3D mammograms should become the norm in five years

Three-dimensional mammograms are proving to be a superior screening tool for conventional 2D exams, but not all insurance companies cover the test. The good news: 3-D is expected to become the norm in the next five years, according to doctors.

"Three-D is a much larger technology and a more sophisticated machine that detects cancer 40% more often [than a 2-D]Said Dr. Diana James, radiologist at Hartford HealthCare. "Gov. Malloy signed a bill saying that it was a covered test and that the insurance commission had canceled it. If a patient has a high deductible, most insurance companies will not cover the cost of a 3D mammogram. It is extremely frustrating to have a good test. "

Although the machine itself is expensive, 3D technology ends up being cost effective as it reduces the number of unnecessary recalls and biopsies, as well as patient anxiety, said James.

"For us, as women, it's terrifying to have a call to come back for additional insights," said Dr. Kristen Zarfos, a breast surgeon at Middlesex Hospital in Middletown. "With digital mammography, there are 30% fewer reminders. Only 6% of the recalled women will have cancer. "

In 2D mammograms, two radiographic images of the breast are taken from top to bottom and side to side. To obtain these images, the breast is compressed (as any woman who has undergone a mammogram) knows between a transparent plastic pallet and an imaging device. This compression is normal, but may also cause an overlap of the breast tissue. This overlap may allow abnormal tissue to hide or make normal tissue look like cancer.

In a three-dimensional mammogram, also called mammary tomosynthesis, the X-ray moves in an arc, thus obtaining many more images from different angles. The computer then synthesizes or reconstructs these digital images into three-dimensional image sets. This minimizes the overlap of tissue that can mask cancers.

A 3D mammogram is indicated for most women. However, patients with very large breasts would probably not have 3-D mammograms because more images would have to be taken and the amount of radiation would increase to an undesirable level, James said.

Women with dense breasts enjoy the most 3D mammograms, said Dr. Sarah O'Connell, a radiologist at Middlesex Hospital, but these women also need breast ultrasound.

The breasts are classified into four groups, from the largest (A) to the densest (D). Only women with Grade A breasts would not benefit from a 3D mammogram, James said. Mammogram reports usually indicate the density or density of the patient's breast tissue.

"3D mammography helps us find cancers smaller than those we could not see before. That changed the game, "O'Connell said.

And the earlier we find cancer, the greater the likelihood of recovery.

"If you find stage 0 or stage 1 cancer, the survival rate is 99 to 100%," Zarfos said. "We want to find cancers earlier, so there is less intrusive surgery or need for chemotherapy."

Dr. Erik Bee, a radiologist at St. Francis Hospital and Medical Center, said the radiation dose of a 3D mammogram is slightly higher than the conventional 2 D dose.

"The dose is a tiny, higher amount and the risk is more than offset by the benefits of annual screening. It's also the opinion of the American College of Radiology, "Bee said. "I think 3D will become the standard of care in the next five years."

The most important message is that all women get a screening mammogram once a year, starting at age 40.

The Centers for Disease Control and Prevention reports that Connecticut has the second highest incidence of breast cancer in the United States, with 143.9 cases per 100,000 women. New Hampshire has the highest rate.

For uninsured and underinsured women, St Francis will sponsor its annual free mammography event, Pink Link, on October 25th. Call 860-714-9729 for more information.