Can advanced imaging limit overdiagnosis of breast cancer?

The continued debate over breast cancer screening recommendations has forcefully pushed the issue of overdiagnosis into the imaging spotlight, with both sides now in agreement that the discovery of indolent cancers and subsequent interventions should be considered potential harms of mammography.

Determining how best to limit breast cancer overdiagnosis and overtreatment is not only an important and necessary goal, it’s also an adventure in medical science, said lead author Habib Rahbar, MD, of the University of Washington School of Medicine in Seattle, and his colleagues in a recent article published online March 23 in Academic Radiology.

“As first-line physicians in a cascade of medical care that is well intentioned, many breast imagers aim to balance the known benefits with the potential harms when making a decision to recall patients from screening,” they wrote. “The most effective approach by which breast imagers can mitigate overdiagnosis is, perhaps, the most exciting aspect of this controversial issue.”

Rahbar and his co-authors reviewed recent advances in breast imaging and put forth a multi-pronged approach to limiting overdiagnosis, consisting of the continued widespread adoption of digital breast tomosynthesis and potential adjustments to screening frequency and thresholds for image-guided breast biopsy.

“There is a great deal of excitement around digital breast tomosynthesis and its ability to decrease screening-related harms, especially false-positive findings,” the authors wrote. “Others have suggested that less frequent screening could mitigate potential harms, including overdiagnosis, at the population level.”

The true turning point in the fight against overdiagnosis, Rahbar and his colleagues conclude, lies in the emerging field of “radiomics”—the extraction and analysis of image features to generate predictive risk models.

“With regard to mitigating the harms of overdiagnosis and overtreatment, further development of novel radiomic approaches to identify and quantify multiparametric advanced imaging features strongly associated with tumor physiology and biology holds the greatest potential for lasting impact,” they wrote. “Through these efforts, breast imagers can have a sustained impact by tipping the balance of screening toward greater benefits and fewer harms.”