At more than two million cases each year and nearly 685,000 deaths in 2020 alone, breast cancer is the most frequently diagnosed cancer and the most common cancer-related cause of death for women globally. Regular mammograms - X-ray pictures of the breast - can save lives by detecting this disease early, even before there are symptoms. However, the quality of these images is crucial for effective screening, diagnosis and treatment. To help Member States plan, design and operate high-quality breast cancer screening services by ensuring that their transition to newer technologies guarantees consistent, high-quality images, the IAEA Division of Human Health's Dosimetry and Medical Radiation Physics Section has published a new guidance document: Worldwide Implementation of Digital Mammography Imaging.
Released on World Breast Cancer Day (19 October), this latest issue (No. 46) of the IAEA's Human Health Series provides decision makers, planners, programme administrators and healthcare policy professionals with the information they need to successfully establish digital mammography facilities or upgrade their existing ones. This independent resource complements an earlier issue (No. 28) of that series, Worldwide Implementation of Digital Imaging in Radiology, which addresses challenges associated with the adoption of digital radiology more broadly. For low- and middle-income countries in particular, this resource could not be timelier as breast cancer incidence and mortality are on the rise.
For most of the 20th century, screen-film mammography - which utilizes film to capture, display and store images - was the gold standard, given its high spatial resolution, ease of display and low cost. The introduction of digital mammography has since shifted the preference away from analogue in favour of digital's notable advantages for patients and providers: improved efficiencies in workflows and overall costs and reduced radiation doses for patients; immediate availability; ease of display, storage and electronic sharing; wider range; and better reliability, to name but a few. Moreover, advanced analysis software and artificial intelligence can be applied to digital images to facilitate diagnoses, improve workflows and enhance screening.
Yet, optimizing mammography imaging is not a simple nor singular process. It cannot be done through the adoption of digital systems alone; rather, it demands proper infrastructure, well-trained staff, the best equipment and a rigorous quality assurance programme. Without these critical elements, image quality not only suffers and but can also compromise the care that patients receive.
Against this backdrop, the IAEA's new publication provides countries with a "road map" to navigate this calculus within their available resources. The practical information on relevant considerations, contexts, needs, challenges and decisions across various implementation scenarios can help mammography facilities around the world meet the needs of their patients more effectively by ensuring the best possible images. As well, facilities can draw on good implementation practices as they learn from the experiences of others.
"Ensuring access to high-quality mammography services is paramount. Digital advancements provide promise, but without proper infrastructure and training, we risk compromising patient care," said Maria-Ester Brandan, Professor of Physics at the National Autonomous University of Mexico and one of the global experts who contributed to the publication's drafting. "This guidance offers a path forward, ensuring that healthcare facilities worldwide can provide the best possible care to their patients."
