Digital breast tomosynthesis (DBT / 3D mammography)
The speaker recommends prioritizing DBT (3D mammography) over standard 2D digital mammography for all women getting screening mammograms, especially those with dense breasts.
DBT was rolled out in 2011 and represents a meaningful technical improvement over standard 2D digital mammography (approved in 2000). It takes multiple low-dose X-ray images from different angles to create a layered, slice-by-slice view of the breast, reducing the problem of tissue overlap that causes both false positives and false negatives. The result is better cancer detection with lower recall rates, a rare combination of improved sensitivity and specificity. The benefit is particularly pronounced for women with dense breasts, where tissue overlap on 2D mammography is most problematic. The speaker notes that not every center offers DBT and there may be an added cost, but positions it as the clearly preferred version.
Compared to standard 2D digital mammography: DBT yields better cancer detection AND lower recall rates. Compared to film-based mammography (obsolete): even larger advantage. There is no imaging modality that replaces mammography — it remains the foundational tool for all women — but DBT is the best version of that foundation.
This is the version of mammography I would prioritize. Again, especially for women with dense breasts.