3-D mammograms may reduce callbacks, increase cancer detection

Nancy Yang dreaded another false alarm on her mammogram.

The anxiety. The fear. Would she need a biopsy? Would additional testing show the presence of cancer?

Doctors told her it might be equipment related, but that did little to soothe her fears.

“That doesn’t mean anything to you,” said the 65-year-old retired dietitian, whose maternal aunt had breast cancer. It’s one of the most common cancers for women. “All you hear is that you have to go back.”

But three-dimensional technology, which several hospitals in metro Atlanta now use along with two-dimensional imaging, could alleviate such concerns for women like Yang.

Earlier this year, doctors at Emory University Hospital Midtown, Emory Johns Creek Hospital and the Winship Cancer Institute of Emory University started using three-dimensional technology in mammograms. The technology, when used with two-dimensional imaging, reduces the number of callbacks. The biggest draw, however, is that the 3-D technology, called digital tomosynthesis, will allow doctors to spot some cancers earlier.

“There hasn’t been a real advance in mammography in a long time,” said Dr. Michael Cohen, director of the Division of Breast Imaging for Emory Healthcare. “This is a huge step forward.”

Cohen said 3-D is recommended for all women, but it’s particularly effective for women with dense breast tissue.

The compression is the same as with a standard 2-D mammogram but lasts a few seconds longer.

Here’s how it works:

During three-dimensional imaging, the X-ray arm sweeps in a slight arc over the breast, taking several images. A computer then produces a 3-D image of the breast tissue in 1 millimeter slices, providing better visibility for the radiologist to see the inside of the breast with much greater detail.

Cohen described it as being able to scroll through the images like a book, “page by page.”

It’s still a developing area and there are a few downsides.

The machines typically cost much more than traditional mammogram machines. And some experts wonder if it’s not too early to determine what effect the technology will have on overall mortality.

Also, the technology is not offered everywhere, and some insurers will not cover the additional cost — which can be as much as $150 extra. For now, there is no additional cost at the Emory University hospitals that offer three-dimensional screening.

There is also the question of increased radiation from the combination of 3-D and 2-D mammography, which is still below the approved limit set by the U.S. Food and Drug Administration.

About 12 percent of women — or one in eight — in the United States will develop invasive breast cancer during their lifetimes, according to the American Cancer Society.

In 2014, the ACS estimates that more than 40,000 U.S. women will die from breast cancer.

Cohen said the technology offers an estimated 10 to 15 percent improvement in cancer detection and a 30 to 40 percent decrease in unnecessary callbacks. So it’s a “win-win.”

Other local hospitals offer 3-D imaging as well.

“As education is coming out, more and more women are finding it offers greater peace of mind when they have that technology used,” said Katherine Watson, a spokeswoman for Northside Hospital, which has offered the enhanced screenings since 2011.

There is an extra charge for the 3-D technology at Northside. If patients decide to have the 3-D in addition to their 2-D exam, they sign a form stating that they understand the charges and consent to the scan. Some insurance companies cover a portion of the 3-D exam. Northside recommends that patients should check with their insurance companies to determine what their out-of-pocket expense might be.

Dr. Lynn Baxter, director of breast imaging for Northside Hospital, said in a statement that she is “thrilled about the benefits that tomosynthesis can offer to our patients.”

As for women who decided on the newer technology, “it just sounded so much better,” Yang said. “In the back of my mind was I didn’t want a repeat of the year before. … Nobody looks forward to having it done again. I feel pretty confident now that if I get a callback, I know there is a problem.”