Mammograms are one of the most effective tools for early detection of breast cancer and typically are able to identify cancer before it can be felt or begin to exhibit symptoms. 3-D mammography, officially called tomosynthesis, is the latest advancement in detection of breast cancer at its earliest stages. Traditional mammograms construct a two-dimensional image of the breast through the use of two x-ray images. Three-dimensional mammography uses numerous images of the breast from different angles to create a three-dimensional image of the breast.
Emerging research indicates that 3-D mammograms will avoid a few shortfalls that are concerns for traditional 2-D mammography. 2-D mammograms are very good at detecting breast cancer but they have high rates of false positives for the presence of cancer, which often leads to additional unnecessary follow-up testing. The 2-D method can also lead to false negatives, incorrectly giving a cancer-free diagnosis. The possible discomfort of the process makes some people adverse to getting screenings.
3-D mammography may eliminate the main barriers for individuals to seek and follow-up with breast cancer detection guidelines: pain and discomfort, multiple follow-up tests, and false results. A study published in 2016 indicated that 3-D mammograms lead to less follow-up visits and less false positives for study participants. Even more promising, when follow-up visits were necessary to address abnormal results, 3-D mammograms had higher rates of breast cancer detection. Study participants that received 3-D mammograms also had lower rates of breast cancer detected between annual mammograms. Additionally, the method of 3-D mammography is more comfortable for patients because the breast is only compressed enough to hold in place for a stable image (McDonald et al 2016). An earlier study published in 2014 found that when 3-D mammography was conducted in addition to traditional 2-D testing, there was a 41% increase in invasive breast cancer detection, a 15% decrease in follow-up testing, and 29% increase in all breast cancer detection (Friedewald et al 2014).
All women that are insured under PA law or covered by Medicaid or Medicare Part B can chose to have a 3-D mammogram as part of their annual screening at no cost to themselves.
Due to 3-D mammography’s effectiveness for detecting breast cancer, Pennsylvania Governor Wolf’s Administration mandated that the procedure be included as preventative screening and offered at no cost for non-self-insured Pennsylvanian women as of January 2016. Self-insured or self-funded health insurance offered by employers are not required to comply with this PA state law because they are regulated by the federal government. Women that receive a bill for 3-D mammogram services that they are unable to resolve with their insurance company can file a complaint with the Pennsylvania Insurance Department (1-877-881-6388 or www.insurance.pa.gov) (Pennsylvania Insurance Department, 2016).
Uninsured or underinsured PA women can also access mammogram services through the HealthyWomen Program (HWP) offered through the PA Department of Health and Centers for Disease Control and Prevention. HWP will cover at no cost for eligible women breast and cervical cancer screening procedures including mammograms and pap smears. Individuals that qualify have incomes below 250% of the federal poverty level (family of 1 = $29,700/year, family of 2 = $40, 050, etc.), are PA residents, and either have no insurance or insurance that is too expensive for them to receive care. For more information contact the Consumer Health Coalition at 412-456-1877 x207.
Friedewald SM, Rafferty EA, Rose SL, Durand MA, Plecha DM, Greenberg JS, Hayes MK, Copit DS, Carlson KL, Cink TM, Barke LD, Greer LN, Miller DP, Conant EF. Breast Cancer Screening Using Tomosynthesis in Combination With Digital Mammography. JAMA. 2014;311(24):2499-2507. doi:10.1001/jama.2014.6095
McDonald ES, Oustimov A, Weinstein SP, Synnestvedt MB, Schnall M, Conant EF. Effectiveness of Digital Breast Tomosynthesis Compared With Digital Mammography Outcomes Analysis From 3 Years of Breast Cancer Screening. JAMA Oncol. 2016;2(6):737-743. doi:10.1001/jamaoncol.2015.5536
Pennsylvania Insurance Department. “3D Mammography FAQs.”. Commonwealth of Pennsylvania, 2016. Web. <http://www.insurance.pa.gov/Coverage/Pages/3D-Mammography-FAQs.aspx>.
About the Author
Katie Holler, MPH, is a Health Care Navigator and Health Educator at Consumer Health Coalition.