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The Benefits and Uses of 3D Tomosynthesis and Breast MRI

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Published on August 30, 2012

Advances in technology using 3D tomosynthesis are allowing experts to “examine breast tissue one layer at a time.” Breast radiologist, Dr. Vilert Loving of Banner MD Anderson Cancer Center talks about the latest technologies for diagnosing breast cancer, including breast MRI and various tools used in the past. Hear more about imaging techniques helping doctors to understand what’s normal, what’s abnormal and making strides to improve diagnostic tools for breast cancer patients with the hope of them returning to healthy normal lives.

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Transcript | The Benefits and Uses of 3D Tomosynthesis and Breast MRI

Please remember the opinions expressed on Patient Power are not necessarily the views of Banner Health, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hello.  I’m Andrew Schorr from Patient Power for Banner MD Anderson Cancer Center. 

Women wonder of course about mammography, how often should they have it, how reliable is it, when should they perhaps have something they may have heard about, a breast MRI, and is there anything new that’s come along to make things better so they can be more confident in the health of their breasts or should cancer be detected that it’s detected accurately.  Well, there is a new development.  We’re going to hear about that and also certainly more about the guidelines and where breast MRI fits in. 

To help us understand this is a breast radiologist, a subspecialist in that area of radiology, and that’s Dr. Vilert Loving from the Banner MD Anderson Cancer Center.  Dr. Loving, thank you for being with us. 

Dr. Loving:

Of course. 

Andrew Schorr:

Dr. Loving, so is there something now that is more useful than mammography that we’ve had for many years? 

Dr. Loving:

Yes.  So with mammography there’s been kind of a step-wise advance in terms of our technology.  So the widespread use of mammography started back in the 80s, and since then it’s slowly progressed to better imaging.  Now we use what’s called digital mammography to improve imaging in the majority of women.  But recently there has been another jump in technology, and that’s with something called tomosynthesis.  You may hear it also called 3D mammography.  But it’s been a significant advance in terms of our breast imaging because it helps improve our cancer detection. 

Andrew Schorr:

So for you as a radiologist does 3D tomosynthesis give you a more complete view of the breast? 

Dr. Loving:

Yeah.  So an easy way to think of it is a traditional mammogram, a 2D mammogram, is basically taking a picture of the breast.  And so it’s like when you have a camera and you’re taking a picture of something and it prints out a photo which is a two-dimensional photo but there’s no depth to it.  There’s no third dimension.  And with tomosynthesis we’re adding that third dimension. 

And how that works is instead of taking a normal two-dimensional picture the tomosynthesis machine is actually moving kind of like an arc over the breast, and as it’s moving over that arc it’s taking multiple additional pictures.  And so with those additional pictures it’s giving us more information about the breast. 

One analogy that I use for patients, when I try to describe tomosynthesis and explain how it works, is to imagine if you’re standing in the middle of a forest.  At the edge of the forest of trees there’s a person waving at you.  If you had a camera in your hand and were taking a picture of that person you would get a two-dimensional picture.  So sometimes you can see the person easily and sometimes that person is obscured by trees and you can’t see them at all.  Sometimes you may see an arm sticking out waving at you, but oftentimes you may or may not get a good picture of that person just with that single photo.  And that’s an analogy to traditional mammograms that just take a traditional two-dimensional picture. 

And with tomosynthesis the difference being when you go back to that tree analogy it’s as if you’re moving, taking a picture from one angle, moving to a different spot, taking another picture, moving to a third spot, taking another picture.  And when you compile the data from all the pictures together you get a better view.  You get to see around the trees.  You get a better view of that person who is standing there.  And so that’s the same idea with tomosynthesis.  We’re taking these multiple views, and we’re looking around the breast tissue and looking through it and more around it on the edges to see the potential for breast cancer behind things. 

Andrew Schorr:

So does that give you more confidence that you’re getting a clear picture? 

Dr. Loving:

Yes.  So it definitely improves the person we’re looking at, and we consider it to be a tool on top of traditional mammography and that just helps us to be much more confident and much more sure of what we’re looking at to look for abnormalities that could be hiding in the breast. 

Andrew Schorr:

Is this something you’re now using routinely at Banner MD Anderson Cancer Center? 

Dr. Loving:

We are.  So when women come in for their yearly screening mammograms every year we do perform tomosynthesis on all those patients.  So it’s very helpful, and we do offer it to everyone that comes in. 

Andrew Schorr:

So women have heard about breast MRI, some have had it.  Where does breast MRI fit in? 

Dr. Loving:

That’s a good question.  So MRI, it’s—there’s a lot of publicity and people may have heard about it.  The tests—or the studies have shown that MRIs are actually superior to mammography in determining or in detecting breast cancer, so we can find it much more easily.  But the disadvantage that comes with that is that with that sensitivity in finding breast cancer we’re also finding a lot more benign or non-cancerous things in the breast.  And with the MRI pictures alone sometimes we may not be able to tell easily at least if something is cancerous or if something is non-cancerous, and what that leads us to, in some people, are biopsies.  So a lot of people are going through with biopsies that are potentially unnecessary, could be biopsying things that turn out to be non-cancerous. 

So for that reason we don’t recommend it routinely for all people.  We only recommend it for people that are considered to be at higher risk compared to the average population.  And the reason being is because people that are at higher risk—it’s justifiable potentially to go through with more biopsies because of their increased chance of having breast cancer compared to the average population. 

Andrew Schorr:

So if a woman has a family history, maybe with a mom or her sister with breast cancer, where does breast MRI fit in?  Is she considered high risk? 

Dr. Loving:

Yes, definitely.  So we encourage all women that have either questioned or they know they have a higher risk to discuss that with their primary care physicians.  There’s a number of factors that contribute to a woman’s risk of breast cancer, the common ones being family history such as someone with their mother or sister that had breast cancer particularly at an early age, or in some people they have genetic conditions that they know of that predispose them to developing breast cancer.  And people like that, it’s important to talk to your doctor and discuss your risk factor and determine if MRI plays a role in your screening routine for breast cancer. 

Andrew Schorr:

So it sounds like you’re now at the point with imaging techniques that you have a good chance of spotting the breast cancer early where it can either be cured or the effects can be limited. 

Dr. Loving:

Yes.  So in the breast imaging world there’s been a lot of research to improve our technology.  Tomosynthesis and MRI being two examples of those, and we’re constantly researching and developing new techniques.  And the goal ultimately is to look at the breast and to be able to distinguish what’s normal and what’s abnormal and of the things that are abnormal to be able to find them earlier and smaller at an earlier stage.  We found that the earlier you find breast cancer the better the chances of ultimately getting a cure. 

Andrew Schorr:

So I know there have been federal panels that have made some recommendations. There’s been some controversy.  What do you recommend as far as breast cancer screening guidelines? 

Dr. Loving:

So at Banner MD Anderson Cancer Center we are in agreement with the American Cancer Society in that we recommend annual screening mammography, so once a year starting at age 40 and on from that point.  We found that that screening schedule is optimal for minimizing breast cancer mortality, in other words finding breast cancer at its earlier stage and improving chances for a cure. 

Andrew Schorr:

Dr. Vilert Loving, breast radiologist at Banner MD Anderson Cancer Center, thank you for explaining this for us and our viewers. 

Dr. Loving:

You’re welcome.  Thank you. 

Andrew Schorr:

I’m Andrew Schorr from Patient Power.  Remember, knowledge can be the best medicine of all. 


Please remember the opinions expressed on Patient Power are not necessarily the views of Banner Health, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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