Breast Tomosynthesis (3D Mammography) Q&A
Breast Cancer
How often should patients get screened for breast cancer?
Hoag Breast Center advocates the American Cancer Society’s recommendation
that beginning at age 40, all women should receive a screening mammogram
every year and should continue to do so for as long as they are in good
health. Women in their 20s and 30s should have a clinical breast examination
by a health care professional every three years, and women 40 and older
should have a clinical breast examination by a health care professional
every year.
Women at high risk for breast cancer – those at a greater than 20
percent lifetime risk (high risk) – should get an MRI and a mammogram
every year. The American Cancer Society recommends that the high-risk
screening program should begin at age 30 and continue for as long as a
woman is in good health; however, there is limited evidence about the
best age to start screening. Women who have been determined to be at high
risk should consult their health care provider to decide on the right
screening regimen for them, taking personal circumstances and preferences
into consideration.
Breast Cancer Statistics
- Breast Cancer is the most common form of cancer among women other than
skin cancer
- Breast Cancer is the second leading cause of cancer death in women after
lung cancer
- A woman’s chance of developing breast cancer increases significantly with age.
- A woman’s chance of developing breast cancer sometime in her lifetime
is approximately 1 in 8
- The chance that breast cancer will be responsible for a woman’s death
is about 1 in 35
- If detected in the earliest stages, the five-year survival rate for breast
cancer is 98 percent.
- Today, there are over 2.5 million breast cancersurvivors in the United States.
What is Breast Tomosynthesis or 3D Mammography?
Breast Tomosynthesis, or 3D Mammography, is a new, FDA-approved imaging
modality. Recent reader trials have shown DBT to be a more accurate method
for detecting early breast cancers in women with radiographically dense
breast tissue compared to traditional 2D mammography alone. Breast Tomosynthesiscaptures
15 digital “projection” images as it arcs over the breast,
during a short four-second scan. These images are then digitally reconstructed
into a series of high-resolution one millimeter slices that can be reviewed
individually or played back in a cine loop.
How is Breast Tomosynthesis (3D Mammography) different than traditional
digital or 2D mammography?
While traditional digital mammography is still one of the most advanced
technologies available today, it is only a two-dimensional picture of
the breast. Since the breast is often composed of pockets of dense tissue
surrounded by fat, when X-rayed, the image may be obscured. The overlapping
tissue in the image may result in difficulty viewing tiny “spots,”
called microcalcifications, and other subtle signs of early cancer. In
some cases, the radiologist may ask a patient to come back for a follow-up
examination such as a diagnostic mammogram to rule out any suspicious
areas. Breast Tomosynthesis allows radiologists to examine breast tissue
one layer at a time. Instead of viewing all the complexities of breast
tissue in a single flat image, the physician can examine the tissue one
millimeter at a time. Fine details are more visible, and no longer hidden
by the surrounding tissue.
Why is there a need for Breast Tomosynthesis or 3D Mammography?
While advances in 2D mammography (routine annual mammograms) have advanced
and it remains the gold standard for breast imaging for the majority of
women, new technologies continue to be explored and tested. According
to a study published by the Journal of the National Cancer Institute,
the need to diagnose breast cancer more accurately and earlier for patients
with dense breast tissue has increased because those patients are at a
higher risk for breast cancer. The study found that women with ≥50
percent breast density on mammographic study had triple the risk of breast
cancer compared with women who had <10 percent density.
Dense breast tissue and overlapping structures may lead to false positive
or false negative results during a traditional mammography. Breast Tomosynthesis
allows radiologists to detect many early stage tumors that cannot be detected
via 2D mammography, especially in women with dense breast tissue.
What other breast care services does Hoag Breast Center offer?
Hoag Breast Center provides leading-edge care including state-of-the-art
diagnosis and treatment, a wide-range of support services and educational
resources and minimallyinvasive breast biopsy, the gold standard in breast
biopsy. In addition, Hoag launched the first dedicated breast MRI system
and is also the highest volume provider of breast MRI, in Orange County.
Hoag Breast Center surgeons are leaders in oncoplastic surgery, an innovative,
breast-conserving surgical technique that allows curative breast cancer
surgery while at the same time conserving or even improving the cosmetic
appearance of the breast, resulting in optimal patient outcomes.
