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Go Ask Mom

Explained: Should you get a 3D mammogram?

Posted November 10, 2014
Updated April 3, 2015

I turned 40 this year, a milestone that means it's time for me to start getting annual mammograms.

I knew I had to get one, but when I walked into the imaging center, the receptionist stopped me in my tracks with her question: Do you want a 3D mammogram?

I'd read about these at some point in the last year. Or, rather, I'd read the headlines about these in the last year that seemed to indicate they were better than the old standard, but I hadn't really delved into it. I hesitated when she told me that insurance doesn't cover the 3D test, so it would cost me an extra $50.

But, I bit the bullet and went all the way, thinking of all of the other things I'd rather buy for $50 as I donned that paper gown. Thankfully, everything turned out just fine.

So, after getting that 3D mammogram, I decided to do a little investigating to learn more about what it is and whether it's any better than the traditional mammogram that women have been getting for years. I figured a lot of Go Ask Mom readers would be faced with this same question as they walk in for their annual mammogram.

I checked in with Dr. Julie Taber from Raleigh Radiology at Rex Healthcare to learn more about the testing, which the Food and Drug Administration approved in 2011. It's been slowly making its way into doctor's offices and hospitals since then. Taber's office began offering the service in March. It's also offered through WakeMed, Duke Medicine and UNC Healthcare, among other places.

Breast tomosynthesis, which is what the professionals call 3D mammography, provides a better view of what's inside our breasts, Taber said. Traditional mammograms have consisted of four views from top to bottom and side to side.

The 3D version is kind of like a flip book - those books with a series of picture that slightly change from page to page so it looks like they are moving as you flip the page.

"The computer takes the information of the imaging and portrays it," Taber said. "When we look at the 3D, it looks like the top to bottom compressed. We use a toggle switch on the comptuer. You scroll through the top of the breast to the bottom and back up to the top. On a regular mammogram, all of that tissue is overlapping. You just see one image of the total breast. This takes each individual little slice.

"... We look at it almost like a video," she said. "We can pan back and forth through the breast, looking for masses, mass distortion and calcification."

The 3D views can make it easier to detect problems, especially in women who have very dense breasts, Taber said. Dense breasts are those made up of between 75 percent to 100 percent of breast tissue. The rest is fat. Heterogeneously dense breasts are made of 50 percent to 75 percent breast tissue.

"The information is all still there," she said of the traditional mammogram. "It's just compressed on top of each other."

Taber said there's no firm rule on whether patients should go the 3D route.

"It's hard to tell on the first go round whether you need a 3D mammogram or not," she said. But, she said, younger women typically have denser breasts than older women, especially if you're slim or generally don't have a lot of body fat.

If you're wondering whether you have dense breasts, North Carolina doctors must tell you. Starting this year, state law requires doctors to inform every woman who has had a mammogram about her breast density. I got a pamphlet in the mail after my mammogram.

Among radiologists, Taber said her colleagues are typically getting 3D mammograms.

"Everybody who is in this business, all of the mammographers, we have all been getting 3Ds if we have heterogeneously dense or very dense breasts," she said.

Indeed, studies have found that 3D mammograms are 40 percent better at picking up breast cancers, according to Duke Medicine. And they can result is as many as 30 percent fewer callbacks.

In other words, 30 percent fewer women are getting freaked out by phone calls from their doctors telling them that they might have something that looks like breast cancer. Those are real numbers.

"It is decreasing our call back rates and it is picking up more cancers in our patients with heterogeneously dense or dense breasts," Taber said.

The test takes about 10 minutes, not much longer than a traditional mammogram. I've heard horror stories of people experiencing painful mammograms as their breasts are smashed in the machine, but I had absolutely no problem when I got mine.

Of course, there can be drawbacks to new technology.

"At this time, right now, there is a little bit more radiation per study than what you would get from a regular mammogram," Taber said. "It's not significantly great, but it is greater."

And then, there is the money. Right now, insurance companies aren't covering the full cost of 3D mammograms, so doctors are charging to cover their costs. Taber said the equipment is much more expensive than what's used for traditional mammograms. It also takes doctors four to five times longer to read the results, she said.

Most insurance companies cover the cost of a traditional mammogram, but not the 3D mammogram. Doctors typically charge around $50 more for the test, said Taber, who pays that upcharge herself.

Taber said patients should talk with their doctor to learn more about 3D mammograms and whether it's a good idea to take the new test.

"It doesn’t replace certainly exams by your physical doctor and your monthly breast exams," she said. "Because even a 3D mammogram can be negative and you can still have a breast cancer. It’s pretty uncommon and we hate to see those. But it does happen."


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