When I went to the imaging center for my regular mammogram last year, the woman behind the desk asked me if I鈥檇 like to get a 鈥�3-D鈥� mammogram instead of the standard test I鈥檇 had in the past.
鈥淚t鈥檚 more accurate,鈥� she said.
What do you say to that? 鈥淣o, thanks, I鈥檇 rather have the test that gets it wrong?鈥� Of course, I agreed.
A growing number of women are likely to face a similar choice in coming years as imaging centers across the country add three-dimensional (3-D) mammography, also called digital breast tomosynthesis, to the two-dimensional (2-D) screening women customarily receive.
What鈥檚 not yet clear is whether this newer, more expensive technology is better at catching cancers that are likely to kill. So should it be widely recommended? And who should pick up the extra cost involved?
According to the , there were 3,915 certified mammography imaging facilities that offered digital breast tomosynthesis in January. That鈥檚 a sharp increase over the previous January, when the total was 3,011.
Some facilities have switched over entirely to 3-D imaging, but many practices have both, experts said.
鈥淭here鈥檚 a lot of marketing pressure to offer these new machines,鈥� said Robert Smith, vice president of cancer screening at the American Cancer Society.
Both types of tests use X-ray technology to create images of the breast. The 2-D digital mammograms that most women receive typically provide front and side images, while for the 3-D test the X-ray arcs across the breast, creating multiple images of breast tissue. The experience is the same for women, though, because both scans involve compressing the breast between two plates extending from the machine.
Studies that the 3-D test is slightly better at detecting cancers than the 2-D test, and women typically have to return less often to have additional images taken.聽But the jury is still out on whether the newer technology is any better at identifying the advanced cancers that will become lethal.
鈥淐ancers don鈥檛 always progress and kill people,鈥� said Dr. Etta Pisano, chief science officer at the American College of Radiology鈥檚 Center for Research and Innovation and a faculty member at Harvard Medical School. Pisano is leading a of 165,000 women that will compare the two types of screening tests to evaluate whether the new technology reduces the risk that women will develop life-threatening cancers.
鈥淚f tomosynthesis is improving the likelihood of women to survive their breast cancers, they should have fewer cancers that are more likely to kill women over the 4.5 years of screening. Since tomosynthesis caught them early, they鈥檒l never grow up to be bad cancers,鈥� Pisano said.
Overdiagnosis is one of the potential downsides of this technology, said Dr. David Grossman, chair of the U.S. Preventive Services Task Force. The more sensitive test picks up more breast lesions for which the , potentially resulting in women receiving more testing and treatment they don鈥檛 need. Some research suggests the biopsy rate is slightly higher with 3-D mammograms.
In addition, some of the mammography systems require both 2-D and 3-D X-rays, which can expose women to twice as much radiation. Other systems are able to generate a 2-D image from the 3-D version with software, eliminating the extra exposure. The 2-D image is important because clusters of calcifications, which may signal breast cancer, might be easier to see on the 2-D image, said Pisano.
Under the Affordable Care Act, most health plans are required to cover preventive services that are recommended by the task force without charging patients anything out-of-pocket. The biennial mammograms for women ages 50 to 74, but it says that there鈥檚 not enough evidence to recommend 3-D mammograms at this time.
Insurance coverage of 3-D testing has improved in recent years, but it鈥檚 not assured. The 3-D test typically costs about $50 more than a 2-D test, according to a by Truven Health Analytics聽that was funded by , a manufacturer of 3-D mammography systems.聽Medicare also covers 3-D tests.
A growing number of states require commercial insurers to cover 3-D mammograms, including Arkansas, Texas, Connecticut, Maryland, Illinois and Pennsylvania.
My state of New York also , without any out-of-pocket payments.聽Though I didn鈥檛 have to pay it, the explanation of benefits form I got from my insurer said the 3-D portion of the test added $51 to the $157 cost of the mammogram.
鈥淐osts are high for new technologies,鈥� Pisano said. 鈥淢aybe they are better, but we need to have evidence before we recommend it for the entire population.鈥�
So if you鈥檙e offered a 3-D test, should you get it?
鈥淚f the examination is available at no extra cost, the data we have now tells us it has some advantages,鈥� said Smith. On the other hand, 鈥渁ny woman who鈥檚 feeling stressed about the extra cost 鈥� should feel comfortable getting a regular mammogram,鈥� he said.