A New Dimension
Battle Against Breast Cancer Gets a Better Weapon With 3-D Mammography
If you are confused about what to eat or what not to eat, what medical test to have or not have, you’re not alone. What is recommended by experts today may be taboo tomorrow. Consider the fact that for years, men were advised to get regular PSA tests to screen for prostate cancer while women were told annual mammography screenings were the key to early detection of breast cancer. But then headlines screamed of false positives and unnecessary biopsies and, once again, Americans were left to ask, “Should we or shouldn’t we?”
Annual mammograms have been credited with reducing deaths due to breast cancer by nearly 35 percent. But even with traditional two-dimensional (2-D) mammography, radiologists can still miss 15 to 20 percent of all cancers. And because the images produced through 2-D technology do not always provide a definitive diagnosis, women with suspicious findings may be forced to deal with the anxiety, cost and additional radiation exposure from follow-up screenings.
Part of the problem stems from the fact that women’s breasts vary in density, given their age, their weight and fluid retention. “Fats, cysts, fibrous tissue and glandular elements all add to breast density. For women with dense breasts, trying to find a tumor in a 2-D image is like trying to find an almond in a loaf of raisin bread by simply looking at the outside of the loaf,” says Dr. Peter Kremers, director of mammography and breast intervention for Frederick Memorial Hospital Regional Health System. “With 3-D, we can now look at each individual slice in the loaf to more easily find the almond (cancer).”
CLEARER PICTURE, BETTER DIAGNOSIS
In 2013, Maryland’s lawmakers mandated that patients with dense breast tissue be informed that they should discuss the possibility of additional screenings with their physicians. For these women in particular, better screening technology could improve their mammogram results.
Enter the new machine on the block. In a process called tomosynthesis, a camera moves around the breast in an arc to take two sets of 1-millimeter-thin sliced images of each breast. Those individual pictures (which total more than 160 for a bilateral breast exam) are then studied by the radiologists.
3-D technology gives us a view through overlapping breast tissue, we can identify small, early stage tumors, even in dense Breast tissue.
Kremers says the level of radiation exposure in 3-D mammography is the same as that for traditional 2-D screening. And because radiologists can construct 2-D images from the 3-D data, they can compare the patient’s previous 2-D mammographies with the new 3-D images without the need for additional radiation exposure.
“I tell my patients that getting a mammogram is the same as spending two weeks in Colorado in terms of radiation exposure,” Kremers says. As far as he’s concerned, the benefits far outweigh any risks. “Because 3-D technology gives us a clearer view through overlapping breast tissue, we can identify small, early-stage tumors, even in dense breast tissue. 3-D is not a perfect test, it still will not find all cancers. But it is a significant improvement over standard 2-D mammograms for many women.” In national and international studies, the technology has resulted in a 30- to 40-percent increase in the detection of invasive cancers and has reduced the call-back rate for additional screenings by anywhere from 20 to 30 percent.
The benefits of 3-D technology do not come cheap. 3-D tomography machines cost $400,000, compared to traditional 2-D machines that generally run about $80,000. Yet insurance companies typically only reimburse at the rate established for 2-D exams. In addition, because of the number of sectional images the 3-D technology creates, the amount and cost of storing 3-D data is also higher.
The Hurwitz Breast Cancer Fund, which has raised more than $1 million to fight breast cancer in Frederick County, helped purchase the highly technical software that Kremers and his fellow radiologists rely upon to assess breast density. The fund’s founder, Patty Hurwitz, is a breast cancer survivor and is pleased that the organization is helping to bring state-of- the-art technology to Frederick. “I believe the reason I have had a good outcome is because I was diagnosed very early,” she says. “So we want to bring the best diagnosis and treatment options to women in our community.”
Kremers and Hurwitz express frustration that insurance companies are still balking at covering 3-D exams. When you take into consideration the cost of call-back exams, unnecessary biopsies and other associated costs, “the cost-effectiveness of 3-D makes so much more sense,” Hurwitz says.
FMH currently charges $40 to cover the additional cost of 3-D screenings, but will waive the fee for Medicare patients. Therefore, those not covered by Medicare and whose insurance will not cover the extra expense of 3-D mammography must decide whether they want it or can afford it. Kremers points out that most breast centers charge all patients, including Medicare patients, anywhere from $40 to $60 for 3-D exams.
MONEY WELL SPENT
Knowing she has dense breast tissue, Marj Bernstein of Frederick didn’t think twice about spending the $40. It turned out to be a life-saving investment in her future. Kremers read her 3-D mammogram and discovered a tumor about the size of a baby pea. Assessed as Stage 1A cancer (the earliest stage of invasive cancer), the tumor was removed via lumpectomy and Bernstein will only have to go through a six-week course of radiation, with no chemotherapy at all.
“I’ve been telling everybody about my experience,” Bernstein says. She heaps praise on everyone at the FMH Women’s Center for Breast Care, from the radiologists and surgeons to the oncologists and “navigators” who help patients schedule appointments and manage their treatement. “When I was first diagnosed, I was asked if I wanted to stay in Frederick for my treatment or go down the road. I absolutely wanted to stay in Frederick,” she says.
Kremers reports FMH has seen 1,000 new patients since employing 3-D mammography and that over a five-month period, three-quarters of the dense breast patients in Frederick opted for a 3-D screening.
“Frederick has really stepped up to the plate to bring the best technology to our community,” Hurwitz says. “Sure, we could drive an hour to Hopkins or D.C., but who really wants to do that? We’re so fortunate that we have this here.”