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Melanie Cole (Host):  One in eight women is diagnosed with breast cancer in the United States each year. Annual screening mammography remains the best tool for early breast cancer detection. Today, 3D mammography is a new tool in the screening discussion. My guest today is Dr. Lisa Schneider. She is the co-medical director and radiologist with Piper Breast Center, part of the Virginia Piper Cancer Institute. Welcome to the show, Dr. Schneider. Tell us about the recommendations as they stand now for annual screening mammography.

Dr. Lisa Schneider (Guest):  The recommendations for annual screening mammography are based on the American Cancer Society guidelines, the American College of Surgeon guidelines, and the American College of Radiology, and it should be starting at age 40 and every year thereafter. Every woman should start mammograms at age 40 and have one every year thereafter as long as she enjoys good health. 

Melanie:  Typically, a mammogram, those of us that have had them know they are not scary. They don’t hurt that much, they go very quickly, and they’re so important. What’s going on in the world of mammography that’s changing a little bit for us? 

Dr. Schneider:  Well, we have the latest and the newest generation of mammography right now, also known as 3D mammography or digital breast tomosynthesis, sometimes DBT because digital breast tomosynthesis is a mouthful. It is, like I said, the latest generation mammography and it takes tiny little slices of the breast. Instead of just two images of the breast, we get multiple images throughout the breast and we can look at the breast like a computed tomosynthesis exam, like a CAT scan almost, in that we can uncouple those images and look down at each little slice of the breast. 

Melanie:  How does that differ from what we’ve previously been doing with 2D mammography? 

Dr. Schneider:  Well, 2D mammography is the standard of care and it is the only screening modality that’s been shown to decrease the breast cancer mortality rate. It creates two images, two side images of the breast and in 3D, what happens is an x-ray machine will arch over the breast and take multiple little slices of x-rays through the breast to allow the radiologist sitting at their work station to uncouple each little slice and look at each little slice through the breast individually. 

Melanie:  Wow, that’s really fascinating. Are there any differences to the woman getting a mammogram? Would she know the difference? 

Dr. Schneider:  From a patient perspective, she should not notice any difference. She will still be compressed the same way, a little gentle compression in two views. The machine, she will notice, will just arch over her. She will still be getting a standard 2D mammogram. In addition, the machine will take the little thin cuts through her breasts and she may be compressed instead of for three seconds, her breasts may be compressed for seven seconds. From her standpoint, she will notice no difference. 

Melanie:  Is there a reason why a woman wouldn’t want this? Is this now going to be, in your opinion, the standard of care? Is insurance getting on board with it? 

Dr. Schneider:  Right. Those are all great questions. There are a few reasons a woman may not want to get it and it mainly has to do with cost. Not all insurance companies are covering it at the moment. The Centers for Medicare and Medicaid Services or CMS is covering 3D mammography but some insurance providers haven’t updated their policies to adapt to this change. We urge all women before they consider this technology to check with their insurance providers to see whether it isn’t covered.  As a healthcare professional, I’m optimistic that this improved technology is going to be covered more thoroughly in the future. I do believe this will be the standard of care in the future.

Melanie:  Tell us about some of the other benefits of having the 3D mammography and why you, as a physician, would really want women to be using this tool.

Dr. Schneider:  Right. The main reason is we are finding breast cancers earlier with this technology. We’ve done great studies in Europe and in the United States that show that we are having about 40 percent increase in our cancer detection rate. That’s really enormous when you consider a large population study. The other benefit of this technology is that we’re recalling women less frequently. Not uncommonly, about five to 12 percent of the time, when a woman has a mammogram, she’ll need to come back for additional images or additional views, those so-called false positive. With additional breast tomosynthesis or the 3D mammography, we’re showing that there’s a decreased rate in that recall, about 15 percent less chance of being recalled for additional images. 

Melanie:  We all know how we hate that waiting and that phone call that says you have to come in and have additional images. It’s quite a scary phone call so if this reduces the need for that, I think all women would be relieved by that. 

Dr. Schneider:  Absolutely. Quite frequently, we do need to call women back because we’re not sure if there’s something there or is it just the tissue overlapping. This technology, particularly women with the denser breasts, is probably going to show that this is going to alleviate a lot of that stress and anxiety. We have improved delineation of the margins and we’re just a lot more confident when we look at that mammogram particularly, as I said, in a woman with dense breast.  

