Explaining today’s different mammograms | Dr. Ulissey

Published 6:00 pm Thursday, April 16, 2015

Q. A friend of mine said she had a 3D mammogram. What is the difference between that and the digital mammograms I get every year?

A. There is mounting evidence that obtaining a mammogram with Tomosynthesis (also known as 3D) is one of the greatest advancements in the arena of early detection, for two main reasons: 1. Tomosynthesis detects small cancers at an earlier stage, especially for women with dense breast tissue; and 2. It significantly reduces call-back rates and false alarms compared to standard 2D digital mammograms. Very few medical tests ever have the ability to increase both sensitivity and specificity – in medicine this almost never happens – yet 3D has proven itself capable of doing just that.

To elaborate, standard digital mammograms essentially take a picture of a woman’s breast tissue using an X-ray, and from that, create a photograph that a radiologist evaluates to look for signs of breast cancer.

Detecting breast cancer is more difficult for women with dense breast tissue. To illustrate, picture a photograph of a forest full of trees. If there are very few trees, it is easy to see a deer in the forest. However, if there are lots and lots of trees, it becomes more difficult.

Breast cancer hiding in dense breast tissue is the same way – normal overlapping breast tissue can sometimes hide a cancer. 3D Tomosynthesis displays the breast tissue in thin layers and allows the radiologist to detect a cancer that might have been hidden.

About 10 percent of the time, women get called back for an additional evaluation of a potentially suspicious area on her mammogram, but in about 95 percent of cases, the suspicious area turns out to be a false alarm. Those recall evaluations may cause temporary anxiety for women and can be expensive.

Tomosynthesis allows the radiologist to examine the suspicious areas more clearly and resolve if it is – or is not – potentially cancer. 3D mammography significantly reduces call back rates and false alarms compared to 2D mammography.

Q. I know you have mentioned not skipping years in between mammograms before, but my doctor still says it is OK to do so.

A. Yes, I covered skipping years versus yearly mammograms in a previous article. Recently, new research published in a leading scientific journal found that skipping even one year gave that population of women a 2.3 fold increase risk in mortality versus the women who had not missed any years.

In addition, there was a progressive risk in mortality as the number of skipped years increased. So please remember, friends don’t let friends skip mammograms, not even for a single year.

Michael J. Ulissey, M.D., is a partner at the Breast Diagnostic Centers of Auburn and Federal Way. He received his medical degree from Texas A&M University, College of Medicine and subsequently served as a physician in the U.S. Navy. His career since has been a mix of private practice, academic teaching and research in the fields of breast imaging, breast cancer and early detection. In addition to taking care of patients locally, he continues to participate in research as an Adjunct Professor at the University of Texas Health Sciences Center. You can reach him at Mike@breastdiagnostic.com.