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Digital mammograms are better, but scarce

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Although a study sponsored by the National Cancer Institute has concluded that digital mammography is superior to film mammography for certain women, most candidates for the new screening technology will have a hard time finding it, at least at first.

Digital equipment represents only about 8% of the U.S. mammography market, says Etta Pisano, the University of North Carolina-Chapel Hill radiologist who led the study. It was presented Friday at an American College of Radiology meeting in suburban Washington, D.C.

The study of more than 40,000 women found that digital mammography was more effective in detecting cancers than film in women under 50 or perimenopausal (had had a menstrual period within the previous 12 months) or who had dense breasts. For the remaining third of study participants who did not fall into any of those categories, the technologies were equally effective.

Pisano says she and her co-authors suspect that digital mammography is superior in some women because it allows radiologists to heighten the contrast between dense tissue and cancerous cells, which both appear to be white on a film mammogram.

Cost has blocked wider use of digital mammography, Pisano says. In a paper posted online Friday by The New England Journal of Medicine, she and her co-authors write that digital mammography costs 1 1/2 to four times more than film mammography. Medicare pays $135 for a digital mammogram and $85 for film, Pisano says.

She says she expects that the price will drop once Fuji Medical Systems enters the market. Fuji, whose technology was among those used in Pisano's study, is awaiting approval from the Food and Drug Administration. Fuji says its system converts film mammography systems to digital at one-third of the cost of totally replacing them.

The new study alone will spur clinics to go digital, says Michael Knopp, radiology chairman at The Ohio State University. Up to now, "we were not really sure if digital mammography is truly equivalent" to film, says Knopp, who didn't participate in the study.

Any photographer who has switched from film to digital can understand digital mammography's advantages, Knopp says. "There are tremendous efficiency gains," he says, such as electronic archiving.

But if you've been getting your mammograms at the same place over the years, you shouldn't switch just to go digital, Pisano cautions. "Having good readers (radiologists who interpret mammograms) is very important. Just because a place has digital doesn't mean they're doing a good job."

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