Melanie:  You brought up dense breasts. How is this going to help with that? Because we all know, and I have them myself, so I know that I’ve been told it’s a little bit more difficult to get a good, accurate picture and so I have to make sure to do my yearly and my self-exams. Is the tomosynthesis going to help you see better if we have dense breasts? 

Dr. Schneider:  I believe it will. So far, tomosynthesis has been shown to be beneficial in that increased cancer detection rate in all women, not just women with dense breasts, but women with sturdy breasts. We do have ongoing trials right now looking at that very issue. I think it is trickier with the standard 2D mammogram in women with dense breasts. We have all this tissue overlap and it’s harder for us to uncouple and look at each. Is there a shadow there? Is there truly something there? For these women with dense breasts, I’ve seen some great examples and totally how the cancer just showed up [beautifully] on a digital breast tomosynthesis where I would have never picked it up on a standard 2D mammogram. 

Melanie:  Do you feel that most hospitals are now taking up this tool or you’re still seeing it scattered? 

Dr. Schneider:  It is really scattered right now. A recent survey by the Society of Breast Imagers show that it’s about, in the Coast, 20 to 30 percent of places offer this examination. In the Midwest, it’s still lagging behind a bit. I’m still really fortunate working in a center that they have this technology. 

Melanie:  Allina Health does have 3D mammography. 

Dr. Schneider:  We do. We offer 3D mammography at three breast centers: at the United Breast Center in St. Paul, at the Piper Breast Center at Abbott Northwestern in Minneapolis, and the Piper Breast Center at West Health in Plymouth. 

Melanie:  That’s excellent for women to hear and it’s very reassuring to hear from you, Dr. Schneider, that this is another tool in the toolbox to help detect breast cancer early. Are we still recommending self-exams? Tell us just a little bit about that. 

Dr. Schneider:  Well, we are still recommending self-exams. The United States Preventative Task Force Study is not recommending self-exams anymore, but as a healthcare provider, and I work on the frontline every day with women with breast cancer and women with newly diagnosed breast cancer, I believe it is in no one’s detriment to be familiar with your body to do a self-breast exam once a month or once a year and then have your healthcare provider do a breast exam once a year as well. Women frequently will pick up on something subtle and they notice there’s a change and they ask on that and if they ask on it sooner, if it is a breast cancer, they have a lot better outcomes if detected early in terms of treatment options and survival options.

Melanie:  As we’ve heard that now things like Pap smears are not necessarily recommended every year, there was some controversy with mammograms. What’s going on now? You mentioned about screening at the very beginning of the segment. Is this still really the standard recommendation? Is it changing, do you think? 

Dr. Schneider:  Well, I think it was in 2009 that the United States Preventative Task Force Study recommended that women start undergoing mammography at age 50 and then every other year. They said the age group between 40 to 49 should undergo it once they’ve discussed it with their physician. At that time, what was the current recommendation is all women should start screening mammography at the age of 40 and thereafter annually. It really threw a monkey wrench into the recommending guidelines at that time. However, the American College of Radiology, the American College of Surgeons, and the American Cancer Society at that time in 2009, stood firm and said, “No, we still believe this is a good screening tool because it has decreased the mortality rate. We still recommend having this exam once a year starting at age 40.” Now, later this year, the United States Task Force, they are going to be issuing new and updated guidelines. I’m hopeful they’ll get it right this time.  

Melanie:  That’s great information. In just the last minute, give your best advice to women who are maybe afraid to get that first mammogram and really what you want them to know about 3D mammography. 

Dr. Schneider:  Sure. I urge all women again, starting at the age of 40, to start your mammogram. Don’t be afraid. You should know that mammography, be it 3D, 2D, whatever it is, it’s heavily regulated by the government and there are high, high standards that every center has to meet in order to even have their doors open. You’re already well taken care of and high standards exist the second you walk in that door. If you are a little bit apprehensive or nervous, tell your technologist. These are women that do screening mammography all day long. They’re used to dealing with nervous patients. They’re used to dealing with anxious patients. Then if you really want to push it a little bit and you want your results right away, ask the technologist. Say, “Is there a radiologist on site who can perhaps read my exam and give me my results? I’m willing to wait a little bit.” If not, perhaps later in that day, if you want the technologist could ask the radiologist the result and then call. I think that will help cut the anxiety and the worry. 

Melanie:  Certainly, it can be nerve-racking but it’s well worth it for early detection, better treatment options. You are listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.