesis, images are taken from different angles around the breast and then built into a 3-D like image.

“Tomosynthesis is a much more in-depth evaluation of the breast – it’s almost like doing a CAT scan of the breast,” he said.

Zaren said he believes the 3-D technology is much more accurate than 2-D mammograms, but he noted tomosynthesis has its own drawbacks.

“With tomosynthesis there’s a little more radiation given to the patient, it costs more, takes more time to interpret then digital mammography – there’s no free lunch with this new technology,” he said.

Additionally, while 3-D mammography is likely to detect more findings that require follow-up, it also is likely to lead to more procedures and treatments, according to a press release from St. Joseph’s/Candler. It is not known if this technology is reducing the chances for women to develop a life-threatening, or advanced, cancer compared with 2-D mammography. “So the whole point of this trial is: Does tomosynthesis find more life-threatening cancers than digital mammography?” Zaren said.

St. Joseph’s/Candler is just one of 100 mammography clinics across the U.S. and Canada participating in the study. Researchers hope to get information from 165,000 patients age 45-75, who will be told about the opportunity to enroll in the trial when they schedule a routine mammogram. Once enrolled, they will be assigned to either a 2-D or 3-D mammography screening for five years. Most women enrolled in the trial will be screened annually while postmenopausal women with no high-risk factors will be screened every two years.

During the study, the results of every mammogram from every woman will be collected, whether the mammograms are normal or not. Information about anymedical follow-up, such as more imaging or a biopsy, also will be recorded. All women will be followed until the end of the study for breast cancer status, treatment and results from treatment.

If a woman does receive a diagnosis of any kind of breast cancer while in the trial, she will receive treatment just as she would if she was not part of TMIST, while continuing to be part of the trial.

St. Joseph’s/Candler has already enrolled 200 patients, Zaren said.

“Saint Joseph’s/Candler and Louis Cancer and Research Pavilion is in the top five (clinics) in the country now in recruitment and accrual for patients in this trial. That’s a big deal for patients in this area,” he said.

Both 2-D and 3-D mammography are available at the Telfair Pavilion, located at Candler Hospital, SJ/C Imaging Center-Pooler and Telfair Breast Imaging-Eisenhower. Both screenings are also available at Memorial Health in Savannah, though Memorial is not participating in this trial.

“We’re passionate about this. This is all about doing something good for women,” Zaren said. “And it’s not just like a hello- goodbye thing – this is going to go on for a while because there are lots of women to be included in this trial. So I’m hopeful that, from this screening point of view, we will make a difference and have a better technology for women.”

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Dr. Howard Zaren is the medical director of the Nancy N. and J.C. Lewis Cancer and Research Pavilion in Savannah. Photo provided.
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