Early last winter, when Robyn Podany, of McGaheysville, Va., went for her annual mammogram at the Sentara RMH Funkhouser Women’s Center, the radiologic technologist asked her if she wanted a three-dimensional (3-D) mammogram, also known as 3-D tomography or tomosynthesis.
“I had extra money in my health insurance flexible spending account, so I said yes,” says Podany, 51, who had recently moved to the Shenandoah Valley with her job at the National Park Service.
Several days after her visit to the center, Podany was called back for a diagnostic exam using ultrasound. This type of callback, she says, was not unusual for her.
“I have small, dense breasts, and I always get called back for an ultrasound, so I wasn’t worried,” Podany recalls. “But this time the radiologist came in, and I said: ‘You’re a new twist to this scene.’”
The radiologist, Emily Ritchie, MD, told Podany that she had a small tumor. Dr. Ritchie went on to explain that it was a good thing Podany had the 3-D mammogram, because the tumor likely would not have shown up on a standard two-dimensional (2-D) mammogram.
Podany’s tumor was an aggressive type of cancer. By the time she had a needle biopsy a week later, in fact, the tumor already measured 2.8 centimeters (1.1 inches) in diameter, and another tiny tumor had started to develop as well. Fortunately, no cancer was detected in Podany’s lymph nodes.
“The 3-D tomography machine saved my life,” Podany says. “If I’d waited until the cancer developed to the point where I could feel it, it could have been much worse. It might even have gone into my lymph glands by then.”
Taking a Closer Look
Digital breast tomosynthesis represents an advance and extension of digital breast mammography, according to Scott Pease, MD, a radiologist at Sentara Martha Jefferson Hospital.
In a tomosynthesis exam, Dr. Pease explains, hundreds of very low-dose X-ray exposures are taken during a brief compression of the breast. The X-ray source moves slightly over the breast during this time, resulting in dynamic pictures that provide radiologists with 3-D views of the breast tissues—tissues that normally overlap in a traditional 2-D mammogram. In contrast to the two views of each breast provided by a traditional mammogram, tomosynthesis provides one picture per millimeter of compressed breast thickness, leading to much greater clarity in the image sequence.
Sentara Martha Jefferson has offered tomosynthesis since 2015. Sentara RMH has had the technology since winter 2015, so it was still new to the hospital when Podany had her exam.
“We’re catching more cancers with 3-D tomography,” says Dr. Ritchie. “And callbacks have tended to decrease in frequency, since, with many more images to view, it’s easier to distinguish tumors from normal, overlapping breast tissue—a distinction that is much more difficult with traditional mammograms.”
Several published studies, involving hundreds of thousands of patients, have shown that tomosynthesis imaging offers better detection of invasive breast cancer and ultimately fewer “false alarms,” compared to a traditional mammogram technique used alone, adds Dr. Pease.
The U.S. Food and Drug Administration (FDA) approved tomosynthesis for breast cancer screening five years ago. Before using the new technology, all of the radiologists at Sentara Martha Jefferson and Sentara RMH completed FDA-approved tomosynthesis training, which included intensive review of actual patient case examples.
Growing in Popularity
The word about 3-D mammography is definitely getting out, as more and more women are opting for the benefits of the newer technology.
“We’re always willing to answer questions about 3-D tomography,” says Candice J. Sadler, RT(R)(M), team coordinator of Sentara Martha Jefferson’s mammography services. “But we find that many of our patients are already well informed, so awareness about the technology seems to be growing.”
After discussing the differences between traditional mammography and tomosynthesis, Sadler finds that patients often decide to have the 3-D exam, rather than the 2-D.
“More of our patients’ physicians are ordering this exam now, too,” Sadler notes.
Dr. Ritchie is seeing similar interest in 3-D mammography at Sentara RMH. “It varies from day to day,” she says, “but about 50 percent of the mammograms I’m reading now are 3-D.”
Catching Cancer at the Earliest Possible Stage
In December 2015, Robin Donald, who works in central scheduling at Sentara Martha Jefferson, went for her annual mammogram. Like Podany, she opted for tomosynthesis.
“That’s when they found the cancer on the left side,” says Donald, 46, of Fluvanna. “I was shocked, overwhelmed and scared. It’s not what you anticipate hearing.”
Donald’s cancer was a ductal carcinoma in situ, or DCIS, which is considered the earliest form of breast cancer and is noninvasive, meaning it hasn’t spread out of the milk duct to invade other parts of the breast.
“My cancer was caught at the earliest stage, according to my surgeon,” says Donald. “I’ve always been regular with getting my mammograms, but I’m certain the tomography played a big role in catching it so early. I’m not sure it would have been found with a 2-D mammogram.”
Though Donald and Podany had very different types of cancer, both were important catches. Donald had a partial mastectomy, also known as a lumpectomy, followed by radiation therapy. Podany opted for a bilateral mastectomy with reconstruction, followed by chemotherapy. Thanks to the 3-D tomography option, both patients were able to get the surgeries and treatments they needed at an early stage.
Sold on Tomosynthesis
Dr. Pease believes tomosynthesis is an important advance for screening mammography.
“If a woman is called back from a tomosynthesis screening study, we often know fairly specifically where in the breast the questionable area is located,” he says. “Because tomosynthesis provides information more clearly than a standard 2-D screening study alone, in many cases we can proceed to a targeted ultrasound exam and skip additional diagnostic mammogram imaging.”
That’s what occurred in Podany’s case—her callback was for an ultrasound, and she got the diagnosis right away.
Podany is excited that the Sentara RMH Mobile Health Services van—the “mammo van”—also offers tomosynthesis, and that one of its monthly stops is at Shenandoah National Park headquarters, for the convenience of park employees. She has encouraged several of her colleagues to opt for the tomosynthesis exam.
“I can’t say enough good things about 3-D,” Podany says. “I’m very passionate about it.”