View a video on Battling Breast Cancer: 3-D Breast Cancer Mammograms
What is 3D Mammography?
3D mammography (or breast tomosynthesis), is a technique that was approved by the FDA in 2011. It is performed alone or in addition to regular 2D mammography in order to improve the reliability of breast cancer screening. To obtain the 3D study, a camera moves in an arc over the breasts, taking pictures in a series from multiple angles. The images are then combined by a computer to create a 3D picture.
Conventional 2D mammography obtains a single flattened image of the breast and stores it directly on film. Digital 2D mammography, which involves about 20% less exposure to radiation, stores electronic images as a computer file, allowing the images to be enhanced, magnified and otherwise manipulated for evaluation. Although digital mammography has been shown to be more accurate than conventional mammography for younger women with dense breast tissue, these methods of screening still miss 10-15% of breast cancers.
What are the advantages of 3D Mammography?
It can detect smaller breast cancers – as small as 2-3 mm in size.
It decreases falsely normal mammogram results caused by overlapping breast tissue that can hide cancers.
It decreases falsely abnormal mammogram results caused by overlapping breast tissue that can mimic cancers. This decreases unnecessary follow-up studies and surgery for benign breast changes in addition to minimizing the anxiety and inconvenience associated with the need for additional testing.
It gives a more accurate location of abnormalities to aid surgical biopsy or removal.
In recent large studies, the cancer detection rate was increased by 30-35%. The need for additional studies was decreased by 25-35%, and the increase in the detection rate of invasive cancers was over 50%.
Where can I get a 3D Mammogram?
The Women’s Health Care Group of PA opened a facility in Paoli across the street from Paoli Hospital in July of 2013, and is pleased to have been the first in the immediate area to offer this improved technology. Over 5000 studies have been done there in their first year of operation. Their address is: Center for Breast Health, 4 Industrial Boulevard, Suite 130, Paoli, PA 19301. They accept all insurances except Aetna HMOs, Aetna QPOS, Aetna Better Health, Keystone First, United Health Care Community Cares, Medical Assistance and Jeff Plus.
Many of the hospitals in the area are now adding this technology as well, and their radiologists are being trained in interpreting the test.
Talk with your practitioner if you are interested in having a 3D test, or if you have any questions. If you will be having the 3D study at the Center for Breast Health (CBH), the test must be scheduled by our office so that arrangements can be made to have your most recent previous mammogram pictures available to the radiologist for comparison.
Who will benefit from 3D Mammography?
Studies show that women with all breast types benefit from 3D mammography, but it is likely to be most beneficial for those with dense breast tissue, a personal history of breast cancer, and/or a genetic predisposition to breast cancer. It may not be beneficial for older women with minimally dense breast tissue. Radiologists are now including a quantitative evaluation of the density of your breast tissue on your mammogram report and you should be getting a letter from the radiology center with your mammogram results that will include that information. Your health practitioner will be happy to review your report with you.
Will 3D Mammography feel the same as other mammography techniques?
The breast compression is the same. The test will take approximately 4 additional seconds per picture while the breast is being compressed. Keep in mind that the more the breast tissue is compressed, the less it is exposed to radiation, and the better the pictures will be.
Why do I still need 2D mammography?
There are some findings that are still best visualized on the 2D images. If you have already had your 2D mammogram for the current year, you will need to wait until you are again due for a mammogram in order to have the 3D test done.
When will I find out the results?
Your study will be read immediately, and you will find out the results before you leave the breast center, or be contacted later that day.
Is 3D Mammography covered by insurance?
Yes, as of January 1 of 2015, when a new procedure code for the test was released. There is no out of pocket cost to the patient for having the 3D test done.
What other services are offered at the Center for Breast Health?
Breast self exam teaching done by a nurse practitioner is optional at the time of the mammogram. She will use a risk calculation method called the Gail model to calculate the patient’s personal risk of developing breast cancer in the next 5 years, as well as a lifetime risk. She will also do a family risk assessment for breast cancer and, if it is appropriate to do so, she will provide a referral for genetic cancer screening.
What if I have breast implants?
3D mammography can still be done, but will be done only for the views that involve displacement of the implants.
What if I have clips in the breast from a prior biopsy?
The clips may produce some artifact or distortion of the images, but the study can still be done.
What is the radiation exposure from the combined 2D and 3D Mammography technique?
The risk is low but repeated radiation exposure does have the potential to cause cancer. The goal is to minimize exposure without sacrificing image quality. In the United States, mammography is strictly regulated and must be below 3 mSV. The 3D portion of the study involves approximately the same exposure as conventional mammography. So the combined study is similar to having two conventional mammograms. This is still less than the established government safety standard, and the FDA has found that the benefit of the additional information gained exceeds the potential risk.
Some patients are called back after 2D mammography for additional views because of a possible abnormality on the screening study. If the 3D test makes additional views unnecessary, the radiation exposure for those patients will end up being about the same or perhaps even less depending on the number of additional views needed.
The exact radiation dosage varies with several factors including breast size and the specific machine being used. In general, digital screening mammography with two views of each breast involves approximately 0.08 rad (0.8 mSv) of exposure. Conventional screening mammography with two views of each breast involves approximately .1 rad (1 mSv) of exposure. Bases on initial studies, the 2D and 3D tests together involve approximately .2 rads (2 mSv) of exposure. Background radiation exposure from the earth and the atmosphere exposes us all to around 3 mSv of radiation per year. Having the combined test involves roughly the same exposure as a round trip commercial airline flight between New York and California or from simply being alive for one year.
The American College of Ob/Gyn published a “Technology Assessment” about 3D mammography in June of 2013. They report that although “initial data indicated a doubling of the mean glandular radiation dose with digital breast tomosynthesis compared with digital mammography,” “a recent report indicates digital breast tomosysthesis produces a mean glandular radiation dose to an average-sized breast 8% higher compared with digital mammogram.”
The risk of the extra radiation exposure is greater for women who have had prior radiation therapy to the chest and/or other radiation exposure beyond the norm, so it is important to take your specific personal and family history into account when deciding whether or not to get 3D mammography.
What about using ultrasound and MRI of the breast to screen for breast cancer?
While these methods do not involve any radiation exposure, they have their own drawbacks. Ultrasound results in a large false positive (falsely abnormal) rate and leads to a lot of unnecessary additional testing but is particularly helpful in distinguishing between cystic and solid masses. MRI is prohibitively expensive for general screening and, because of positioning and time requirements, is not well tolerated by all patients. However, there is now a procedure called a FAST (First post-contrast Acquisition Subtracted protocol) Breast MRI available for low risk patients with dense breast tissue (especially type 4 density) who desire additional reassurance. It does not replace mammography and is not appropriate for high risk patients. The test only takes about 10 minutes but requires placement of an IV for the injection of contrast material. There is no radiation exposure but also no guidelines as to how often this test should be done. Insurance does not cover this test – it is an out of pocket expense of $299 which must be paid up-front. There are only a couple of places providing this service in our area – let us know if you have more questions or would like us to order the test for you.
If I am on hormone replacement therapy (HRT), should I temporarily stop it before having my mammogram?
There is some evidence that breasts are less susceptible to radiation exposure with less circulating estrogen. Therefore, that may be a reasonably good idea. However, there is no specific data to guide a recommendation for doing this.
What else should I know?
Finding breast cancer when it is small does not always improve a woman’s chance of cure because an aggressive cancer can start to spread early in the disease process. However, breast cancer screening programs and early detection have saved many lives. 3D mammography increases the benefit of screening mammography and has become the standard of care.