Should You Get a 3D Mammogram Instead of a Regular Mammogram?
Key takeaways:
A 3D mammogram (breast tomosynthesis) involves multiple X-ray pictures of your breasts to create a 3D image. This process differs from a traditional mammogram, which usually involves two 2D pictures of each breast.
A 3D mammogram can get better images than a traditional mammogram. It does a better job of picking up early cancer, and it has a lower rate of false alarms from abnormal results.
It’s not clear exactly who needs a 3D mammogram. But it might be especially helpful for women who have dense breasts, a family history of breast cancer, or previous abnormal mammograms.
Breast cancer screening saves lives. Women who get regular screening can lower their risk of dying from breast cancer by 40%. But there are a few different screening tests, and it can be hard to know which one is the best for you.
You’re probably familiar with the classic 2D mammogram, which involves taking two-dimensional images of your breasts. But sometimes a 3D mammogram may be a better option. We’ll review what a 3D mammogram is, as well as the pros and cons of this newer technology.
What is a 3D mammogram (breast tomosynthesis)?
A 3D mammogram is an imaging test that uses low-dose X-rays to create a three-dimensional image of your breast. This helps screen for and diagnose breast cancer.
A 3D mammogram is also referred to as a:
Digital breast tomosynthesis (DBT)
2D mammogram with tomosynthesis
The FDA approved the use of 3D mammograms in 2011. Some studies suggest the test does a better job at catching early breast cancer than traditional mammograms. A 3D mammogram isn’t available at all hospitals and testing centers. But the use of 3D mammograms is quickly becoming more widespread. According to the FDA, by 2023, 85% of testing centers in the U.S. offered 3D mammograms.
Almost half of women over age 40 have dense breasts. So, it’s helpful to understand what it means to have dense breasts and how that can influence your mammogram results.
A mammogram is the best way to screen for breast cancer. Sometimes a breast ultrasound can also help with diagnosis.
Does it hurt to get a mammogram? Three medical professionals share their experiences getting this common screening test.
3D mammograms vs. 2D mammograms
The main differences between a 3D mammogram and a 2D mammogram are the number of images taken, as well as the level of detail in those images.
A traditional, 2D mammogram is the type of mammogram that most people are familiar with. With this process, technicians usually take two pictures of each breast: one picture from the top and one from the side.
A 3D mammogram also involves using an X-ray machine to examine each breast. But the X-ray machine moves in an arc over the breast. It takes multiple pictures from different angles as it moves. A computer then creates a 3D image of the breast. This provides a more detailed view of the breast.
Pros and cons of 3D mammograms
Many people consider a 3D mammogram to be a newer, better version of the standard mammogram. But does it stand up to the hype?
Pros of a 3D mammogram include:
Better detection rates: It does a better job of picking up early breast cancer than a regular mammogram.
Lower recall rates: It causes fewer false positives. This means fewer women will be called back for abnormal results that end up being noncancerous.
Better images: This is especially important for women with dense breasts, since dense breasts are more likely to hide early cancer on regular mammograms.
Cons of a 3D mammogram include:
Increased radiation: Both forms of mammogram use low amounts of radiation overall. But 3D mammograms may increase your radiation exposure because it takes more pictures. The increase is small and well within safety standards.
Increased cost: Some insurance plans will cover the cost. But, if your plan doesn’t cover it, you’ll usually pay more for a 3D mammogram.
Availability: Some facilities don’t offer 3D mammograms, so you might have to travel further to get one.
Who should get a 3D mammogram?
Not everyone agrees on who should get a 3D mammogram. Some healthcare professionals feel 3D mammograms should be used for everyone since they’re better at detecting early breast cancer. In fact, the American Society of Breast Surgeons recommends 3D mammograms as the preferred screening test for all women.
But, even though 3D mammograms are better at detection, it’s unclear if this ultimately affects survival rates. 3D mammograms haven’t been shown to lower the risk of dying from breast cancer for most women. For this reason, many guidelines don’t state a preference for one over the other.
