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A recent study suggests that breast cancer survivors aren’t getting regular follow-up mammograms – even when their insurance covers the procedure.

Most doctors recommend that women undergo frequent mammograms after surviving a breast cancer diagnosis in order to detect disease recurrence, and catch it in its earliest stages. However, a recent study published in the May issue of the Journal of the National Comprehensive Cancer Network, suggests that many breast cancer survivors are not keeping up with their mammograms.

In the retroactive study, Dr. Kathryn Ruddy from the Mayo Clinic in Rochester, MN, found that the further survivors were from their breast cancer diagnosis, the less likely they were to undergo mammograms – even when they had health insurance.

Dr. Ruddy followed 27,212 breast cancer patients for a median of 2.9 years after definitive breast cancer surgery. One year after treatment, 13 percent of cohorts  had not followed up with any kind of imaging after surgery. By the 5th year, the

proportion of the remaining cohort (4790) who had no breast imaging was 19 percent. Dr. Ruddy also found that black women previously diagnosed with breast cancer were less likely than white women to follow their doctors’ mammography recommendations.

There was one common denominator among the women in the study: they all had health insurance.

As a retroactive study based on administrative health insurance claims, Dr. Ruddy’s work has a number of limitations – but it raises important questions. The most pertinent being: what are the reasons that an insured breast cancer survivor wouldn’t follow up on mammograms when the non-invasive procedure could literally save her life?

At Bergen Imaging Center we believe in educating all women—especially those who have had a breast cancer diagnosis in NJ—about the importance of mammograms. Mammograms save lives, but only if you show up for the appointment.

According to a recent survey study by Dr. Lars Grimm of Duke University School of Medicine, some women prefer an immediate breast biopsy to follow-up imaging.

The findings suggest that women who believe there’s any chance that they have breast cancer are more comfortable with an immediate biopsy – a preference Dr. Grimm believes may be linked to an overestimation of their breast cancer risk.

Dr. Grimm and his team of researchers examined women’s perceptions of their own breast cancer risk, their threshold for choosing a breast biopsy, and their anxiety levels using the State-Trait Anxiety Inventory (STAI).

Participants were asked for responses to two hypothetical scenarios:

• A radiologist recommending short-term follow-up imaging six months after the initial exam
• A radiologist recommending an immediate breast biopsy, with the acknowledgement that there was a low risk of malignancy

Women with high baseline anxiety levels estimated their breast cancer risk to be 27 percent more than twice the average woman’s risk of 12.4 percent. In the first scenario, participants estimated their risk at 33 percent; and just 46 percent of those women were willing to wait for hypothetical follow-up imaging. However, when an immediate biopsy was recommended, women estimated their risk at 46 percent; and 66 percent said they preferred a breast biopsy if there was any chance at all of breast cancer.

“For a select group of patients, especially those women with high baseline anxiety and a personal history of breast cancer, a recommendation for biopsy instead of short-term follow-up may lead to less regret and more relief,” Dr. Grimm said in an interview with AuntMinnie.Com.

The purported benefits of 3D mammography include everything from higher breast cancer detection rates to lower patient recall rates. But in a hype driven world, is the technology behind digital breast tomosynthesis (DBT) really superior to traditional mammography?

Benefits of 3D Mammography

While 2D mammograms produce ‘flat’ images, 3D mammograms can ‘see through’ even dense breast tissue, providing a more detailed look at what’s inside. These 3D images are similar to pages in a book, and allow radiologists to closely examine each layer of breast tissue for abnormalities. In traditional mammograms, breast tissue often overlaps, resulting in hard to read images and higher recall rates.

The false alarms associated with 2D mammography create unnecessary stress and anxiety for patients, and increase healthcare costs.

3D mammography not only reduces recall rates by up to 40 percent, it can also help improve the accuracy of biopsy recommendations.

Current research indicates that tomosynthesis finds more cancers than its 2D counterpart, and may detect breast cancer earlier than traditional mammography as well.

Disadvantages of 3D Mammography

DBT is often combined with digital mammography, potentially increasing radiation exposure. At Bergen Imaging Center we use GE Healthcare’s Senoclaire technology, which uses low dose radiation—similar to the amount in a traditional mammogram.

Probably the biggest drawback associated with 3D mammography is cost. The equipment is more expensive, and it takes longer to interpret images.

That said, preliminary findings presented by researchers from Perelman School of Medicine at the University of Pennsylvania, during the 2017 San Antonio Breast Cancer Symposium, suggest that when diagnosis related costs are taken into account, 3D mammography is more cost efficient than 2D mammography.

Verdict: 3D Mammography Wins

Based on current research, as well as our first-hand experience with 3D mammography at Bergen Imaging Center, the answer is a resounding yes!

A recent study conducted by Yale researchers, and presented at the RSNA 2017 meeting in Chicago, found that digital breast tomosynthesis (DBT), more commonly referred to as 3D mammography, identifies smaller breast cancer than traditional 2D screening mammograms.

While previous research has demonstrated that 3D mammography results in higher breast cancer detection rates and fewer false positives than digital screening mammograms—specific characteristics of cancers identified by the technology are not well understood.

“DBT is a relatively new technique in breast imaging, and available data on screen-detected cancers over several years of consecutive use is limited,” Dr. Maryam Etesami of Yale University School of Medicine and the Smilow Cancer Hospital at Yale New Haven said.

The Study: Digital Mammograms Vs. 3D Mammograms

In the study, Dr. Etesami and her peers set out to identify cancer characteristics found by 3D mammograms. The team examined results from 44,050 screening mammograms completed between 2008 and 2016. More than 28,000 came from mammograms conducted between 2011 and 2016, and contained a combination of 3D mammography and 2D digital mammogram results.

The researchers found that 3D mammography better detected smaller cancers than its digital 2D counterpart, and that DBT had fewer positive axillary lymph nodes as well.

“As we know, axillary lymph node metastasis significantly increases morbidity and mortality of breast cancer,” Etesami said. “Our results show that DBT performs better than 2D mammography alone in what we expect from a screening tool, which is early detection of clinically significant cancers before they spread to axillary lymph nodes.”

The results are significant because once cancer spreads to lymph nodes it is harder to treat, and more deadly. The finding indicates that 3D mammography can improve outcomes for women diagnosed with early breast cancer.