July 1, 2021

Here’s what you need to know about the difference between 2D and 3D mammogram imaging for breast cancer screening.

If your annual mammogram is coming up, you may be wondering about a relatively new breast-imaging procedure referred to as 3D mammography (or tomosynthesis) that can enhance the ability to spot cancerous tissue. In 2011, the U.S. Food and Drug Administration approved usage of 3D imaging in combination with 2D imaging, which is the standard digital mammography for breast cancer screening. This new type of imaging is not approved to replace 2D imaging, instead, it enhances your screening’s precision.

We asked Reagan Leverett, M.D., a radiologist with the Vanderbilt Breast Center to explain what 3D mammography is and how it aids in breast cancer detection.

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What is the difference between 3D and 2D mammogram imaging?

With 2D mammography, the breast is compressed, and pictures are taken in two directions. “This results in overlapping tissue that may hide a cancer,” Leverett said. “However, 3D allows us to ‘slice through’ the breast, making thin sections, like on a CT scan. This decreases the overlap and makes it easier to see cancers.”

Additionally, the combination of 2D and 3D mammogram imaging has been shown to reduce false positives that require a patient to return to the clinic for additional screening, reports a recent JAMA study. “This may lead to decreased cost and anxiety for the patient,” Leverett said.

What can a patient expect when undergoing this combination of imaging?

Although some equipment can take the 2D and 3D mammogram pictures at the same time, reducing the screening period by a few seconds, other equipment may require taking the images separately. “The pressure on the breast is the same,” Leverett explained, “and both kinds of equipment produce good pictures.”

How can a patient advocate for the type of test they want?

If you want to get 3D imaging in addition to the standard 2D mammography, start by contacting your insurance company. Although most insurance companies in Tennessee are now covering 3D, not all are, Leverett said. If your insurance company will cover it, the next step is to ask for it at your mammogram appointment. At Vanderbilt, your clinician will not need any additional orders for a 3D mammogram.

Who should ask for 3D imaging?

“At Vanderbilt, we have determined that 3D is best for women who have dense breast tissue,” Leverett said. “But if the patient’s insurance is willing to pay for 3D, there is really no reason not to have it.”

Should a patient worry about not getting 3D imaging?

“No,” Leverett said. “A few additional cancers are found with 3D, but most cancers are found with standard 2D mammograms. The most important thing is to have regular mammograms. If you can also have 3D imaging, that’s even better.”

How often and when should patients get mammograms?

In the early stages of breast cancer, a patient may not present any symptoms of illness, according to the American Cancer Society. Regular mammograms are important to help detect changes or abnormalities in breast tissue so that if cancer is present it can be diagnosed early and treated appropriately.

Women 40 and older of average risk for breast cancer should get a yearly mammogram. If you have an increased risk, such as a personal history or a family history of breast cancer or have a genetic mutation known to increase your risk, talk to your physician about the potential need to start screenings at an earlier age.

The Vanderbilt Breast Center provides the most complete range of services for breast health in Middle Tennessee. The center offers screening, imaging at various locations, genetic testing, high-risk screening and breast cancer care. To make an appointment, call 615-322-2064.

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