There’s a lot of press about the importance of a 3-D mammogram (breast tomosynthesis) and how much better it is in terms of detecting cancer than the traditional 2-D (standard digital) mammogram.
Here’s a little known secret:
While it is true that there is a difference in the cancer detection rate between the two technologies, what I notice on a daily basis is that the most important consideration for a patient should actually be who interprets their study.
A mammogram is one of the most subjective radiological studies in the field of radiology and there are huge differences in the breast cancer detection rates between radiologists.
I often see breast cancers that were missed (on both 2-D and 3-D mammograms) that would have been detected if a different radiologist had interpreted the study.
Interestingly, most of these statistics are recorded and regularly reported for radiologists. However, they are rarely made public. In part, there is resistance to releasing data such as this because of the potential for misinterpretation by patients and the public in general.
However, today’s patients are increasingly sophisticated and it is my personal opinion that it may be time to bring awareness to this topic.
I have written about this before, but I receive so many questions about this on a daily basis that I want to revisit the question.
There are organizations that advocate both.
Organizations such as the United States Preventative Services Task Force (USPSTF) advise mammograms every other year. They acknowledge that many cancers will be missed with this model, but they believe the number is “small” (it is estimated an additional 100,000 women will die as a result of the recommendations) but they believe this is outweighed by the anxiety, additional biopsies, and the potential for misdiagnosis that can occur by yearly mammograms.
Organizations such as the American College of Radiology (ACR), still recommend yearly mammograms because they believe the number of lives that will be saved by yearly screening far outweighs the anxiety, the extra biopsies, and the potential for misdiagnosis.
I personally want every important woman in my life to have a mammogram every year because I am more concerned that they could end up as one of the 100,000 women that will die from a missed cancer than I am that they could experience some anxiety, an extra biopsy, or misdiagnosis.
But this may not be the right decision for everyone and most importantly I believe in patients being given all the facts…and the freedom…to make their own choices.
There are multiple options available for reconstruction of the breast following breast cancer surgery (oncoplastic breast surgery). In the setting of augmentation required for symmetry of the breast, flaps of tissue from the patient’s own body (such as the abdomen) or synthetic implants can be used. Synthetic implants commercially available include saline, silicone/gel and combination products.
From an aesthetic perspective, the choice is best made in consultation with your plastic/breast surgeon. From the viewpoint of a breast imager (radiologist) in terms of future breast cancer screening, there are pros and cons to each of the options, but none overwhelmingly outweigh any other. Officially, there is no recommendation.