Cedars-Sinai breast radiologist explains benefits of 3D mammography for every woman

Reviewed by James Ives, M.Psych. (Editor)Oct 9 2019

If it's October, it's Breast Cancer Awareness Month, when pink ribbons sprout up on everything from suit lapels to yogurt containers, reminding women to turn their attention to breast health --, especially mammograms.

As 3D mammography, also called digital breast tomosynthesis, has become more available nationwide, a big question many women face is whether they should step up and get one. Are they safe, more effective and for every woman?

The answers are yes, yes and yes, said Cynthia A. Litwer, MD, chief of breast imaging at Cedars-Sinai.

I recommend 3D mammograms for all women. They pick up more cancers because they're not obscured by dense breast tissue. That is true for all women, of all ages and all levels of breast density."

Cynthia A. Litwer, MD, breast radiologist

Litwer sat down with Cedars-Sinai's Newsroom to address the benefits of 3D mammography.

Newsroom: What is 3D mammography? How does it differ from the previous technology?

Litwer: In general, a mammogram is a low-dose X-ray that allows radiologists to look for changes in breast tissue. The gold standard in breast cancer screening has been 2D digital mammography, which takes two X-ray images of the breast, one from the top and one from the side. It identifies a large number of breast cancers, but its value is limited: The images are flat, making them more difficult to interpret because overlapping tissue can hide cancerous tumors.

3D mammography is an imaging procedure in which an X-ray moves in an arc over the breast, taking multiple images from different angles. The 3D pictures are synthesized by a computer into thin, 1-millimeter images, making it easier to see tumors. The radiologist reviews about 200-300 images with 3D mammography, compared to only four derived from a 2D mammogram.

Newsroom: What additional advantages does 3D mammography have over the 2D version?

Litwer: With 2D mammography, we sometimes have to ask patients to come back so we can get different images to confirm that no abnormality is present. With 3D mammography, that occurs less often. Studies have shown that since the advent of 3D mammography, the number of patient callbacks has decreased by 15%-30%.

Newsroom: Is the 3D mammogram procedure the same as 2D mammography?

Litwer: The breast is positioned and compressed the same way in both procedures.

Newsroom: Who should get 3D mammograms, and at what age should they start them?

Litwer: All women should get them, especially if they have dense breasts; about 50% of women do. The availability and popularity of 3D mammography have grown notably since the Food and Drug Administration (FDA) approved it in 2011.

Yearly screening should start at age 40 for patients with an average risk for breast cancer. Women with a gene mutation such as BRCA 1 or BRCA 2, or those with a strong family history of breast cancer, should consult with their physicians-but normally we recommend they get their first 3D mammograms at age 30.

Newsroom: Do women have to worry about false positive results with 3D mammography?

Litwer: False positives in breast imaging occurs when a mammogram shows an abnormal area that turns out not to be a cancerous growth. With 2D mammography, 1 in 10 patients is recalled for something that may look suspicious and thus requires additional imaging. With 3D mammography, that happens less frequently.

Newsroom: How much more radiation is used with 3D mammography compared with 2D mammography?

Litwer: When 3D mammography is performed with 2D imaging-and many facilities still do that-the amount of radiation is increased. The amount, however, is still within FDA-approved limits. 3D mammograms alone provide an excellent overview of the breast without additional radiation.

Newsroom: How available are 3D mammograms?

Litwer: Many doctors' offices in the U.S. and Europe have 3D mammography equipment. About half of the U.S. certified breast imaging centers offer it.

Newsroom: Do 3D mammograms cost more than 2D mammography?

Litwer: They cost about $60 more.

Newsroom: Does insurance cover 3D mammography?

Litwer: It is pretty widely covered by commercial insurance providers, Medicaid and Medicare. Check with your insurance company before your procedure. Imaging centers can assist with insurance issues.