The pros and cons of the latest breast cancer detection tool.
You can watch a 3D action movie at the multiplex and enjoy a nature documentary on your 3D television at home. But should you get a 3D mammogram?
The U.S. Food and Drug Administration approved the first device that could provide both two-dimensional and three-dimensional images of the breast in 2011. Since the technology is still fairly new, most women still get a standard 2D mammogram.
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But a growing number of medical centers are investing in the technology so they can offer the service to their patients. “I think this is going to be a game changer,” predicts Dr. Nadja Lesko, medical director of breast imaging for Wake Forest Baptist Health, which began offering combination 2D-3D mammograms in February.
The difference between 2D and 3D
With 2D mammography, the breast is compressed between two plates, pulling the tissue away from the chest wall, so the technician can capture one image of the top and another of the side. This produces a set of flat images.
With a 3D mammogram, or tomosynthesis, the camera sweeps in an arc, capturing images of many small slices of the breast tissue. Then the slices are combined into one three-dimensional image.
The main advantage of a 3D mammogram is that it gives what Dr. Robert Smith of the American Cancer Society calls “a 3D fly-through of the breast.” When the multiple images of the breast are assembled, the radiologist can get a clear picture of the breast without the trouble of overlapping images from a traditional mammogram that might make a shadow resemble a suspicious-looking mass or, worse, hide a mass.
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Women won’t likely notice much difference, other than a slight difference in length, in the actual experience, though.
“It’s going to feel the same, except for a breath hold of three seconds instead of one second,” Lesko says.
Pros and cons
Many facilities offering 3D mammograms are finding that the method reduces their false negative and their false positive rates. As a result, 3D mammography seems to result in fewer callbacks—that is, women are less likely to be “called back” for additional testing because something unusual appeared on their first mammogram.
That can be very reassuring to women, says Dr. Cynthia Hanemann, section chief of mammography at Tulane University Medical Center, which began offering 3D mammography in June 2012.
“It creates anxiety and distress when you get a letter or a call saying, ‘You need to come back in,’” she says.
But there are disadvantages to consider. The most commonly cited disadvantage is that a 3D mammogram does expose a woman to slightly more radiation than 2D mammogram.
“You’re going to have additional radiation, but it’s not outside the limits of what the FDA sets for a single exam,” says Smith. “Technically it’s not a big concern.”
And cost could be a deterrent for some women, since their insurance is probably not going to cover a 3D mammogram.
Not standard yet
The 3D mammogram is not currently considered the standard of care for screening mammograms, but that may change.
“It will take more time and more research and studies to confirm these findings,” says Hanemann. “I expect this to replace 2D mammography.”
In the meantime, Smith stresses that women should continue to get regular mammograms as recommended.
“Women should not feel that they are not able to get a good mammogram in their community if tomosynthesis is not available,” Smith says. “That’s just not the case.”