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    Advancing a clearer picture of mammography

    As the inventor and developer of digital breast tomosynthesis (the name that I gave to it), I would add a few points to Deborah Kotz’s article “3-D imaging shows promise” (G section, Dec. 3). Digital breast tomosynthesis is not a sudden idea. I thought of using tomosynthesis for mammography in 1978, but had to wait for digital detectors to be developed in the 1990s. I met with great skepticism, but my research team persevered to prove that it could improve on mammography and to convince companies, including Hologic, of its importance. Hologic was the first to obtain approval from the Food and Drug Administration, but digital breast tomosynthesis is based on my team’s almost two decades of effort.

    Further, the public is mostly hearing one side of the most recent attack on mammography screening. The recent study that suggests breast cancer is “overdiagnosed” and “overtreated” is not based on direct data, but on assumptions and estimates. Using actual data, there is no “overdiagnosis” of the small invasive cancers whose detection saves lives. Ductal carcinoma in situ, or noninvasive breast cancer, and its treatment is a major unresolved issue, but focusing on these lesions to dilute the benefit from screening is dangerously misleading.

    Dr. Daniel B. Kopans


    The writer is a professor of radiology at Harvard Medical School and senior radiologist in the breast imaging division of the department of radiology at Massachusetts General Hospital.