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Radiologist's view Dr Erika Denton How has the screening process changed in recent years? "When the NHS Breast Screening Programme (NHSBSP) was established in 1988, funding was initially provided for a single mammographic view to be taken of each breast and films were read by a single reporting doctor. Since then, research has shown that double reading of the films and taking two views of each breast improves cancer detection. By 2003, all women having screening mammograms will have two views at each attendance and wherever possible, films are now double read in the NHSBSP." What have been the main technological changes? "Magnetic resonance imaging (MRI) has been used increasingly as a problem-solving tool and avoids the use of x-rays, using magnetic fields instead. Breast MRI is particularly useful in young women with dense breasts where mammography is less effective. The possibility of using MRI to screen young women at high genetic risk for breast cancer is currently being investigated. MRI is also increasingly used to evaluate breast implants." "Over the last 10 years breast ultrasound has become excellent at detecting small abnormalities. Ultrasound can also be used to guide biopsies. Researchers are currently investigating whether ultrasound could be useful to differentiate benign from malignant abnormalities." "Digital imaging is increasingly used in main x-ray departments and also in breast imaging. This allows images to be stored digitally without the need for hard copy film, enabling images on a patient to be viewed throughout the hospital or elsewhere." What other changes have there been? "Over the last 10 years most breast imaging departments have moved from using fine needle aspiration (FNA) cytology as their main biopsy method towards core needle biopsy. There are disadvantages of core biopsy as the result is not routinely available on the same day as the test is performed. However, there is a greater proportion of definitive results using core biopsy when compared to FNA." "Newer large volume biopsy techniques such mammotomy enable a larger volume of abnormal breast tissue to be obtained providing better diagnositic accuracy. Mammotomy also avoids the need for multiple needle insertions." "Prone (face down) stereotactic biopsy devices have become increasingly used to guide biopsies, rather than upright devices, as they have improved sensitivity and specificity. The increased use of digital imaging with upright devices has also improved results. Digital images are available within a few seconds rather than waiting for a film to be developed and the woman only has to remain within the biopsy machine for a much shorter time than using standard analogue imaging equipment." Glossary of medical terms. Click here for further reading. Woman's view | Radiologist's view | Researcher's view | Research process |