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Radiology Life • February 2017

16 | ADVANCE FOR RADIOLOGY LiFE | TECHNOLOGY TMIST Trial Further investigation into breast cancer screening was recently approved by the National Cancer Institute. The trial, called the Tomosynthesis Mammography Imaging Screening Trial (TMIST), will compare the diagnostic accuracy of screening with tomosynthesis to screening with digital mammography.3 Although the study involves tomosynthesis, it has much broader aims than just to study tomosynthesis, according to Etta Pisano, MD, the lead investigator of the trial. “This is really a screening trial,” Pisano said. The last large-scale screening trial, performed was in the 1980s, examined traditional film-based mammography, Pisano said. Since then, therapies have improved and technology has improved dramatically. “We’ve had digital mammography, we’ve developed tomosynthesis, we have better ultrasound and MRI; we have a lot of things going on that help us find cancer,” Pisano said. Although the early studies showed fairly definitively that cancer mortality was significantly reduced with mammography screening, since then screening has received a significant amount of criticism. “Probably the most serious criticism comes from people who believe that now, with modern technology, we’re finding cancers that don’t matter very much, or we’re finding them earlier than we need to — that a lot of them could be found later and treated just as effectively if they’re found later,” Pisano explained. Most radiologists do not agree with this. “It’s sending a confusing message to women about when they should be screened, how often, when they should start, when they should stop — there is all sorts of confusion now in the recommendations about screening,” Pisano said. The goal of the TMIST trial, therefore, is to demonstrate the value of screening, particularly with tomosynthesis. “Essentially we’re trying to figure out if screening in the modern era is still effective, if the newer tools are necessary to reduce mortality, or whether we’re just finding more things that don’t matter to women very much or we’re finding them too early for them to be important to the patient,” Pisano explained. Overall, the TMIST trial will enroll 165,000 women between the ages of 45 and 74 in 90 centers throughout the U.S. and Canada.3 The trial will measure the number of advanced cancers present in women screened with these two technologies for four-and-a-half years. “We’re basically saying, if tomosynthesis is better, it should reduce the advanced cancers in the population,” Pisano said. Pisano is optimistic about the continued use of tomosynthesis. “If we show what I’m expecting us to show, which is that we do have fewer advanced breast cancers in the tomo arm versus the digital arm, one would expect the machines to replace digital,” she said. “If we don’t find that, we’re going to have to really assess what we are doing with better tools to find cancer. That includes all of our tools — ultrasound, MRI, everything.” The TMIST trial will be led by the ECOG-ACRIN Cancer Research Group and is set to begin by mid-2017.3 References 1. Carol Milgard Breast Center website. Tomo Q&As. http://www.carolmilgardbreastcenter. org/tomo-q 2. Breast Cancer.Org website. Digital Tomosynthesis. http://www.breastcancer.org/symptoms/ testing/types/dig_tomosynth 3. ECOG-ACRIN Cancer Research Group website. TMIST Site Recruitment Begins. http:// ecog-acrin.org/news-and-info/press-releases/tmist-site-recruitment-begins Malenke is a staff writer at ADVANCE. Contact:kmalenke@advanceweb.com We’re trying to figure out if screening in the modern era is still effective, if the newer tools are necessary to reduce mortality.” — Debra Monticciolo, MD, FACR Related Content For news on further advances in the fight against breast cancer, read 2016: A Banner Year for Breast Health at RadiologyLife. advanceweb.com / FEBRUARY 2017


Radiology Life • February 2017
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