Digital Mammography: This cutting-edge X-ray test can be used in place of a standard mammogram and is performed in the same way as the traditional screening tool—your breasts are compressed between two plates as whole images are taken. But instead traditional X-ray film, electronic detectors convert X-rays into electric signals (much like a digital camera does), which can be used to produce images on a computer screen. These pictures can also be printed on special film.

Pros/Cons: Studies show that digital mammograms aren’t any more sensitive in diagnosing breast cancer than conventional mammograms; however, doctors who use the technology feel it has distinct advantages. “We have been using digital mammography as our primary screening tool since 2000, and I feel that it’s superior to traditional film,” says Ulana Suprun, M.D., vice medical director of Medical Imaging of Manhattan.

“Radiologists can manipulate a digital image and see contrasts in tissue density more clearly,” says Dr. Suprun. That may ultimately reduce the need to call patients back to decipher questionable findings, an inconvenient and anxiety-producing process. In fact, in a study by Sughra Raza, M.D., director of the Women’s Imaging Program at Brigham and Women’s Hospital, in Boston, involving more than 12,000 women, digital mammography reduced the call-back rate by 12 fewer women per thousand, compared with conventional mammography, which is statistically significant. Digital X-rays, unlike film mammograms, can also be sent from one computer to another, making consultation among physicians, reviews of earlier mammograms and second opinions just a mouse click away.

It’s estimated that more than 90 percent of mammography centers across the United States still use conventional film mammography. “But as digital technology improves and equipment becomes more affordable, digital mammography will be the wave of the future,” says the Komen Foundation’s Dr. Perkins.

Should You Ask for It? Currently, because the equipment is expensive, digital mammography is only available at major breast centers, which tend to be located in major cities. When you schedule your next mammogram, it’s worth asking whether the center offers digitals and, if necessary, traveling farther to lower your risk of needing a repeat screening, says Dr. Raza. The screening test is typically covered by insurance, but check your policy to be sure.

Computer-Aided Detection (CAD): With this emerging technique, a computer scans a digitized mammogram or a conventional one that has been digitized and flags areas of concern, enabling a radiologist to take another look and decide whether the computer markings warrant further action. “It’s like having an automatic second opinion,” says Mitchell D. Schnall, M.D., Ph.D., deputy chair of the American College of Radiology Imaging Network (ACRIN), a research group in Philadelphia funded by the National Cancer Foundation.

Pros/Cons: Two studies reported that CAD helped radiologists detect 20 percent more cancer than mammography alone. But the research also suggests that CAD caused radiologists to disregard their own findings if the computer didn’t highlight them. Because CAD tends to also mark lesions that aren’t cancerous, such as bunched-up tissue, benign lymph nodes and benign calcifications, the rate of false positives is high, especially in the screening a population of healthy women. Less than 1 percent of findings marked by CAD turn out to be cancer.

Still, that doesn’t necessarily translate to unnecessary biopsies. “Most of the time, we take a quick look at CAD markings on mammograms and discount them,” says Stamatia Destounis, M.D., associate clinical professor at the University of Rochester and staff radiologist at the Elizabeth Wende Breast Clinic, also in Rochester, New York. “But on occasion, it does mark something we need to pay attention to.” CAD is widely available at mammography centers and university- and hospital-affiliated breast clinics across the country and is generally covered by insurance.

Should You Ask for It? Although CAD isn’t a perfect tool, “it should be the standard of care for every woman who gets a mammogram,” says Dr. Destounis, who has been using CAD since 2000. “But there’s definitely a learning curve and a lot depends on the expertise of the radiologist reading your mammogram.” To reduce your risk of unnecessary additional testing, such as biopsy, find a facility with mammography-certified technologists and trained radiologists who have been using CAD for at least a year.

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