Wednesday, January 1, 2014

Women: Is the 3D Mammogram Right for You?

In a word, NO.  That was rather simple and probably not fair and certainly out of my professional realm.   It's more appropriate for me to recommend that you think twice before having a 3D mammogram.  At this time, there is little evidence that the 3D scan is more effective at detecting cancerous lumps and reducing false positives on its own, though early results suggest it might be helpful at doing that when used at the same time as the 2D digital mammogram.  (Please see the linked article for a very interesting history on how the 2D mammogram replaced the Screen Film Mammography before research indicated that it should. spoiler: it never really did)

At this time, it makes more sense for women to continue with the usual, insurance covered (actually free because there is no copay for this covered preventative service) 2D digital mammogram.  At least one large clinical trial is currently underway to determine if the 3D scan, actually called Digital Breast Tomosynthesis or DBT is better than the 2D alone and whether or not the improvement is worth the extra radiation. The DBT is similar to a CT scan, which I have discussed in past posts. 

The reason I wanted to look into the 3D evidence is because for the last two years when I went in for my screening, I was asked by the imaging center staff - not my doctor - if I wanted the 3D scan.  It is not covered by insurance - its not free anyways.  The first year I asked why? Why would I want this type of imaging? I am pretty certain that the radiology tech told me that the 3D exam gives a clearer image and may reduce false positives (which appears to be true).  I then asked, "is there more radiation?"  The answer was yes so I declined this 'better' test.  This year, a few weeks ago, the image center receptionist asked me if I wanted the 3D scan and when I said NO without hesitation, I was told to read and sign a WAIVER form.  I was documenting that I was offered the 3D scan and declined it.  That was odd, so I asked, "Do you make people who agree to the exam sign a form too?"   She said yes, and I should have asked to see it, because the feeling I had at the time, as the patient, was that they were trying to scare me into getting an exam - without clinical indication and at extra cost to me.  Why would they do that?  I expect because the imaging center makes a profit from it.

I would like to see the results of a randomized clinical trial that compares the 2 types of mammograms. Based on my strong concern over radiation, I expect that even if the 3D comes out ahead, I will skip it... remember radiation is itself a cause of cancer.  That is my PERSONAL informed decision; you must make your own informed decision.

Click here to see a document listing what is known and unknown about this type of imaging to date.  It includes information on the large clinical trial that is still under way - The Oslo Screening Trial.

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