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Fighting Breast Cancer In 3D

When you go in for a mammogram, you now have a choice to make. Approved last year by the Food and Drug Administration, a 3-D mammogram is touted as a more accurate check for breast cancer. But it’s also more expensive. In a KERA Health Checkup, Dr. Jim Schroeder, a radiologist at Lake Pointe Breast Centerin Rockwall, compares the two choices – beginning with the usual mammogram.

Dr. Schroeder: It’s a two-dimensional image and it’s created by putting the breast in compression and by X-rays that pass through the breast onto a detection plate, and then the detector makes an image, one-plate image. Whereas 3-D, it also uses X-rays similar to a mammogram, but the technology is much more like a CAT scan where, instead of doing one image that goes through the issue, it’s a detector. What happens is we take multiple images as the X-rays are passing through on an arc.

And the primary benefit of this is what?

Dr. Schroeder: When you look at a 2-D image, you’re basically looking through all that tissue at once. When you look at a 3-D image, you’re gonna look at that tissue as a volume but you’re going to kind of look through that volume at one millimeter intervals.

Let’s say you have a room full of people. You want to find one person in that room. If you’re looking outside through a glass door, you may not see the person you’re looking for because they’re hiding behind someone or they’re superimposed over someone. Now imagine it, being able to open the door, go in the room, look side to side, look for your person, and go through that room at one millimeter intervals for the person you’re looking for. That’s what three dimensional imaging basically does. It’s able to see through tissue, particularly in patients that have dense breast tissue.  

What they’ve shown in the studies that have done, thus far, is that it’s a seven to ten percent increase in detection of breast cancer. And the call back rate of patients goes down 20 to 30 percent. The other thing is too even though you’re doing more X-ray images so there’s more radiation, the total radiation from the 2-D and 3-D is below the FDA requirements.

Does this replace 2-D or is it meant to supplement it?

Dr. Schroeder: Right now, every place I know that’s using it, the patient comes in, they get a 2-D image. Then, while they’re in compression, using that same angle, we do the 3-D image. We look at the 2-D and 3-D at the same time.

Who exactly needs to have 3-D mammography at this point?

Dr. Schroeder: If a patient has very fatty breast tissue, 3-D will help, but it will not help as much as someone who has very dense breast tissue. And typically that can be a patient with a fibril cystic condition, or young patients. The older you get, your breast tissue’s slowly replaced by fat. So usually, that 35-year, 40-year old patient is the one we see a lot with dense breast tissue that would probably benefit the most from this.

There’s some concern about costs and whether insurance will pay for 3-D.

Dr. Schroeder: Yeah, at this point, it is not reimbursed by insurance companies, as far as I know. What we do is we offer the patient, I believe, is 50 dollars for the 3-D portion of it. And if they want to have it, then they get it at the same time as their 3-D image. The 2-D, obviously, is reimbursed by insurance.

Dr. Jim Schroeder is a radiologist at Lake Pointe Breast Center in Rockwall.

For more information:

Video on Quality Standards for Mammograms

Video on 3-D Mammograms

Demo of 3-D Imaging

U.S. Library of Medicine on Breast Cancer

National Cancer Institute on Mammograms