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 cancer survivors in the United States.

What is Breast Tomosynthesis or 3D Mammography?

Breast Tomosynthesis, or 3D Mammography, is an FDA-approved imaging modality. Reader trials have shown Tomosynthesis 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 Tomosynthesis captures 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 minimally invasive 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 fellowship trained 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 fellowship trained 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 was 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.

How was 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 ultimately resulted in FDA approval of the technology in February 2011.

Which Hoag locations provide Breast Tomosynthesis?

Presently, this screening technology is offered at all our breast Hoag imaging locations. 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.

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.