Standard mammography misses 15–30% of breast cancers, particularly in women with dense breast tissue or those under 50. The TOMMY trial is testing whether a newer 3D imaging technique—digital breast tomosynthesis (DBT)—can spot more of those missed cancers and reduce unnecessary call-backs. The problem is that overlapping tissue in a standard 2D mammogram can hide tumours or create false alarms. DBT builds a 3D image of the breast, letting radiologists see through the tissue layers more clearly. The trial will compare both imaging methods in 7,000 women aged 40–73 who have either been recalled after an abnormal mammogram or have a family history of breast cancer. Each woman will receive both scans, and the results will be checked against the final diagnosis. If DBT proves more accurate, the NHS Breast Screening Programme could adopt it for routine use. That would mean fewer cancers missed in younger women and those with dense breasts, and fewer women called back for unnecessary tests and anxiety. The change would be invisible to patients but could quietly improve the reliability of a screening programme that already saves thousands of lives each year.
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Breast screening is recognised as the most effective method of detecting early stage breast cancer and reducing breast cancer mortality. However, 15-30% of cancers are not detected by standard mammography screening. This percentage is higher in dense breasts and in women under 50 years. One of the major limitations of standard mammography is that overlapping dense fibroglandular tissue in normal breast tissue can decrease the visibility of malignant abnormalities, or mimic abnormalities. This results in some cancers being missed or unnecessary recalls, assessments and psychological stress. Digital Breast Tomosynthesis (DBT) is a newly developed three dimensional (3D) imaging technique that has the potential to improve the accuracy of mammography by reducing interference from breast tissue overlap and facilitating differentiation between malignant and non malignant features. The aim of this study is to assess whether DBT could improve upon digital mammography as a screening tool, particularly in certain groups of women e.g. those with a family history of breast cancer, or women with dense breasts. A total of 7000 cases will be collected over a 15-18 month period. Women (aged 47-73) who have been recalled to an assessment clinic following abnormal screening mammography and women (aged 40-49) with a family history of breast cancer attending annual mammography will undergo both a standard digital mammogram and DBT imaging. The diagnostic accuracy of the two imaging modalities will be compared in an independent retrospective reading study and compared to the final outcome (normal/benign/malignant) for each case.
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