New mammography techniques assisting doctors, patients in discovering cancer in women
Courtesy of Mon Valley Hospital
Courtesy of Mon Valley Hospital
Radiologic technologist Jessica Meier poses with the 3-D mammography unit at Monongahela Valley Hospital.
Courtesy of Mon Valley Hospital
Natalie Furgiuele, M.D., FACS, breast surgeon with MVH
New rules proposed by the U.S. Food and Drug Administration would help to provide new information to women when it comes to mammography and detecting possible breast cancer.
The proposed regulations would require medical providers to inform women if they have dense breast tissue.
This is nothing new in Pennsylvania, which enacted the same requirements back in 2013 when the General Assembly enacted the Breast Density Notification Act for women receiving mammograms.
Why is that information important to women?
Having dense breast tissue means cancers can hide more easily from traditional mammogram imaging, so the use of 3D mammography can be very helpful.
“For women with dense breast tissue, 3D mammography is a very positive advancement because we can find cancer earlier and more accurately,” said Dr. Natalie Furgiuele, breast surgeon at Monongahela Valley Hospital. “We have no control over our breast density. It’s like saying we have control over whether we have blue eyes or brown eyes. We really don’t.”
Furgiuele said patients with denser breasts do have an increased risk of breast cancer, but a woman’s breast density also changes throughout her life.
“A younger woman by definition is going to have denser breasts, more glandular tissue than an older woman after the age of 65 or 70 because our breasts go from all that glandular tissue as we age to fatty tissue,” Furgiuele said. “It’s a lot easier to see things through mammography in fatty tissue than it is in dense tissue.”
That’s where the relatively recent advent of 3D mammography comes into play.
Mammography has been around for nearly 40 years, but advancing technology has taken it first to digital imaging and most recently into three dimensions. Each improvement in technology gives doctors a better overall look at breast tissue.
3D mammography, also known as digital breast tomosynthesis, captures a series of consecutive images from different angles across the arc of the breast to produce three-dimensional slice images. The slices enable radiologists to examine breast tissue one layer at a time instead of viewing all of the layers together as a flat image.
An abnormality that is hidden behind dense tissue in one image may be visible in another image at a slightly different angle.
“If you consider the breast like a book, digital mammography kind of looks at that whole object, whereas 3D mammography you open each page, take a picture of each page then create the book,” Furgiuele said. “You’re not going to miss too much if you do it that way.”
What are the benefit and takeaway from women having this information?
“I think that provides more incentive for imaging centers to provide 3D mammography,” Furgiuele said. “For example, here at Mon Valley Hospital, we have 3D mammography at both of our imaging centers. That’s why it makes a difference where you go to get your imaging.”
She said telling a woman whether she has dense breast tissue is sort of like giving her a heads up when it comes to breast health.
“Listen, if you have dense breasts, things can hide in them,” Furgiuele said, “and I think the takeaway message is that 3D mammography is wonderful for dense breasts.”
Furgiuele said it’s important to remember even 3D mammography is not 100 percent infallible.
“They are excellent and we find most small cancers through imaging rather than physical exam,” she said.
The upshot is the FDA is just now proposing rules Pennsylvania and many other states have already had in place since 2013.
“We have an obligation to tell patients that they have extremely dense breasts if that’s the case,” Furgiuele said. “That way they have more knowledge knowing that dense breasts can make it more difficult to find cancers. If a patient suspects something’s going on, she should proceed with further evaluation by her physician even though she had a mammogram that was fine.”
In 2015, Pennsylvania Governor Tom Wolf clarified under existing state law, 3D mammograms must be covered at no cost to women in the same manner as traditional two-dimensional mammograms.
“I think that 3D should be the standard everywhere,” Furgiuele said. “What good reason would there be not to? I think that there should be an incentive to provide 3D mammography as standard of care. But things take time. These things always take time to push along. I constantly remind women that the best way to detect breast cancer early, when the outcomes can be most positive, is through annual mammograms. If you haven’t had a mammogram in over a year, plan to get one tomorrow.”