By Kathy Finley, Director of Family Services at Concierge Care Advisors
Is it time for your next mammogram? Which kind should you choose? You mean there is more than one kind? I myself am overdue to have a mammogram done. So, when I saw an article in the Seattle Times about the new 3D mammogram, I did a double take. 3D you say? When you schedule your appointment or get to it, you may be asked if you want to upgrade to the 3D mammogram or tomosynthesis. Let me explain the differences and similarities of both:
Tomosynthesis and mammography are similar in that they’re both breast imaging techniques that are used to detect signs of breast cancer. They can both be used for annual exams and to check the progression of breast cancer.
Mammography is the process of using low-energy X-rays to examine the human breast for diagnosis and screening. It is a 2D image providing two views of each breast, one from top to bottom and one from the side. The goal of mammography is the early detection of breast cancer, typically through detection of characteristic masses or microcalcifications.
Tomosynthesis is an imaging or X-ray technique that can be used to screen for early signs of breast cancer in women with no symptoms. This type of imaging can also be used as a diagnostic tool for women that are having breast cancer symptoms. Tomosynthesis is an advanced type of mammography. A tomosynthesis takes multiple images of the breast. These images are sent to a computer that uses an algorithm to combine them into a 3-D image of the entire breast.
Both tests require that plates flatten out the breast to get the best overall picture of the breast tissue. Both use X-rays that contain radiation. Depending on which article you read they may have the same amount of radiation or more in the 3D testing.
Which test is better? Again, it depends on the article or advertisement and who wrote it. We are bombarded by medical advertisements on TV, the internet, newspapers and magazines. Typically, it is for the newest drug to help whatever ails you, followed by 46 contraindications of what can happen if you take that drug. It is now happening with detecting breast cancer. In this same article it was disturbing to see how much money and hype the manufacturers of this equipment will spend to upgrade you to the 3D mammogram. They are paying researchers, doctors and celebrities millions of dollars to convince you that the new technology is better. They are targeting a very vulnerable audience of women who are scared to death of getting breast cancer.
In 2017 a study estimated the one in three women with breast cancer detected by a mammogram are treated unnecessarily. There is concern that the 3D mammograms could make that problem worse by finding even more small, slow-growing breast tumors. Not all breast tumors are life threatening. Some grow so slowly that women would live just as long if they ignored them or never knew they were there. Finding these tumors often lead women to undergo treatments they don’t need. Some experts worry that patients who over-estimate their risk of dying from breast cancer are acting out of fear when they choose treatment.
Dr. Worta McCaskill-Stevens, a senior researcher at the National Cancer Institute asks “Can we say that 3D is better? We don’t know”. The American Cancer Society, Susan G. Koman and the US Preventive Services Task Force says there isn’t enough evidence to advise women on 3D mammograms. This is concerning since lobbyists were able to insure that private insurance companies in 16 states are now legally required to cover 3D screenings, Medicaid programs in 36 states. Medicare spent an additional $230 million on breast cancer screenings in the first three years of coverage.
When the Food and Drug Administration approved the first 3D mammography equipment, the agency required the technology to be safe and effective at finding breast cancer, not at improving survival. Diana Zuckerman, president for the National Center for Health Research stated that “The companies do the minimal research needed to get FDA approval, and that usually means no meaningful evidence of how it helps patients.” As one breast cancer survivor said “It is incredibly troubling that everyone has a different stake in all of this, and it all seems to be tied to financial gain.”
So, I still need to get my mammogram done. I think it is vital part of keeping healthy as we age. I am going to talk to my doctor and with my insurance company to see which of the 2 screenings are covered. Maybe I will have a choice and maybe I won’t. I will keep you posted.
