The Promise of 3-D Mammography

Tomosynthesis gives clearer images of dense breast tissue, and can detect cancers that could be overlooked.

New breast screening technologies can find hard to detect cancers in dense breast tissue

New breast screening technologies can find hard to detect cancers in dense breast tissue.

Breast density is a strong risk factor for breast cancer, but 2D mammograms don't always show small cancers growing in women with dense breasts. New cancer screening technologies make it easier to find these cancers, and also help to reduce unnecessary testing.

More women are learning that they have dense breasts – but, have no idea what that means. Breast density is a very strong risk factor for breast cancer. The good news is that a recent study by the National Cancer Institute has found that breast density does not increase the risk of death in cancer patients. But, the trick is finding the cancer in that dense breast tissue. Doctors often recommend further screening for women with dense breasts and other risk factors. That's where digital tomosynthesis or three-dimensional (3-D) mammography can make a difference.

Tomosynthesis can find hard to detect cancers in dense breast tissue

Dartmouth-Hitchcock is a pioneer in 3D mammography. For nearly10 years, Dartmouth-Hitchcock researchers have been at the forefront of breast health, developing new breast imaging technologies to detect breast cancer and limit false alarms. "We were among the first in the U.S. to research tomosynthesis technology," says radiologist Steven Poplack, M.D., the director of breast imaging at D-H. "The academic medical center [DHMC-Lebanon] was one of five institutions that conducted clinical trials and contributed data that ultimately lead to Food and Drug Administration (FDA) approval."

D-H Brings 3-D Mammography to patients in Lebanon, Manchester, and Nashua

Digital tomosynthesis is considered one of the most significant advancements in breast imaging in nearly four decades. When 3-D mammography was approved by the FDA in 2011, Dartmouth Hitchcock Medical Center was the first in the state to use it to screen patients; it's now being used at D-H Manchester, and D-H Nashua. "We benefit from the research that was performed at DHMC," says radiologist Daniel Abbis, D.O., at D-H Nashua's Breast Health & Imaging Center. "Now, tomosynthesis is being implemented in more of our clinical practices." Radiologist Todd Noce, D.O., at D-H Manchester, agrees: "Most breast centers in the state don't have a collaborative relationship with a tertiary center providing expertise. D-H is ahead of the curve in getting this out to their patient population and using it to screen the appropriate patients."

Patients like Linda Burroughs know the benefits of tomosynthesis technology first hand. On the eve of undergoing a partial mastectomy, Burroughs was asked if she would be willing to join a D-H study on the latest breast imaging technology. She agreed, and the 3-D mammography detected the presence of cancer in her other breast; her doctor performed partial mastectomies on both breasts. "Another year," says Burroughs, "could have been too late for me." (Read full story.)

Dr. Poplack with Linda Burroughs, who participated in a D-H study on tomosynthesis

Dr. Poplack with Linda Burroughs, who participated in a D-H study on tomosynthesis.

Multiple x-rays are formed into 3D images that are cleaner and clearer

"The technology yields a cleaner, clearer image," says Abbis. "Tomosynthesis allows us to see through breast tissue better than traditional 2-D mammography; allowing us to see a small cancer that otherwise could easily be overlooked." The 3-D breast imaging is generally done in combination with a traditional 2-D digital screening mammogram exam; it uses a technology similar to CT scans. The imaging machine moves in a short arc, taking multiple X-rays that a computer forms into a 3-D image. "Imaging providers at D-H," says Abbis, "all have additional certification to interpret the new tomo studies."

For most women, 2-D digital mammography is still considered the current standard. D-H now offers 3-D mammography to those showing up for their first mammogram; to serve as a baseline, says Abbis. In addition to first-timers, 3-D is also beneficial to those whose previous test results weren't clear, and those with radiographically dense breast. Most radiologists predict tomosynthesis will eventually become the gold standard of breast imaging.

Reduced false positives: less anxiety and fewer additional costs

While there is a slight increase in radiation with 3-D exams, the benefits far outweigh the risks, says Dr. Noce. "It provides a better study, reduces the likelihood of additional imaging, and gives patients a definitive answer which means less patient anxiety. Since being implemented in mid-July, digital tomosynthesis has already reduced the number of mammogram callbacks. In Manchester, callback rates are below five percent; in Nashua they're now down to four percent. "That means patients don't have to come back, get more imaging, or go through a six month follow-up', says Noce. " It actually becomes more cost effective and more convenient; especially for patients with high deductible insurance plans who would have to pay for any additional tests or costs."

3-D Biopsy Available in Lebanon

"A key factor in a patients' prognosis is being able to pick up breast cancers very early, and digital tomosynthesis has been shown to do that," says Dr. Abbis. "What we're doing biopsies on now, is actually more often proving to be something of significance for patients. It's getting rid of a lot of the false alarms that many patients had encountered in the past."

When there's a finding on the 3-D image only, you generally need a specialized device to biopsy that finding. So, along with the advanced 3-D mammogram equipment, D-H also provides 3-D biopsies at the medical center in Lebanon. "In time that technology", says Abbis, "will hopefully be widely available at Community Group Practices across the D-H system." The new imaging tool improves biopsy technology in much the same way that tomosynthesis advanced mammography; it will be especially beneficial to women with hard-to-detect cancers.

Digital tomosynthesis and 3-D biopsy technology offer new hope in the fight against cancer. Along with the technology, Dartmouth-Hitchcock also has the largest, most comprehensive team of breast imaging specialists in the state. One in eight women will be diagnosed with breast cancer in their lifetime. D-H is committed to providing the most advanced technologies available for the early detection and treatment of breast cancer, as well as reducing unnecessary testing.

For more information on breast mammography and the 3-D technology available, visit Dartmouth-Hitchcock's Breast Health & Imaging site. Watch this video to hear the experts talk about the technology and benefits of 3-D mammography.

Fight Cancer in a Uniquely New Hampshire Way: Join the Friends of Norris Cotton Cancer Center's "Climb to Conquer Breast Cancer" on Mt. Moosilauke, on Sept. 28 and 29.

By Beth Carroll

September 16, 2013