Leah Zitter

Leah Zitter

Keeping Abreast of Mammogram Changes (interviewing Dr. Polly Stephen, Bon Secours Hospital, VA)

Radar Zero (2018) | January 17th, 2018

The "Congregation of the Sisters of Bon Secours" is a Roman Catholic congregation for nursing, whose stated goal is to care for patients from all socio-economic groups in Richmond, Virginia. They are also in the forefront of medicine, with two of its local hospitals winning the 2018 Distinguished Hospital Award for Clinical Excellence.

Bon Secours' women's imaging center recently bought its first 3D mammogram machine for detecting breast cancer.

“It costs women who want to use it a lot - all out of pocket. There's along line to use it so you'll need to wait at least five months for your chance,” Dr. Polly Stephens told me. “There’s sort of a snob appeal to this machine.”

Dr. Stephens is the founder of Bon Secours Virginia Breast Center.

“Next year,” she added, “it may be free. We’re campaigning for that... Between you and me, I think the hype's inflated. It’s only a slight improvement over our regular 2D.”

The Doctor reported that according to the FDA, a low-dose 3D digital mammography is at least as accurate as a 2D image. When Bon Secours gets its machine, they can also get 2D digital images from its 3D mammography data.

So what's the difference between 2D and 3D mammography?

3D mammography works in the same way as 2D mammography, with the woman’s breast pressed between two plates for about six seconds and the camera scanning the breast. The one big difference is, while the 2D xrays only the front and side of the breast, the 3D photographs each of the breast's inner layers. This is something like lasering in through a closed volume of Shakespeare's Complete Plays and detecting a spot on one of the pages of that book. In this way, abnormalities that may otherwise have been overlooked have a better chance with the 3D device. This sort of xray machine is enormously valuable for women with dense breasts.

What do studies say on 3D Mammography?

Dr. Stephen told me that before the FDA approved 3D, pilot studies found that a combination of 2D plus 3D imagery was more accurate than 2D imagery alone, although that difference in accuracy was almost insignificant. Studies also found that women who are screened with the 3D+2D mammography are less likely to be recalled for further testing due to suspicious findings that turn out negative. In other words, the mix of mammograms creates far fewer false alarms. On the flip side, it exposes patients to surplus radiation.

The bottom line

Even though the differences are small, 3D tests seem to have some advantage over 2D tests in that they're slightly better at detecting dangerous cancers and at reducing repeat tests.

“So does that mean,” I asked Dr. Stephens, “that because my insurance doesn't pay, I have to continue with the 2D machine and may have to die because of some hidden thing it won’t pick up!”

I was only partly joking.

“Not necessarily,” she told me. “Differences between the capacities of the two machines are extremely small. If there’s anything significant there, it would have spread to the lymph nodes by now.”

And what about radiation exposure?

“Well, with the 3D machine you're slightly longer time under the plate. But despite its power, the way the 3D's made is that it actually exposes you to less radiation than its 2D counterpart.”

“The most important thing,” Dr. Stephen consoled me, “is you’re doing a yearly mammogram which has a better chance of catching cancer early. One of the things we’re looking for when we do a mammogram is very subtle changes from one year to the next, so that we can catch cancer at the very earliest stage. If we’re concerned about something, we call you back.”

So that's the difference between the 2D and the 3D.

For me, the 3D will have to wait while I continue keeping abreast of my breast situation.

That's something we, more mature women, constantly have to do. As breast cancer awareness products say: “Boobs: They Need Your Support!” Or more simply “Save the Boobies.”