Early detection of disease is usually seen as a good thing. The sooner a problem is found, the better the chances of successful treatment.
But what if screening finds too much? Sometimes tests detect health issues that would never have become dangerous.
This can lead to unnecessary stress and treatment, a problem known as overdiagnosis.
Breast cancer screening is one area where this balance is very important. Detecting breast cancer early can save lives, but there is also the risk of discovering slow-growing tumors that may never have threatened health. A major new study, called TOSYMA, is taking a close look at this challenge.
TOSYMA is the world’s largest randomized study designed to compare different screening methods for early breast cancer detection. Nearly 100,000 women in Germany took part. The study is led by researchers at the University of Münster, with results recently published in the journal Radiology.
The researchers compared the standard digital mammography (DM) with a newer method that combines Digital Breast Tomosynthesis (DBT) and Synthetic 2D Mammography (SM), known together as DBT+SM. DBT takes 3D-like images of the breast, which may show tumors more clearly, while SM reconstructs standard 2D views from the same data.
The results showed that DBT+SM found more invasive breast cancers than digital mammography alone. At first glance, this sounds like a clear win. But finding more tumors is not always better. The key question is whether these are the kinds of tumors that matter most for survival.
In a detailed analysis, the researchers found encouraging news. DBT+SM was especially good at detecting more serious tumors, such as grades 2 and 3 cancers, at an earlier stage. These are the types of cancers that are more likely to shorten life if not treated. By catching them earlier, DBT+SM may help reduce deaths from breast cancer in the long run.
Professor Stefanie Weigel, one of the study’s authors, explained that detecting these more dangerous tumors at earlier stages is a real advantage. It means DBT+SM is not just finding more cases overall but is focusing on the ones that are most important for saving lives.
Still, the question of overdiagnosis remains. DBT+SM may also detect harmless tumors that would never cause harm. That’s why the researchers are now planning to evaluate long-term data from cancer registries in North Rhine-Westphalia and Lower Saxony.
These follow-up studies will help confirm whether DBT+SM truly improves survival compared to standard mammography.
The TOSYMA project began in 2016 and involves 17 screening centers in Germany. It is supported by the German Research Foundation, with funding running until 2025. While more work is needed, the latest results suggest that DBT+SM could represent a step forward in breast cancer screening—finding the tumors that really matter, earlier.
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