3 ways patients benefit from 3D mammograms
November 13, 2019
Time and again, research has shown that early cancer detection is key to effective treatment and increased survival. Today, 98% of women diagnosed with early stage breast cancer live five years or longer after treatment. Survival is expected due not only to improved treatments, but also because of advanced screening technology.
One such innovation is 3D mammography, or breast tomosynthesis. It is the preferred screening modality of the American Society of Breast Surgeons and our go-to screening tool at the Harold C. Simmons Comprehensive Cancer Center.
The primary benefit of 3D imaging is that it can detect small cancers and masses hidden in dense breast tissue much earlier than standard 2D mammography. Earlier detection gives a patient the choice whether to watch and wait for changes in the mass or remove the tumor right away, reducing the need for whole-body cancer treatment if the tumor spreads – and the cost, time, and discomfort that go along with it.
Comparing 2D to 3D mammography is like comparing a flip phone to your smartphone. While you can talk or text on both, the smartphone gives you additional access to GPS, internet access, and so much more. For a slightly higher upfront cost, you can avoid purchasing an armful of additional services or devices to achieve the same level of connectivity.
3D mammography offers patients so much more than just a means to detect their cancers. Patients will need less diagnostic work up because 3D mammography can replace most diagnostic images. Further, 3D mammography is shown to decrease false positive recalls, so women are less likely to receive false alerts.
We believe so strongly in the benefits of 3D mammography that our cancer center team and others across the U.S. have worked tirelessly to get 3D mammograms covered by insurance. Texas passed coverage into law in 2017.
But even with the known benefits, critics have suggested that 3D mammography is not in patients’ best interests, and 2D mammography is sufficient. An October 2019 article in USA Today calls 3D mammography, which can cost more upfront than a 2D mammogram, an “upsell” to make hospitals money at their patients’ expense.
While it’s true 3D mammography is a young technology – it was approved by the U.S. Food and Drug Administration in 2011 – short-term data suggests superiority in early detection and empowering women with time savings, reduced healthcare costs, and greater control over how patients choose to approach early breast cancer treatment.
3 distinct benefits of 3D mammography
1. Requesting fewer ‘callbacks’
Many research studies have shown that 3D mammography results in fewer callbacks, or asking a patient to return to the doctor’s office because something suspicious was found on a mammogram.
Using 3D technology, we can see smaller masses and lumps hidden within dense breast tissue. When we do call back a patient, it’s likely because her previous mammograms were 2D and we want to ensure the masses were not tissue changes that can indicate cancer. Similarly, most of the women screened using 3D mammogram in the study referenced in the USA Today article were getting it for the first time, unlike their 2D counterparts. This likely led to unmasking multiple previously unknown masses in their breasts with 3D mammogram and falsely increased the recalls.
UT Southwestern was among the first institutions in the nation to implement 3D screening, so most of our patients have undergone several rounds of 3D screening. This leads to reaping the benefits of reduced callbacks and only recalling truly new findings that developed in the interval.
The American Cancer Society says fewer than 1 in 10 women who are called back are diagnosed with cancer. However, many patients who are called back tell us they’d rather have an extra visit than not know about a mass at all.
Using 3D technology, we can see smaller masses and lumps hidden within dense breast tissue. When we do call back a patient, it’s likely because her previous mammograms were 2D and we want to ensure the masses were not tissue changes that can indicate cancer. Similarly, most of the women screened using 3D mammogram in the study referenced in the USA Today article were getting it for the first time, unlike their 2D counterparts. This likely led to unmasking multiple previously unknown masses in their breasts with 3D mammogram and falsely increased the recalls.
UT Southwestern was among the first institutions in the nation to implement 3D screening, so most of our patients have undergone several rounds of 3D screening. This leads to reaping the benefits of reduced callbacks and only recalling truly new findings that developed in the interval.
The American Cancer Society says fewer than 1 in 10 women who are called back are diagnosed with cancer. However, many patients who are called back tell us they’d rather have an extra visit than not know about a mass at all.
Related reading: Essential Mammogram Guidelines at Every Age
2. Finding smaller cancers earlier
Along with less invasive diagnostics, 3D technology allows us to diagnose breast cancer earlier, when it is smaller and easier to treat. Furthermore, 3D mammography is found to be more effective in young women with dense breasts.
Finding cancers at an early stage, including ductal carcinoma in situ (DCIS) – a cancer typically confined to the milk ducts – gives patients more power to choose a treatment path. There are clinical trials investigating whether selected ductal carcinoma in situ can be monitored with imaging to see whether it changes or grows over time. Detecting cancer early gives women the freedom to choose from multiple treatment options and determine which best fit their beliefs and priorities.
Care decisions should be reached by balancing the patient’s personal and cultural preferences with her personal risk factors and the urgency of her condition. For example, clinical trial data have shown that women in Europe are more likely to participate in active monitoring, whereas women in the U.S. typically prefer immediate treatment.
Critics of 3D mammography suggest that finding some indolent-type ductal carcinoma in situ can lead to overtreatment – removing or otherwise treating a cancer that might never grow or spread. Rather than blaming mammography for identifying these early cancers, doctors should inform patients that they have conservative options about their management. The patients deserve to know whether they have early breast cancer so they can make informed choices.
We see “five-year survival” rate as an insufficient contemporary outcome metric for breast cancer screening. With an excellent five-year survival rate for early, screening-detected breast cancer, women are looking for (and can have):
- Less toxic treatment
- Abbreviated treatment
- Small volume, local excision rather than mastectomy
- An excellent cosmetic result
Therefore, finding smaller cancers with 3D mammography helps women to expect more than simply “survive” the next five years.
3. Saving patients money, time, and discomfort
For many patients and providers, the financial savings associated with 3D mammography outweigh the perceived risks. Most insurances cover 3D mammogram at no cost to the patient. While there is a small extra l cost billed to the insurance, patients who get 3D imaging will likely spend less money on additional diagnostic mammograms by having fewer recalls and spend less time traveling to and from the doctor’s office for callback appointments.
Those patients who are called back are more likely to skip the diagnostic mammogram and move directly to ultrasound since 3D mammography already provides the image features we would want to evaluate. As a result, 3D recalled patients are potentially exposed to less radiation than 2D-recalled patients, and they wait less.
3D is beneficial over 2D, but not better...yet
We have not done away with 2D mammography. That said, more than two-thirds of the mammograms we perform are 3D. If a patient's insurance covers 3D, that's what she'll get. If insurance coverage is unclear, it's the patient's choice. If she wants 3D and it's not covered, she will need to agree to pay $99. However, if she prefers 2D, we will perform 2D.
UT Southwestern is a nonprofit academic medical center. As such, we are only interested in technologies that can benefit our patients – and we know 3D mammography is the most advanced breast cancer screening we can offer patients today. To suggest that 3D mammography is not a better way to screen women is a step backward in women’s health care.
We acknowledge that 3D imaging is still relatively new, but as more long-term data are accumulated over the next few decades, I expect the full benefits of 3D mammography will be crystal clear in terms of overall savings of money, time, and most importantly, health benefits.
We will continue to offer patients 3D mammograms because we believe it’s the best tool to detect breast cancer before it becomes devastating – and our patients deserve the best care.
To get a 3D mammogram, call 214-645-8300 or request an appointment online.
