by Rhonda Veenhuis
After every annual mammogram Jamie Jones has been called back for further testing. That is, until this past October.
“Although I’ve gone through it before, I’ve been scared every time,” said Jones, 45, who has ‘dense’ breast tissue.
Oftentimes, when radiologists see unclear or questionable areas on mammogram results, they have the patient come back for additional exams. Call backs can be more common for women with ‘dense’ breasts, where overlapping tissue makes it harder to see early signs of cancer or other breast problems.
Each time Jones returned for additional testing, it caused her a great deal of anxiety, as it does for most women who are asked to return. Although her results ultimately turned out fine, being ‘recalled’ took more time, and added cost and stress.
The Search for 3D Mammography.
This time, Jones specifically sought out a facility that offered digital breast tomosynthesis, also known as 3D mammography.
Jones learned about 3D after her mother’s recent diagnosis of breast cancer, which was detected with 3D at a center in Kansas City, where her mother lives. Jones learned the test offered physicians more detailed images of the breasts, enabling smaller cancers to be detected.
She looked to find 3D in St. Louis; the place she normally went did not have it. Jones even considered making a special trip to Kansas City, as she was determined to have her mammogram with 3D, especially now that she had a ‘family history’ of breast cancer.
Then, the mother of her daughter’s best friend told her that the Breast HealthCare Center at Missouri Baptist had the technology.
The Breast HealthCare Center started offering 3D for screening mammography last September. Since January 2012, they had used the technology with diagnostic mammography to make sure it really offered benefits.
What is 3D Mammography?
3D mammography is a relatively new technology, approved by the FDA in 2011. It takes a series of 15 images in an arc within four seconds. These thin cross-sections allow radiologists to examine breast tissue layer-by-layer.
Clinical trials in the U.S. and Europe have shown that breast cancers often are better seen in 3D because of improved resolution and visualization.
Linda Proctor, MD, a Breast HealthCare Center radiologist said their entire mammography physician team agrees. “With 3D images we can look at breast tissue one layer at a time, and find masses that might otherwise be hidden. While there is no perfect test, this is an important new tool in our arsenal for the fight against breast cancer.”
Missouri Baptist is one of only a few hospitals in the state to offer 3D. Women who come for their yearly screening are given the option of adding 3D to their mammogram.
An elated Jones said of her October test, “This was the first time I did not have to be called back.” Her test showed that nothing abnormal was detected.
Another strong reason Jones wanted 3D was that her mother had a regular mammogram and was told she was fine. Shortly thereafter, her mother was asked by her breast center if she would be willing to be one of the first in her area to test the 3D technology.
“Since my mother has dense breast tissue, like I do, they told her she’d be a great candidate for the study,” said Jones.
Jones’ mom felt she wanted to help with the study, even though she’d recently had her annual.
Jones said, “God was on her side. If she had not done the study, we’d be singing a different tune.”
A very aggressive, small, early stage cancer was detected that physicians could only see with the increased visualization of 3D.
A TINY CANCER FOUND.
A retired nurse, Phyllis Jackson has had her annual mammogram every October for many years.
This time, she saw the information about 3D and asked the front desk more about it.
“For $20, why wouldn’t I have that! I go shopping and spend that,” said Jackson, 76, who said she would have been willing to pay even more for the breast screening if she’d had to.
Jackson now believes it was a spiritual thought guiding her, as well. While she had never previously been called back, this time she received different news.
“I feel very lucky. The 3D may have been the thing that saved my life. What if I hadn’t done it?”
A very small cancer was detected and Jackson since has had a lumpectomy and will undergo a very brief course of treatment, since the cancer was detected so early.
More Details on the Exam.
Missouri Baptist began offering the optional 3D (which is added to a regular mammogram) for screening mammography in mid-September 2013 for the additional fee of only $20, payable at one’s screening.
The small fee helps cover the increased time radiologists must spend reviewing the 3D image. While most insurance plans and Medicare continue to pay the established rates for mammograms, there currently is no additional reimbursement for the 3D part.
Dr. Proctor said that the Breast Center’s radiologists had specific training to become expert with the new technology.
Jones said, “I had no problem at all paying the $20. I would have been willing to pay more.”
The 3D exam itself is similar to a traditional mammogram and, from the patient’s perspective, takes approximately the same length of time.
Both Jones and Jackson said they did not notice any difference during their screenings with the added 3D.
More about 3D Mammography.
With 3D, patients benefit in several ways:
- The 3D technology helps doctors find smaller cancers sooner.
- 3D is especially important for dense breast tissue, because it allows doctors to examine breast tissue one layer at a time, versus a regular mammogram where overlapping tissue can make it hard to see signs of early stage cancer.
- It’s also proven to reduce call-back visits for additional testing when results have been unclear, because with 3D doctors have the ability to better see the fine details.
It Takes a Team.
Many ob/gyns at Missouri Baptist have been quick to champion the new technology.
Mary Elizabeth Mani, MD, is Jackson’s ob/gyn, “Since 3D digital breast tomosynthesis is relatively new, I explain to patients its usefulness in routine screenings,” she said.
“I particularly encourage women with a family history of breast cancer or dense breast tissue to add the 3D to their mammogram screening.”
“When I go for my annual mammogram, I plan on adding 3D as well,” said
Dr. Proctor said, “I will absolutely get a 3D mammogram when having mine.”
Dr. Mani echoed that her patients’ anxieties are definitely reduced with decreased recalls, and more importantly, can help radiologists detect more subtle cancers.
Missouri Baptist’s oncology physicians also are strong believers in the 3D technology.
Deborah Wienski, MD, a medical oncologist at Missouri Baptist Medical Center, is all for 3D mammography. She knows that early detection of any cancer enhances the odds for successful treatment. In fact, if breast cancer is detected early enough, the five-year survival rate is 97 percent.
She describes the 3D technology as helping radiologists detect early stage or smaller cancers by allowing them “to see the individual trees through the forest.”
Jackson said, “We have a family history of various cancers on my dad’s side. I told my daughter she has to do 3D from now on!”
Jones said her husband is happy, too, about 3D because each year he had to “hold my hand” through the anxiety of needing further testing. With three young daughters and a family history of breast cancer on both her and her husband’s side of the family, Jones is glad technology is advancing and can only imagine what it will be by the time her daughters need mammogram screenings.
Mary Elizabeth Mani, MD, is a board-certified ob/gyn on staff at Missouri Baptist Medical Center. She received her medical degree and completed her residency in ob/gyn at St. Louis University School of Medicine.
Linda Proctor, MD, is a board-certified radiologist on staff at the Breast HealthCare Center at Missouri Baptist Medical Center. She received her medical degree from the University of Pennsylvania School of Medicine, Philadelphia. She completed her internship in medicine at Pennsylvania Hospital in Philadelphia and her residency in diagnostic radiology at Mallinckrodt Institute of Radiology, St. Louis.
Deborah Wienski, MD, is board-certified in internal medicine and oncology, and is a medical oncologist on staff at Missouri Baptist Cancer Center. She received her medical degree from Tufts University School of Medicine, Boston, and completed her internship and residency at the University of Rochester in New York.