To detect cancer, a 3D mammogram is better than a 2D mammogram
Here’s a medical fact that should be uncontroversial: the better your mammogram, the more likely you are to beat breast cancer.
Indeed, detecting breast cancer is among the most important health challenges of our time. Why, then, aren’t more health insurers covering breast tomosynthesis, commonly known as 3D mammography?
Here’s what we know. Early detection is the best defense against breast cancer. Yet even digital mammograms offer only a two-dimensional picture, which means your doctor may miss your deadly cancer legion or see one where none exists (a false positive).
3D mammograms were developed to conquer these limitations. They allow the radiologist to examine breast tissue layer by layer. When screened this way, fine details become significantly more visible.
Some say that 3D mammograms are still experimental or investigational. On the contrary, they were approved in 2011, and have since been widely adopted around the country. Last year, of the 35 million women in the U.S. who were screened for breast cancer, 10 million underwent a 3D mammogram.
What’s more, the clinical results are consistently clear. Data published in hundreds of peer-reviewed publications reviewed 750,000 exams. The numbers speak for themselves: 3D mammograms reduce false positives by up to 40 percent; detect invasive cancer more accurately by 41 percent; reduce the need for a diagnostic mammogram by up to 37 percent; and strengthen the positive predictive value of a biopsy.
As a result, costs for patients, insurers, employers are lowered; recalls are reduced; and cancer is detected earlier.
Still, some insurers remain unconvinced. They ask, “Does the data stand up over time?” It does. Just last month, the University of Pennsylvania published a large, longitudinal study in JAMA Oncology. (This is the fourth independent study of its kind.) Not only did 3D mammograms dramatically decrease the number of callbacks for unnecessary follow-ups, this breakthrough was also sustained over time. At my institution, the results are not only sustained, but continually improving over time.
The study found the same pattern for the detection of invasive cancers: on average, these killer cancers were identified 15 months earlier.
This last finding is critical. The earlier your cancer is detected, the longer you live and the less costly your treatment will be. Put another way, 3D mammograms create a substantial reduction in time, anxiety, and expense for women, and a significant savings in cost for our healthcare system.
The good news is that some women in Connecticut already enjoy these benefits. That’s because they’re covered by Medicare or Connecticut Medicaid. Those with private insurance are not so lucky.
That can change — with your help. Just last week, the Connecticut House of Representatives passed H.B. 5233, in an overwhelming vote of 139-3. With only a few days left this legislative session, it’s now up to the Senate to pass this important piece of legislation to require health insurance coverage for tomosynthesis in Connecticut.
If you believe women in Connecticut deserve the most advanced mammograms, please call and email your senator today and tell them. Let them know that when it comes to cancer, you and your loved ones deserve 3D over 2D.
Liane Philpotts, MD, is the Chief of Breast Imaging at Yale University’s School of Medicine. She wrote this op-ed on behalf of CT4BreastHealth.org, which is included among the sponsors of this website.
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