Most of us know that early detection of disease allows for the best possible health outcomes. In the instance of breast cancer, The American Cancer Society reports that the death rate from breast cancer was on the rise until the advent of widespread mammogram screenings in 1990. According to the National Center for Health Statistics, the death rate from breast cancer has decreased by 34 percent between 1990 and 2010 in the United States.
Over these many decades, improvements in imaging technologies has taken the mammogram from a diagnostic tool in its infancy to high powered three-dimensional images used for routine screening for the earliest signs of breast cancer. Standard x-rays were the predecessors to mammography as far back as the early 1900s. Around the 1960s in the U.S., technologies developed for aerospace engineering that offered high-resolution imaging began to pivot to medical applications.
At its essence, mammograms are low dose X-rays of the breast that can show healthcare providers images of the breasts for evaluation. Mammography machines are designed to flatten or compress the breast between two plates to maximize the effectiveness of the x-ray. Earlier mammography presented the images onto film that was developed and reviewed by radiologists. These physicians would examine films to look for irregularities in breast tissue, specifically masses and calcifications. These findings are sent back to the referring physician with a detailed report.
Over 10 years ago, many mammography centers converted from film to digital technology that offered several advantages over film. Digital mammograms use less radiation and the images have better picture quality. Digital images are easier to manipulate on a computer and views can be magnified and enhanced to make more accurate assessments. These enhancements are especially helpful for women with dense breast tissue.
Additionally, storing and transferring images to patients’ medical records is far more streamlined with digital over film.
The latest advance in mammography is called tomosynthesis or 3D mammograms. Unlike the standard two-dimensional images, 3D takes multiple images from the top and side view and layers these images, and radiologists are presented with a three-dimensional image to analyze.
3D images capture more views and improve the likelihood of accurately diagnosing potential cancers. Additionally, greater accuracy can reduce the number of call-backs for additional mammograms, lessening worry on the part of patients. A woman will not notice any difference between the standard 2D and newer 3D mammogram. In both instances, a technician will flatten the breast between two plates and each one requires two views, one from the top and one from the side.
As tomosynthesis becomes more accessible, it may soon replace conventional digital mammograms and become what is called the standard of care. Currently both Medicare and Medicaid are allowing coverage for 3D mammography and these two insurers tend to set the customary coverage for other commercial insurers. Some insurers may cover the 3D mammogram but will assess an additional co-pay or patient paid cost.
Mammograms fall into two categories: diagnostic and screening. A diagnostic mammogram occurs when a woman is referred because she has any symptoms with her breast including lumps, pain, and nipple discharge, among others. A diagnostic mammogram may also be required as a follow-up to a screening mammogram if any abnormalities are detected.
A screening mammogram is performed on women with no symptoms or signs of breast cancer and is deemed to be of average risk for breast cancer. Most health organizations recommend these women get a baseline mammogram at age 40 and receive annual mammograms. Some women will be considered at high risk for breast cancer and should get a baseline mammogram beginning at age 30. These include women who have a known BRCA1 or BRCA2 gene mutation or a 1st degree relative with a known BRCA1 or BRCA2 gene mutation. Additionally, women who had radiation therapy to the chest between the ages of 10 and 30 should get a baseline mammogram at age 30.
Women should consult with their health care providers to talk about when to begin this important screening tool.