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Charlotte radiologists offering 3-D mammography

By Karen Garloch
kgarloch@charlotteobserver.com
Karen Garloch
Karen Garloch writes on Health for The Charlotte Observer. Her column appears each Tuesday.

Both Charlotte Radiology and Mecklenburg Radiology Associates, the two large radiology groups in Charlotte, recently announced their ability to offer digital breast tomosynthesis, also known as 3-D mammography, for breast cancer screening and diagnosis.

The procedure is relatively new, approved by the Food and Drug Administration in 2011. It’s not covered by insurance, and there are questions about when and why to use it.

As always with new technology, there are early adopters and those who prefer to wait and see.

Piedmont Medical Center in Rock Hill was first in the Charlotte area to offer 3-D mammography in October 2011. Two years later, it’s in Charlotte, where radiologists are enthusiastic about its advantages.

But Dr. Carol Lee, a New York radiologist and leader in the American College of Radiology, says there is reason for caution, especially because it requires two mammograms, instead of one, on each patient.

“Is this really something that is worthwhile in terms of the expense, the radiation exposure, the increased time that it takes the radiologist to do an additional study in everybody? I still think that has yet to be answered,” Lee said.

Here’s some background.

A 3-D mammogram is performed consecutively with a conventional two-dimensional mammogram, using the same scanner. There’s no noticeable difference for patients.

“The compression would be just a few seconds longer,” said Dr. Terry Wallace with Charlotte Radiology.

The advantage is that 3-D images allow radiologists to visualize multiple layers of breast tissue so they can better distinguish between normal and abnormal. Doctors believe this should lead to fewer false positives, return visits and unnecessary biopsies.

“It will lead to less anxiety for our patients,” said Dr. Nicole Abinanti of Mecklenburg Radiology.

Because a 3-D mammogram must be done with a conventional mammogram, the radiation dose for each patient is doubled.

A double dose is still below the FDA limit for traditional mammography, but some doctors are concerned about increases in radiation exposure overall. The annual radiation dose from medical procedures (not just mammography) has increased sevenfold from 1980 to 2006, according to a 2010 study.

Both Wallace and Abinanti downplayed concerns, noting that the radiation with 3-D mammography is less than a woman would get if she were called back for multiple tests after a questionable mammogram.

Wallace said the 3-D test is particularly useful in patients with dense breast tissues because “tomosynthesis unstacks the shadows and allows us to see the tissues at different levels.”

Breast tissue is both fatty and glandular. Fatty tissue shows up gray on a mammogram and is “easy to see through,” Abinanti explained. Glandular, or dense, tissue shows up white, the same as cancer.

Abinanti said she’ll recommend 3-D mammograms for all patients because she’s seen evidence that 3-D mammography has detected cancer in fatty tissue that wasn’t found on a traditional mammogram.

Cost may be a concern. Most insurance plans cover 100 percent of traditional mammograms, but they don’t cover 3-D mammograms. Charlotte Radiology will charge $50 at the time of service for patients who choose the 3-D test. Abinanti’s group hasn’t yet set the fee.

After eight hours of training recently, Wallace said he was surprised at the differences between 2-D and 3-D images.

“I was not sure what I thought about this technology initially. But I was very impressed at my training session. Having seen it first hand, I’m much more hopeful that it’s going to be a useful expenditure of radiation. Time will tell, as with all things.”

Patients should talk to their doctors about whether to have the additional 3-D mammogram, doctors said.

When I asked Lee, of the American College of Radiology, what she recommends, she said, “I can’t answer for any individual women.”

“I think there are some promising aspects to tomosynthesis,” she said. Studies have shown there are fewer false positives, but “in terms of cancer detection,” she said she’s not sure it’s better than conventional mammography.

“What I don’t like is to push this as, ‘There’s no question that this is better.’ I don’t know that that is necessarily true. … Would I have tomosynthesis? I’m not sure I would. Probably not.”

Garloch: 704-358-5078
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