What is the difference between a dedicated breast center, like Hoag’s,
compared to an imaging center?
Hoag Breast Center provides a wide range of services to its patients. Hoag’s
multidisciplinary team consists of fellowshiptrained sub-specialized breast
radiologists, who are skilled in performing advanced imaging studies as
such tomosynthesis, as well as the latest techniques in minimally invasive
needle biopsy, which is the standard of care at Hoag Breast Center. In
addition, Hoag Breast Center team includes fellowshiptrained breast surgeons
who provide advanced breast-conserving surgical techniques including oncoplastic
surgery. Rounding out the team are technologists, medical and radiation
oncologists, pathologists, plastic surgeons, social workers, genetic counselors,
a certified breast care nurse navigator and a breast health educator.
Who is a candidate for Breast Tomosynthesis?
Breast Tomosynthesis (3D Mammography) helps detect cancers earlier and
more effectively than traditional mammography for women with dense breast
tissue. A patient can learn if her breasts are dense by asking her physician
or the radiologist who performs her routine mammogram. Women scheduled
for screening mammography at Hoag Breast Center in Hoag Hospital Newport
Beach will be evaluated, and if determined to benefit, will have their
screening exam performed using Tomosynthesis. There is no additional cost
for this test.
Approximately 75 percent of women in their forties have dense breasts,
and this percentage typically reduces with age – with 54 percent
of women in their fifties and 42 percent of women in their sixties having
dense breasts.
Do all hospitals or breast centers offer Breast Tomosynthesis?
No. Hoag is the first hospital in California and one of only a few in
the United States to offer this advanced imaging modality, as part of
its comprehensive breast imaging services. Hoag’s specialized breast
radiologists are experts in utilizing this modality and are some of the
nation’s leading experts in breast care.
Why/How is Hoag Breast Center one of the first to have Breast Tomosynthesis?
Hoag Breast Center was one of eleven test sites nationwide designated
to participate in the clinical trial for Breast Tomosynthesis, which began
two years ago and ultimately resulted in FDA approval of the technology
in February 2011.
Which Hoag locations provide Breast Tomosynthesis?
Presently, this screening technology is offered at
Hoag Breast Center
at Hoag Hospital Newport Beach and the
Hoag Imaging and Breast Center in Irvine (Woodbridge). Due to a generous grant from Circle 1000, a dedicated group of women
that have raised funds for Hoag Family Cancer Institute since 1987, Hoag
is pleased to offer breast tomosynthesis to Orange County women. In the
near future, Hoag will be extending this service to Irvine as well. As
with all mammograms, patients must first see their physician, who will
order a screening or diagnostic mammogram. As experts in breast imaging,
Hoag radiologists will be reviewing each patient’s order to determine
if they will benefit from Breast Tomosynthesis.
What can patients expect from a 3D Mammogram?
During a Breast Tomosynthesis (3D Mammography) exam, the X-ray arm sweeps
in a slight arc over the breast, taking multiple breast images in seconds.
Very low X-ray energy is used so exposure is about the same as that of
a traditional mammogram. Patients will likely not notice a difference
between breast tomosynthesis and a traditional digital mammogram exam.
Breast self examination (BSE) is an option for women starting in their
20s. Women should be told about the benefits and limitations of a BSE.
Women should report any breast changes to their health professional right away.
What are signs and symptoms of breast cancer?
Although mammography is generally the most effective method for detecting
breast cancers and other abnormalities at an early stage, it is not foolproof.
In addition, mammography is not routinely performed for screening purposes
until a woman reaches the age of 40. It is therefore important for women
to be aware of potential signs and symptoms of breast disease and breast
cancer and speak with their physician about any concerns during their
annual exam.
Women should consult their physician if they detect any of the following
breast conditions:
- A lump or breast mass
- Swelling of the breast
- Skin irritation or other skin abnormalities, such as redness or dimpling
- Breast pain
- Nipple pain or the nipple turning inward
- Nipple discharge other than milk
- Redness, scaliness, or thickening of the nipple or breast skin
- A lump in the underarm area
Note: The presence of any of the above symptoms does not necessarily mean
that a woman has breast cancer, however, it is important to follow up
with their physician, who can determine if additional evaluation is required.