Three-dimensional mammography is a new technology option which offers several benefits over the traditional procedure. Also referred to as breast tomosynthesis, this option became available to patients in the United States in 2011.
As with the traditional procedure, a 3-D mammogram uses x-rays to produce images of the breast tissue from a patient. Doctors then review this information to determine if there are tumors, lumps, or other abnormalities which may be concerning.
Because it is able to produce more detailed images of the tissue compared to the traditional procedure, the likelihood of detecting a potential health issue increases exponentially. It captures multiple slices of the breast tissue with its imaging from several different angles, and then brings them together into a clear three-dimensional reconstruction of the breast.
It is important to know what your risk factors for breast cancer happen to be before scheduling a mammogram of any type. There are six topics that you will want to discuss with your doctor before evaluating the pros and cons of 3D mammography.
- Your age. The most aggressive forms of breast cancer are typically found in women who are above the age of 55.
- Your genetics. Approximately 10% of breast cancers that women experience is inherited, usually in the form of a mutation in the BRCA1 or BRCA2 genes.
- Your family history of cancer. If you had a sister, mother, or daughter diagnosed with breast cancer, then you are at a higher risk than the general population of experiencing this disease as well.
- Your health. If you have already had cancer in one of your breasts, then you are up to four times more likely to develop it again in the other breast (and sometimes in the same one).
- Your tissue density. Women who have high-density breast tissue are more likely to develop cancer.
- Your treatment plans. If you are taking a combined hormone therapy for any reason, but especially after menopause, then your risk of breast cancer increases.
If your doctor agrees that the risks of cancer development are present, then a referral for a mammogram may take place. These are the key points to review as part of that decision-making process.
List of the Pros of 3D Mammography
1. The procedure results in fewer recalls for additional imaging.
3-D mammography creates a map of the breast tissue which is so extensive that it creates a complete look of the entire area for the radiologist to examine. There are fewer gaps in the coverage thanks to the reconstruction process which occurs, allowing for a better initial exam of the physical information that is present. According to a study published by the Journal of the American Medical Association (JAMA), there is a 15% decrease in the number of women recalled for additional imaging when they use tomosynthesis instead of the traditional mammography.
2. It offers more accurate detection of possible anomalies in the breast tissue.
The 3-D mammography minimize the impact of breast tissue overlapping when compared to the traditional procedure. It can make a tumor easier to see because more of the overall tissue makes it into the images that radiologists review as part of the overall exam. Because there are multiple images involved, doctors can then find more cancers, which means lives can be saved.
There is a 29% increase in the total number of cancers detected with this technology compared to the traditional mammogram. 3-D mammography also offers a 41% increase in the detection of invasive breast cancers compared to its two-dimensional counterpart.
3. 3-D mammography can detect cancer at an earlier stage.
When women have the traditional mammogram performed, the procedure can sometimes hide small cancers because the two-dimensional scan does not see their presence thanks to the folded tissues. Because 3-D mammography takes slices of tissue to reconstruct an image of the breast, there is a better chance of detecting cancer or other health issues at an earlier stage with this technology. Think of it as being like an MRI, but something that is designed to specifically target breast tissue as a preventative measure.
4. It is an effective procedure for dense breast tissue.
Younger women often have breast tissue that is denser when compared to what older women have. This trait for the tissue makes it a challenge for the traditional mammogram to detect potential cancer because it can create shadows on the images displayed to the radiologist thanks to the overlapping tissues. By going to a three-dimensional image, multiple images taken from several different angles make it possible to detect abnormalities no matter how dense the tissues might be for the patient.
5. Women typically have less anxiety when having a 3-D mammogram performed.
3-D mammography creates much less apprehension for women compared to the traditional procedure for a variety of reasons. Many women find that the three-dimensional set up is more comfortable when compared to the 2-D mammogram. There is less “scrunching” or “squishing” of the breast tissue into the device to take an image, so it is more comfortable. It also provides fewer callbacks or moments of uncertainty when examining the images, which means fewer biopsies or additional scans that can cause emotional stress.
