What You Need to Know About Tomosynthesis for Breast Cancer

Tomosynthesis vs. 2-D mammography

Tomosynthesis and mammography are similar in that they’re both imaging techniques that are used to detect signs of breast cancer. They can both be used during annual exams and to check the progression of breast cancer.

However, tomosynthesis is considered a more advanced and detailed imaging technique than traditional mammography.

A traditional mammogram only captures a 2-D image. Tomosynthesis can look at multiple layers of the breast in a 3-D image, filling in the gaps that traditional mammograms have.

The 3-D imaging of tomosynthesis also allows doctors to see small lesions and other signs of breast cancer earlier than they would with a traditional mammogram.

Pros of tomosynthesis

Other benefits of using tomosynthesis in addition to or instead of a traditional mammogram include the following:

• more accurate overall and less likely to result in false positives
• much greater accuracy when screening for breast cancer in people with dense breasts
• earlier detection of breast cancer in people with breast cancer symptoms

Tomosynthesis can be used to detect breast cancer before many people ever start to have any symptoms. Tomosynthesis can often discover breast cancer years before a person or their doctor could feel it or see any symptoms.

Cons of tomosynthesis

Tomosynthesis is still a relatively new procedure and not all imaging technicians or doctors will be familiar with it.

Other possible risks of using tomosynthesis instead of traditional mammography may include the following:

• More radiation, in some cases. Radiation levels will vary by mammography machine. For some people receiving 3-D mammograms, there may be slightly more exposure to radiation due to more images being taken of each breast. However, the radiation levels are still low enough to meet the FDA’s safety standards. The radiation leaves your body shortly after the procedure.
• Inconsistent reconstruction algorithms. Specific algorithms for constructing the 3-D images may vary, which may affect your results.
• Variation in the images. The arc of the movement of the X-ray tube may vary, which may cause variation in the images.

Cost of tomosynthesis

Insurance providers in the United States typically cover the cost of traditional mammography.

Many providers, including Medicare, are now covering tomosynthesis as part of breast cancer screening too.

States that have adopted laws requiring insurers to cover the costs of tomosynthesis for qualifying individuals include:

• Arkansas
• Connecticut (for women ages 35 years and older)
• Missouri
• New York
• Pennsylvania
• Texas (for women ages 35 years and older)

If you have symptoms of breast cancer and will require a diagnostic exam instead of a screening, you may be responsible for some of your own mammogram or tomosynthesis costs. This will depend on your insurance provider as well as your location.

The median cost of a mammogram for uninsured people was $243 in 2016, according to one news article. According to a 2017 news article, tomosynthesis may cost $50 to $100 more than traditional mammography.

More recent research suggests that tomosynthesis may cost less than 2-D mammography in some cases.

A 2020 study looking at Blue Cross Blue Shield customers in their 40s found that initial breast cancer screening and follow-up tests cost an average of $353 a year. That included $125 for a 2-D screening mammogram and $124 for a screening with tomosynthesis. A 2-D diagnostic mammogram cost $21, while diagnostic tomosynthesis cost $8.

A 2018 study used medical claims from 2011 to 2015 to estimate the cost of breast imaging and diagnostic procedures. The researchers found that, on average, a 2-D diagnostic mammogram cost $354 for people ineligible for Medicare. Diagnostic tomosynthesis cost $136 for people ineligible for Medicare.

The insurance companies covered some of these costs, while the insured individuals covered some.

Learn more about the cost of mammograms — and where to find low-cost or free ones.

Preparing for tomosynthesis

Preparing for tomosynthesis is similar to preparing for a traditional mammogram. Some tips to follow are below.

Before you arrive:

• Request your prior mammograms. This allows your doctor to compare both images to better see any changes that may occur in your breasts.
• Schedule the procedure 1 or 2 weeks after your period starts to help reduce breast tenderness.
• Let the doctor and imaging technician know if you think you may be pregnant or if you’re nursing. The doctor may want to use a different procedure or take additional precautions to protect your baby.
• Let the doctor and imaging technician know about:
  • any symptoms you may be having
  • surgeries to or near your breasts
  • a family history of breast cancer
  • personal hormone use
• Let the doctor and imaging technician know if you have breast implants.
• Reduce the amount of caffeine you eat or drink prior to your procedure, or eliminate it entirely. This also helps reduce possible breast tenderness. Ask your doctor how long you should avoid caffeine.

What to wear:

• Wear two-piece clothing. This makes undressing for the procedure easier and allows you to remain dressed from the waist down.
• Avoid using deodorant, powder, lotion, oil, or cream from the waist up on the day of the procedure.

The day of your procedure:

• Let the doctor and imaging technician know, once again, if you:
  • are nursing or think you may be pregnant
  • are having any symptoms
  • have had surgeries to or near your breasts
  • have a family history of breast cancer or a personal history of hormone use
  • have breast implants
• Ask when you should expect the results.

How tomosynthesis is performed

The procedure for tomosynthesis is very similar to that of traditional mammography.

Tomosynthesis even uses the same type of imaging machine as traditional mammography. However, the images it takes are different. Not all imaging machines are equipped to take tomosynthesis images.

Overall, the procedure lasts around 15 to 30 minutes.

Here’s what you should expect:

1. When you arrive, you’ll be taken to a changing room to remove your clothes from the waist up and provided with a gown or cape.
2. You’ll then be taken to the same machine or type of machine that performs a traditional mammogram. The technician will position one breast at a time in the X-ray area.
3. Your breast will be tightly compressed like they are during a traditional 2-D mammogram.
4. The X-ray tube will be positioned over your breast.
5. During the procedure, the X-ray tube will move by making an arc over your breast.
6. During the procedure, 11 images will be taken of your breast in 7 seconds.
7. You’ll then change positions so that images can be taken of your other breast.
8. After the procedure is complete, your images will be sent to a computer that will make a 3-D image of both breasts.
9. The final image will be sent to a radiologist to interpret the results.

Next steps

After the procedure is complete, you can resume your normal activities and diet.

If your results are normal and show no signs of cancer, you may hear from the doctor that same day.

If your results suggest you may have cancer, further testing and follow-up are needed. Result times will vary by facility.

If the results are inconclusive, the doctor may call you back in for further tests, such as an MRI or ultrasound. It may take at least 1 week to receive the results of one of those tests. However, one of the benefits of tomosynthesis is that it results in lower callback rates, according to a 2019 study.

Takeaway

Tomosynthesis is most helpful in screening for breast cancer in people with dense breasts.

If you know you have dense breasts or possible symptoms of breast cancer, you can discuss the option of having tomosynthesis imaging done in addition to or instead of a traditional mammogram.

Tomosynthesis is still a relatively new procedure, so it’s not available at all facilities that perform mammography. Be sure to ask the doctor or imaging center if this option is available for you.