Dr. Gary Levine
Breast cancer doctors are discovering what James Cameron has always known:
3D is the way of the future.
Traditional mammography saves lives everyday. But for women under the
age of 50 and older women who have dense breast tissue, the two-dimensional
images offered by mammography are limited.
Dense breast tissue can obscure the tiny, treatable tumors mammography
is meant to find: Only 50% of cancers are visible in traditional mammograms
of women with dense breast tissue. Dense tissue can also mimic a tumor
on a mammogram, leading to a high (and highly criticized) number of unnecessary
biopsies and anxiety for women who don't have the disease.
By offering three-dimensional images of the breast, a new technology called
tomosynthesis can help doctors like myself get a much clearer picture
of what is – or isn't – happening. Since the FDA approved
tomosynthesis technology in February 2011, Hoag became the only hospital
in Orange County to offer 3D mammograms commercially. Only four other
centers in the state offer the technology.
Now, instead of just having a 2D image of the breast taken at 90-degree
angles, we can take 15 projection images at one degree intervals to construct
a 3-dimensional mammogram of the breast. Think of it like a deck of cards:
Instead of just being shown the first card and being left to wonder what
else is lurking in the deck, you can now go through the entire deck, one
card at a time.
Of course, mammography is still the gold standard. Before routine mammography,
the diagnosis of breast cancer was almost a sure death sentence. The average
size of tumors was 4.5 centimeters, treatment was intense and disfiguring
and mortality was low. Since the mid-1970s, when routine screening began
to take hold, we've been catching cancers earlier and earlier –
most tumors now are less than a centimeter and completely treatable.
Mammograms are particularly useful for older women. As women age, their
estrogen levels drop and their dense, milk-producing glandular tissue
becomes fatty and easy to read on a traditional mammogram.
But for women under the age of 50 – and even a small subset of older
women whose breast tissue never grows fatty – very aggressive cancers
can be missed by two-dimensional mammograms until it's too late.
The greatest tragedy is when I see young mothers who develop breast cancers
that weren't detectable until they grew too large to successfully
treat. It's for this type of woman that tomosynthesis is really meant,
but I expect 3D mammograms to replace traditional mammography for all
women relatively soon.
The march forward couldn't come quickly enough: Another trend in mammography
is gaining steam, and this one terrifies me; the movement away from screening
Mammography is the only technology proven to save lives in the diagnosis
and treatment of breast cancer, but because younger women haven't
always benefited from the 2D technology, some so-called experts have come
out against mammograms and even self-exams.
We don't want to go back to that day in the 1970s when people nearly
always died of the disease. True, we'll be better off when 3D mammography
become the norm, but traditional screening has done a tremendous job saving lives.
I'm definitely a fan of the ""Avatar"" version
of mammography. But until 3D becomes more widespread, it's important
to remember that ""The Artist"" won the Oscar.
Dr. Levine is the director of breast imaging at the Hoag Breast Care Center?