Significant step in breast cancer detection
It can take a big emotional toll on a woman when she gets a call after a mammogram screening and is told something suspicious was found and she needs to come back in for a diagnostic mammogram. Even if the diagnostic mammogram shows there is nothing to worry about, the woman has still had the anxiety, cost and hassle of being called back.
Since November 2011, many rural women in north Arkansas and south Missouri have been spared those call backs. Baxter Regional Medical Center in Mountain Home has become the first healthcare provider in Arkansas and Missouri to offer cutting-edge 3-D mammograms that greatly decreases the number of women who have to come back for a diagnostic mammogram.
“We encourage everyone doing mammography to seriously consider adding this technology,” said William Landrum, MD, chief of radiology, Baxter Regional Medical Center. “This is such a significant step in breast cancer detection. It is making a big difference. We have found cancers we didn’t expect to see based on 2-D mammograms, and we have saved a lot of women the anxiety and expense of having to come back for diagnostic studies.”
The technology doesn’t replace 2-D, but is a powerful supplement that increases the accuracy of the mammograms. It takes just three seconds longer to add 3-D to the 2-D x-ray. The 3-D mammography allows radiologists to have a more comprehensive, multidimensional view of breast tissue that allows for the earliest detection of breast cancer possible.
Landrum said they are using 3-D mammograms on every patient because they think the new technology is so much better than 2-D mammograms alone. Women still get the 2-D mammograms, but then a second 3-D exposure is taken while the breast is still compressed.
“The real power of this is it substantially reduces call backs, which can be considered false positives,” Landrum said. “It allows women to feel good and not have to come back. We can give them a definitive negative mammogram for screening and not need them to come back for additional workup. That saves a lot of anxiety.”
They are also increasing the accuracy of catching the cancer at it earliest possible stages. Landrum said they have had cases where the cancer is invisible on 2-D, but shows up on 3-D. The 3-D technique allows radiologists to see through dense tissues that are hard to cut through without a heavy radiation dose.
Landrum said breast imaging with 3-D tomosynthesis provides exceptionally sharp images of the breast, helping radiologists identify and characterize individual breast structures without the confusion of overlapping tissue. The device takes multiple successive images, each at a slightly different arc across the breast. The data is processed by a computer similar to a CT scanner, producing 1 mm cuts through the breast tissue. The images are viewed on a computer monitor.
The FDA has a maximum of 5 millisieverts of radiation allowed with a mammogram. Landrum said 2-D mammograms are 3 millisieverts and adding 3-D increased that to 4 millisieverts – still below the maximum allowed.
Right now the technology is so new that payers like Medicare and insurance companies haven’t decided on a reimbursement. For now, the professional fee that the radiologist charges is the same as before.
Later this year, it is expected that payers will decide on reimbursement.
“It will probably come in a little higher than 2-D, but not a great deal,” Landrum said.
Diagnostic 2-D mammograms are customized by radiologists to determine whether something found on the screening mammogram is a concern, and radiologists will frequently order a breast ultrasound, as well. But 3-D offers far more detail with up to 600 views of the breast possible that the radiologist can scroll through to answer any questions. That compares to only four views of each x-ray taken with 2-D mammography.
The response by patients to 3-D has been excellent.
“Women like it a lot,” Landrum said. “When we talk to patients, we show them what we would normally be concerned about on the 2-D, but in 3-D, it shows there is nothing to be concerned with. Radiologists like it because it increases our confidence in telling a woman no problems were found, and they can go ahead until it is time to come in again in a year.”
The other thing unique about Baxter’s 3-D mammograms is that the hospital is the initial pilot project for doing this technology in a mobile service. They are working on building a bus that will make the mammogram machine mobile.
“We think we will be the first in the world to have the mobile 3-D study,” Landrum said. “This truly is bringing very advanced new technology to rural areas of Arkansas and Missouri.”