6. It is a safe and effective procedure for diagnosis.
Although women are exposed to a minimal amount of radiation because of the x-rays which are necessary to produce the three-dimensional image, the exposure is well within the regulated limits for mammography in the United States. The risk of exposure is the same as it would be if you had suffered an injury, and your doctor wanted to take multiple x-rays to diagnose a potential bone fracture or break. The Food and Drug Administration (FDA) studied this potential risk factor before approving the procedure, finding that the benefits far outweigh any potential risk that may be present with this procedure.
7. Some women can receive a 3D mammogram for little or no charge.
Medicaid, Medicare, and most health insurance policies will cover the cost of a mammogram. Many of them provide this coverage at 100%. You may have a small co-pay on a high-deductible policy. Some women who must pay an initial deductible before receiving benefits may experience higher charges as well. If you are a woman age 40 or above, then most plans will cover an annual or biannual screening for no out-of-pocket costs.
Several organizations offer low-cost alternatives for women who do not have health coverage. You can contact 1-877-GO-KOMEN from 9am to 10pm Eastern Time Monday thru Friday to see what low-cost options are in your area. Planned Parenthood, Komen Affiliates, and the National Breast and Cervical Cancer Control Program provide access to exams, referrals, and screening for a minimal charge as well.
List of the Cons of 3D Mammography
1. The presence of mammography in society has not significantly impacted mortality rates.
The New England Journal of Medicine published a study conducted by the Swiss Medical Board in 2014 that looked at how women perceived mammography and the need to receive a mammograph to support their health. Over 1,000 women were included in the survey. Over 70% of the participants said that they believed mammography reduce the risk of breast cancer deaths by at least half. 72% of the women thought that at least 80 deaths would be prevented for every 1,000 women who were invited for a mammogram screening.
The reality of mammography is that regular screening helps to prevent about 1 death per 1,000 women screened. It is the marketing and propaganda presented by the healthcare industry which suggests that a service like a 3-D mammogram is critical to care.
2. Mammography can rupture tumors or spread malignant cells.
3-D mammography is a procedure which still requires the woman to place her breasts into two compression plates. Providers say that this process is uncomfortable due to the pressure placed on the tissue, but the “discomfort only lasts for a few seconds.” The equipment used to perform a mammogram today places approximately 40 pounds of pressure on the breast tissue during the exam. It only takes 22 pounds of pressure to rupture the encapsulation of a cancerous tumor which may be present in the breasts. This process could then provide an additional risk of spreading malignant cells into the bloodstream, which may have additional adverse health effects for women in the future.
3. It still offers an adverse risk to some women because of the radiation exposure.
Because healthcare providers are recommending that women receive mammograms earlier, the cumulative effect of routine screening may increase the risk of developing a radiation-induced breast cancer in the future. Women are receiving more mammograms than in previous years, and they are also having this procedure more frequently.
Women who are carriers of the BRCA gene are at a higher risk of experiencing an adverse effect because of the increase in radiation exposure. Having frequent mammograms could become a trigger for the cancer to develop in some situations. Although this risk is exceptionally low, it is still a disadvantage which must be taken into consideration.
4. 3D mammography may still selectively detect favorable tumors.
Mammograms have a tendency to selectively identify tumors which have molecular features that are favorable. These features make the treatment of the cancer easier, which then leads to a better prognosis for the patient. Even though 3-D mammography is an upgrade from the traditional procedure, it still seeks out tumors that grow more slowly, providing a larger diagnosis window that can help to treat the problem. Acute cancers which grow rapidly are still often detected by self-exams first.
5. There may still be tissue density issues with 3-D mammography.
Although three-dimensional mammography detects more abnormalities than the traditional mammogram for women who have dense breast tissue, there is still a higher risk for patients in the situation to have something missed by the radiologist. In fatty breast tissue, the sensitivity rate for all mammography technologies is 98%. When a woman has very dense breast tissue, then the sensitivity rate can be as low as 49%. Because high-density breast tissue carries an increased risk of cancer with it, there is an overestimation on the effects of this procedure that make it potentially unsuitable for some patients.