The U.S. Preventive Services Task Force (USPSTF) and American Academy of Obstetricians and Gynecologists (ACOG) both recommend either 2D mammogram or 3D mammogram for routine screening. ACOG states that more research is needed to know if 3D mammograms should replace regular mammograms for routine screening.
If you’re due for breast cancer screening, you can talk to your healthcare team about what type of screening may be best for you. A 3D mammogram might be recommended if you have:
Dense breasts
A history of abnormal mammograms
Family history of breast cancer
A gene that increases your chance of getting breast cancer (like BRCA)
Any abnormal symptoms, like a lump or other changes in your breast
Note that for some risk factors — like a strong family history or BRCA gene — a healthcare professional might recommend other screening tests, like a yearly MRI. But that’s usually done in addition to a mammogram.
How much does a 3D mammogram cost?
A 3D mammogram usually costs more than a regular mammogram. The national average cost for a 3D mammogram is $658. The average price for a 2D mammogram is about $400 or more. But that doesn’t mean you’ll end up paying more if you get a 3D mammogram.
Private health insurance companies are required to cover mammograms as part of preventative screening. Medicaid Part B covers screening mammograms every year for women aged 40 and older.
When it comes to 3D mammograms, many states have created mandates that require insurance companies to cover 3D mammograms. If you don’t live in one of these states, coverage might depend on whether or not you’re considered at high risk for cancer.
One national study found that when states mandated coverage and more people got 3D mammograms, the out-of-pocket costs weren’t different from states where there was no mandate. This suggests that most types of insurance are covering 3D mammograms.
If you don’t have health insurance, many programs exist to help cover the cost of this important screening.
Getting your 3D mammogram results
Before you get your 3D mammogram results, the images need to be reviewed by a radiologist. The radiologist will write a report and send that to your healthcare team. You’ll usually get the results of your test within 1 to 2 weeks. The timing might vary depending on your testing facility.
If the results show something abnormal, take a deep breath. Most abnormal findings turn out to be nothing serious. Sometimes an unclear image or dense breast tissue can make it difficult to interpret your results. Or the radiologist might have noticed “focal asymmetry.” This just means that one area of your breast looks different from the same area on your other breast. Other findings — like calcium deposits or cysts — aren’t harmful. If the radiologist spots findings like these, they may recommend more imaging to be sure.
In these cases, a healthcare professional will usually recommend another mammogram or an ultrasound to get a clearer look. If further tests are needed, they’ll guide you through the next steps and help explain what they’re looking for.
Frequently asked questions
A 3D mammogram won’t hurt more or less than a 2D mammogram. The part of the mammogram machine that compresses your breast is the same. But a 3D mammogram does take a few seconds longer. Every woman is different. Some people experience no discomfort at all, and others find mammograms painful.
You might need an ultrasound after a 3D mammogram if the mammogram shows any abnormal findings. An ultrasound can help your healthcare team understand if those findings look like cancer or not.
Sometimes healthcare professionals will order an ultrasound for dense breasts. That’s because both cancer and dense breasts can show up as small white spots on a mammogram (whether it’s a 2D or 3D mammogram). An ultrasound can help tell normal breast tissue apart from possible cancer.
Since 3D mammograms take more images of the breasts, they're thought to use more radiation than a 2D mammogram. One report estimated that 3D mammograms increase radiation exposure by 8% when compared to traditional mammograms.
The bottom line
A 3D mammogram — or tomosynthesis — is an excellent tool for screening for breast cancer. Since it’s able to get better pictures than a regular, 2D mammogram, a 3D mammogram can detect breast cancer in earlier stages. It may also reduce unnecessary callbacks. For this reason, some healthcare professionals feel it should be the new standard for screening. But the evidence isn’t strong enough for the major health organizations, like American Academy of Obstetricians and Gynecologists (ACOG), to recommend 3D mammograms for all women. Talk to your healthcare team about whether a 3D mammogram might be a good choice for you, especially if you have any conditions that put you at higher risk for breast cancer.
Why trust our experts?
References
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