3D mammography expands screening options

Oct. 01--Women have a new tool to consider for breast cancer screening.

Breast tomosynthesis, commonly called 3D mammography, is now available across the region, including centers in Corinth, Oxford, New Albany, Starkville and Tupelo.

"The 3D mammogram is kind of like watching a movie," said Tupelo radiologist Dr. Joanna Sadowska, who is fellowship trained in breast imaging.

The 3D mammograms use the same technology as larger CT scanners, collecting multiple images as the scanner moves in an arc. The breast has to be compressed in the same way for either 3D or traditional mammogram. The 3D mammogram takes a few minutes longer.

In the nearly 18 months the Baptist Memorial Imaging Center has used 3D mammography, they've seen a significant reduction in problems created by overlapping tissue, which can make benign structures look suspicious, said Oxford radiologist Dr. Todd Roth.

"It reduces a lot of call backs," Roth said, reducing the stress and anxiety for patients.

The technology has also helped the Oxford center identify a few more early cancers that would not have been visible on standard 2D images, he said.

Studies have shown it is most helpful for women with dense breast tissue. Dense breast tissue, which appears white in mammography images, can obscure the microcalcifications that radiologists look for as signposts of early abnormalities.

"I've seen benefits for women with all kinds of breast density," Sadowska said, "But the biggest benefit is in women with dense breasts."

Insurance coverage for 3D mammography is improving, Roth said. Medicare covers the use of 3D mammograms for screening, and BlueCross and BlueShield of Mississippi recently began covering the screening. It is more expensive because more images are gathered which take more time to analyze.

Women should talk with their referring physician about what type mammogram is best for them.

At Baptist Memorial Imaging in Oxford, all of the women coming in for mammograms are offered the option of 3D mammography.

"The majority are getting 3D," Roth said.

At the NMMC Breast Health Center in Tupelo, the center goes by whichever type of imaging study the referring physician indicates in his orders. Like other medical imaging studies, mammography requires a physician order.

Screening guidelines

The American College of Radiology, Society of Breast Imaging and American College of Obstetrics and Gynecology all recommend women of average risk for breast cancer start annual screening at age 40 and continue as long as they are in good health.

The U.S. Preventive Services Task Force most strongly recommends breast cancer screening every other year between 50 and 74 for women of average risk, because most breast cancers are diagnosed between 50 and 70. It recommends women in their 40s talk to their doctors about the benefits and risks of screening to make an informed decision about when to start.

Radiologists favor starting at 40 because while fewer women are diagnosed in their 40s, breast cancers found in younger women can be more aggressive.

All of the professional and advocacy organizations now stress the importance of women fully understanding the benefits and limits of mammographies and their own personal risk profile.

High risk

As part of its National Accreditation Program for Breast Centers process, the NMMC Breast Health Center has begun screening all women to determine their lifetime risk of developing breast cancer, Sadowska said.

The average risk for developing breast cancer over a lifetime is about 12 percent. Those whose family and personal health history indicates they have a 20 percent or higher risk of developing breast cancer during their lifetime are considered high risk.

For those at high risk, the National Comprehensive Cancer Network guidelines recommend a more frequent screening schedule, typically alternating between mammogram and breast MRI every six months. High risk patients also are referred for genetic counseling.

"We do a family pedigree and see if they meet the criteria for genetic testing," said Angie Taylor, a nurse practitioner certified in genetics who works with cancer patients at North Mississippi Medical Center Cancer Care.

Between Jan. 1 and May 22, the program identified 360 women as high risk and 80 requested genetic counseling.

michaela.morris@journalinc.com

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