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3D Mammography: what’s all the hype?

-by Jameson Guthmiller, MD, Radiologist at Orange City Area Health System

In February 2018 we deployed our 3D mammography system. So what exactly is it? In short, it’s an FDA approved advanced technology that takes 3-dimensional images of the breast, instead of a single photograph.

The best way I’ve heard it explained is to imagine you have a loaf of cinnamon-raisin bread. When you do the 2-dimensional mammogram, you’re probably going to see a bunch of raisins and stripes of cinnamon, but the raisins can be overlapping and hide something underneath.

However, when you do the 3D mammogram, you are analyzing the loaf of bread “slice by slice”. And maybe that time, you find a stray walnut. Finding that walnut is like finding a breast cancer.

3D mammography is quickly becoming the standard of care in breast cancer screening. It’s been shown to find more breast cancers then conventional 2D mammography, and has also been shown to find earlier cancers. The benefits are particularly noticeable in women with dense breasts.

From a patient perspective, women notice very little difference during the exam. The 3D mammogram takes a few more seconds to acquire the image, but is otherwise the same, with “top” and “side” views of each breast.

So when should you get your mammogram? Unfortunately, there’s been a lot of conflicting reports in the news lately, which can make it confusing for patients.

In a typical patient, we still recommend beginning screening at age 40, and continuing annually thereafter. This has been shown to have the greatest mortality reduction, the most lives saved, and the most life-years-gained. In fact, 1 in 6 breast cancers occurs in patients in their 40s.

The bottom line is to have the discussion with your primary care provider, and determine what’s right for you.

One out of every 10 women is called back after a screening mammogram. Why?

  • Dense breast tissue. Difficult to see due to multiple densities. Clarification with specialized views are needed. 
  • There is a breast cyst or calcification. These are often benign but need to be clarified with ultrasound and/or specialized mammogram views.
  • The images are not clear and the radiologist has requested a different angle or view.
  • There is no previous mammogram to compare to. With no way of knowing what is new and what is not, extra caution is exercised.

The diagnostic mammmogram:

  • Can include a mammogram, an ultrasound, or both
  • Results are given immediately by the radiologist
  • Plan on a 90-minute visit

Results of the diagnostic mammogram:

  • It is “nothing” – come back for a screening in one year
  • It is “probably nothing” – come back for follow-up images in six months
  • It is suspicious – referred to a surgeon for a biopsy to test a sample of tissue and determine the make-up of the area of concern

In her words ...

“I had always made a point to get a yearly mammo done, and had heard great things about 3D mammography. I was excited to try the latest technology. I showed up and was brought to the Women’s Imaging Center waiting room, which I appreciated. The tech was very welcoming and professional when I came for my appointment. After the radiologist read my screening exam, I was called back for additional images for a specific area of concern. I was able to return within a couple of days for my follow-up. I appreciated that when I was finished, Dr. Guthmiller came in to talk with me about the results. He suggested a biopsy, and I was able to get it done the same day! I couldn’t have been happier with the patient care I received at Orange City Area Health System, and how they made me feel comfortable and at ease throughout the whole process.” – Jackie W.

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