6. It can still lead to unnecessary treatment and anxiety.
About 10% of women who receive mammography results that offer a false positive finding can experience important psychological distress that includes uncertainty and anxiety for more than a decade in some situations. A Cochrane review on breast cancer screening with all mammography published in 2013 (two years after 3-D mammograms were approved) found that 5 women out of every 1,000 who receive a mammogram from their healthcare provider will undergo treatment for no reason at all.
7. Some of the breast cancers detected in the tissue grow very slowly.
Medical treatment should be about evaluating the risk factors of a disease as it impacts the overall health of a woman instead of treating something that may not have an impact at all. Some of the cancers that this procedure detects grow so slowly that they would not cause any health issues for the patient in her lifetime. Because many of the treatment options have potential risks to them, including surgery or medication, there must be a cautious approach to the malignancies when they are found. Even if a cancer is present, there may be situations when a wait-and-see approach is better than an immediate intervention.
8. There is a procedure cost to consider with 3D mammography.
The average cost of a mammogram in the United States is $100, but it can vary from $75 to $500 depending on your location, the provider offering the services, and the speed at which you want the appointment. According to Susan G. Komen®, most insurance plans will cover this cost, but you will want to check with your provider and the imaging center before receiving a three-dimensional mammogram.
9. The results of your mammogram rely on the skill of the radiologist.
As with any medical procedure, there is a certain amount of uncertainty that is involved with the examination of the images produced with a 3-D mammogram. You are relying on the skill of a radiologist and a doctor to determine what, if any, abnormalities on the image may be. There is always a chance that something could be there, but it is not spotted by the professionals reviewing the results. The opposite issue can occur as well, suggesting that a problem exists when it does not.
10. It may not offer more benefits than what a traditional mammogram provides.
3D mammography offers the benefit of possibly finding a few more breast cancer concerns compared to its traditional counterpart. The problem is that the three-dimensional approach may not be better than a standard procedure for breast cancer screening. There are early studies which indicate that it could be, but the 3-D version still requires additional research to determine its overall effectiveness as a diagnostic tool. The U.S. Preventative Services Task Force and the American Cancer Society still recommend a standard two-dimensional mammogram in their screening guidelines.
11. 3D mammography does not help older women.
Mammograms are recommended for women at least every other year once they reach the age of 50. Some providers issue guidelines which drop that age to 40. Where everyone agrees is the fact that there is not enough evidence to recommend regular screenings for women who are age 75 or older. Three-dimensional mammography does not change those statistics. The risks for older women may actually outweigh the benefits of detecting an issue with cancer. You may still wish to have the procedure performed if you are healthy enough to tolerate a lumpectomy.
12. Variations in algorithms may vary with 3D mammography.
Because you are receiving multiple x-rays with a 3-D mammogram, a computer algorithm is responsible for piecing together the images taken so that they become a usable diagnostic tool. The specific ones used for imaging reconstruction to create a three-dimensional image for study can vary depending on the provider who performs the exam. This disadvantage may impact the results you receive. If you are given a positive result, you may wish to discuss the pros and cons of having a different provider that uses an alternative algorithm perform a second exam.
13. The arc of the movement of the x-ray tube can cause image variation.
X-ray images are processed through a tube which provides an arc, which is how you can see an internal picture of the body. The equipment used to create these images may have varying movements in the structure, which can then cause a variation in the pictures that are produced for reconstruction. Although this disadvantage provides a minimal risk for a misdiagnosis, it may still be an important point to bring up with your medical provider – especially if you are a woman who has high-density breast tissue.
14. It adds time to the diagnostic process.
When 3D mammography is used to determine the potential presence of breast cancer for a woman, then it requires additional reading time which may impact the development of a treatment plan. There are also concerns with connectivity and data storage from an IT standpoint which could create the potential of a medical information breach that may impact the livelihood of the patient in other ways outside of her health as well. This combination of factors can lead to a potential delay in the treatment possibilities that may be disadvantageous if there is an aggressive malignancy present.
The pros and cons of 3-D mammography will not change the recommendation from the National Cancer Institute that all women between the ages of 40-49 years of age to receive a regular mammogram. Because there is a chance that it could detect an early cancer better, this procedure has some definite advantages to consider, especially for women who have a history of this disease inn their family. Because there are also specific risks to consider, informed consent may be necessary in the future to reduce the risk of potential controversies forming.