What’s better- the old film based (analog) mammography or digital?

The question is similar to asking if you prefer the old film-roll-based camera or the modern digital camera- the one which is also in your phone, for your everyday pictures. If your answer is digital, the same holds true for mammography too. Let’s understand why: 

Mammography technology has made rapid progress in recent years from analog to digital to enable speedier and more comfortable mammograms at much lower radiation doses than ever before. 

Advantages of digital mammography over analog machines:

• In older analog mammography, the films were used to capture images. In the newer digital mammography, the image is directly captured by the computer, which can be magnified, enhanced, etc., for further evaluation when needed.  
• The cancer detection rate is significantly higher (21% more) in digital mammography than in analog.^[1]
• Much less radiation (averaging 22% lower) is used by digital mammography vs analog.^[2]
• Digital imaging is faster than analog which means a woman’s breasts are compressed for less time. 
• Digital images are immediately available for the doctors. There is no waiting time for film development. 

Why routine mammography is important even if you are healthy? 

• Breast cancer is India’s most common women’s cancer now.^[3] Earlier it used to be cervical cancer. Not anymore. 
• There is no way to prevent breast cancer. Early detection – when it’s too small to pose any serious threat to your life and treating it – is the best protection. 
• About 50% of breast cancers develop in women with no identifiable risks other than gender and age.^[4] 
• Women with dense breast tissue are more prone to breast cancer,^[5] while it’s common to have dense breasts, especially at a younger age.
• The gold standard for early detection of breast cancer is mammography.^[6] 

Why not other modalities such as breast self-examination, ultrasound, or MRI? 

• Breast self-examination is not recommended by most medical organizations across the world^[7] because it does not help early detection. By the time the lump is big enough to be felt by your or your doctor’s hands, it’s already too big, and too late.
• Ultrasound is more useful for further diagnosing a suspicious finding than for regular screening because it can neither capture the whole image of the breast nor see deep like a mammogram. 
• MRI’s high cost and lower ability to correctly exclude women without breast cancer prohibit its routine use for screening.^[8]

Why never miss your annual mammogram? 

• Breast cancer deaths are reduced by 30% to 50% with annual screening mammography performed on all women beginning at age 40 years.^[9] 
• Annual screening mammograms can substantially reduce your stress & medical expenses: Just like car insurance premiums, spending a small amount on mammography every year may help you save 30% to over 100% of the treatment costs of breast cancer compared to the women who are diagnosed with advanced-stage breast cancers^[7]. You may avoid the need for chemotherapy, removing the entire breasts, etc., with early detection with mammography. 

How to select an appropriate center for your mammogram? 

You deserve access to the best of technology & facilities when it’s time for your annual mammogram.

Here are three easy steps to help you navigate well in choosing the right Mammography Centre, whether it’s in a hospital, a diagnostic lab, or a breast clinic:

1. Is at least Digital or the latest 3D Mammography available at the center? 

• • Please check if the center has a digital or the latest 3D mammography machine. 
  • The latest 3D mammography machines in the digital family are designed to deliver the fastest and the highest resolution mammograms, with more comfort, and at the lowest radiation dose within the allowable limits. 
  • Studies have shown that 3D mammography significantly helps in early breast cancer detection, enabling the detection of more cancer cells,^[10] and significantly reducing recall rates^[11] for any additional tests.
  • 3D mammography is especially useful in high-risk women, i.e., including those with:
  • Changes or lumps in the breasts 
  • A family history of breast or ovarian cancer^[12]
  • Dense breast tissue (nearly half of all women above the age of 40 have dense breasts)^[13]
  • A previous diagnosis of breast disease

2. Does the center have other relevant capabilities for mammography?

• • Radiologists are specialist medical doctors who study your mammograms and interpret the scans for you. Usually, the website of the center will have detailed information about the doctor’s qualifications, experience, advanced training or fellowship in radiology, etc. This may give you a good idea about the professional expertise at the Centre. 
  • Mammography is only an imaging test that has no cuts, pricks, or admission to the hospital, etc. You can either take a prior appointment or walk-in if the center advises so for mammography that usually takes only a few minutes excluding waiting time. Within those few minutes too, your breast tissue will be compressed only for less than 10 seconds in the latest 3D Mammography machines to take clear images and avoid recalls. 
  • Most health plans cover the cost of mammography if you are insured for diagnostic tests. Even if not, the cost of mammography is negligible compared to the benefits it provides. 

If you are eligible for breast screening either by age (40 years and above) or due to high-risk factors such as family history (in which case even if you are younger than 40 years), subscribe to an Annual Screening Mammography Plan right away– A simple ritual that can save your life! 

1. Hambly NM, McNicholas MM, Phelan N, Hargaden GC, O’Doherty A, Flanagan FL. Comparison of Digital Mammography and Screen-Film Mammography in Breast Cancer Screening: A Review in the Irish Breast Screening Program. American Journal of Roentgenology. 2009;193(4):1010-1018. doi:10.2214/ajr.08.2157
2. Hendrick RE, Pisano ED, Averbukh A, et al. Comparison of Acquisition Parameters and Breast Dose in Digital Mammography and Screen-Film Mammography in the American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial. AJR American journal of roentgenology. 2010;194(2):362. doi:10.2214/AJR.08.2114
3. Mathur P, Sathishkumar K, Chaturvedi M, et al. Cancer Statistics, 2020: Report from National Cancer Registry Programme, India. JCO Global Oncology. 2020;6(6):1063-1075. doi:10.1200/go.20.00122
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5. Boyd NF, Guo H, Martin LJ, et al. Mammographic Density and the Risk and Detection of Breast Cancer. New England Journal of Medicine. 2007;356(3):227-236. doi:10.1056/nejmoa062790
6. https://www.webmd.com/breast-cancer/features/mammography-still-gold-standard-for-breast-cancer. Accessed on 19 Dec 2022.
7. https://www.mayoclinic.org/tests-procedures/breast-exam/about/pac-20393237. Accessed on 19 Dec 2022.
8. Elmore JG, Armstrong K, Lehman CD, Fletcher SW. Screening for breast cancer. JAMA. 2005;293(10):1245-1256. doi:10.1001/jama.293.10.1245
9.  Feig S. Comparison of Costs and Benefits of Breast Cancer Screening with Mammography, Ultrasonography, and MRI. Obstetrics and Gynecology Clinics of North America. 2011;38(1):179-196. doi: 10.1016/j.ogc.2011.02.009
10. Skaane P, Bandos AI, Gullien R, et al. Comparison of Digital Mammography Alone and Digital Mammography Plus Tomosynthesis in a Population-based Screening Program. Radiology. 2013;267(1):47-56. doi:10.1148/radiol.12121373
11. Rose SL, Tidwell AL, Bujnoch LJ, Kushwaha AC, Nordmann AS, Sexton R. Implementation of Breast Tomosynthesis in a Routine Screening Practice: An Observational Study. American Journal of Roentgenology. 2013;200(6):1401-1408. doi:10.2214/ajr.12.9672
12. https://www.canceraustralia.gov.au/sites/default/files/publications/breast-cancer-risk-factors-review-evidence/pdf/rfrw-breast-cancer-risk-factors-a-review-of-the-evidence_1.15.pdf  Accessed 16 Sep 2022
13. https://www.cancer.gov/types/breast/breast-changes/dense-breasts Accessed 16 Sep 2022