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Feature Breast Cancer Screening

3D mammography is on the upswing in the US, as experts argue about its value

BMJ 2019; 366 doi: (Published 17 July 2019) Cite this as: BMJ 2019;366:l4506
  1. Jeanne Lenzer, associate editor
  1. The BMJ
  1. jeanne.lenzer{at}

While some doctors are happily recommending digital breast tomosynthesis, Jeanne Lenzer reports that the value of adding an extra dimension to mammography remains decidedly unproven

Dr Sanderson (not her real name) stood half naked, about to undergo routine screening mammography at Brigham and Women’s Hospital in Boston, when a technician asked if she’d like to “upgrade” to a 3D mammogram. The physician told The BMJ that she was shocked to be put on the spot with virtually no information about the new and presumably superior technique. She was even more disturbed when the technician couldn’t answer her questions: what are the test’s sensitivity and specificity? What about radiation exposure? Later, Sanderson heard from other women who had been offered the new mammogram at the point of service, a form of “upselling.” “Surely, patients shouldn’t be put in the position of making a decision when they are vulnerable and without the opportunity to receive balanced information,” Sanderson says. “It doesn’t seem to meet basic standards of informed consent.”

The potential benefits and harms of 3D mammography, also called digital breast tomosynthesis (DBT), are the subject of a fiery controversy among experts12—but concerns about the test are virtually unknown to the women who are encouraged to have it. If they are given any information at all, it is generally derived from marketing materials that proclaim the technology as “lifesaving,” “a great step forward,” and “cutting edge.”34 Celebrity spokespeople, including Grammy award winning singer Sheryl Crow, amplify the message. Crow tells women that “early detection saved my life” and urges women to request Hologic’s 3D Genius system because it “detects cancer 15 months earlier than any other machine.”5 Crow is a paid spokesperson for Hologic.6

Uptake of …

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