3-D breast cancer screening comes to LI
Mammography patient Virginia Velez receives a breast screening at Nassau University Medical Center. (July 11, 2011) Credit: Chris Ware
Breast cancer screening is going 3-D, and women on Long Island are among the first to benefit from the potentially lifesaving technology.
Doctors say the newest incarnation of the mammogram will eliminate many of the false positives that now require patients to return for additional, often invasive, tests.
The emergence of the new technology on Long Island is yet another step toward providing a more accurate degree of screening in a region in which breast cancer rates exceed the national norm but where women just like those anywhere are subject to the inaccuracies of conventional screening.
About one in 10 women who undergo mammography are subject to false alarms -- suspicious "shadows" on a mammogram that turn out not to be cancer. And worse, with conventional technology, small tumors sometimes go undetected. The reason: Current digital and film-based machines produce only two-dimensional images.
The new device, using a process called tomosynthesis, takes 15 X-ray images of the breast in a sweeping arc, providing the angles needed to better detect subtle cancers.
A first for Long Island
On Long Island, Nassau University Medical Center in East Meadow is the first to use the new technology for routine screening. The device has been in its new breast health center for three weeks, and the imaging staff has quickly undergone training to come up to speed. "We think this is going to be the future of breast imaging," said Dr. Victor Scarmato, NUMC's chief of radiology.
The Mount Sinai Hospital in Manhattan has recently installed a tomosynthesis device, and Good Samaritan Hospital in West Islip has one as well and plans to use it in its new women's imaging center opening Aug. 1, a spokeswoman said.
The Food and Drug Administration approved the device in February for routine screening based on clinical trials demonstrating significant improvement in tumor detection. Research also showed greater tissue clarity, providing doctors in the studies with enough confidence to rule out cancer without calling back patients for further tests.
The first device to be government-approved is manufactured by Massachusetts-based Hologic. Other companies, such as Siemens and General Electric, are developing similar technology.
Hologic expects to deliver another half-dozen machines on Long Island within six months to other centers, said Kristin Schwarz, the company's regional account manager. They cost between $200,000 and $500,000.
A more pinpoint diagnosis
Even with just a few patients screened to date, NUMC's Scarmato is impressed. He said the new procedure is better at pinpointing the size, shape and location of abnormalities and distinguishing harmless growths from dangerous tumors.
"We're one of the pioneer sites, which is sort of new for us," Scarmato said. "Nassau University Medical Center is usually not the first with a lot of things, but this is something we not only wanted our patients to have, we wanted them to have the best equipment first."
The screening is being offered at no cost. It's so new that insurance codes setting a service fee haven't yet been established, Scarmato said. Tomosynthesis will be eligible for public and private insurance coverage.
The machine was paid for by a grant from the Gitenstein Foundation.
Tomosynthesis images are digital but produced in ultrathin slices, similar to CT scans. X-ray images are taken in quick succession along an arc at slightly different angles. The data is fed into a computer, where the radiologist "reads" the results.
"All the benefits of mammography are still there," said Dr. Ephraim Weingarten, NUMC's chief of breast imaging. "But we get additional information that's not available with regular mammography. We can actually see subtle cancers."
Conventional mammograms can obscure tumors, especially in younger women with dense tissue, he said.
As for radiation exposure, tomosynthesis produces a slightly higher dose than a conventional digital mammogram, which exposes patients to about 1.86 milligrays of ionizing radiation -- considered a safe level not much more than a dental X-ray. Weingarten estimates the amount in tomosynthesis is equivalent to a film-based mammogram at about 2.37 milligrays. About 30 percent of mammography machines nationwide involve film.
Dr. Paul Fisher, associated professor of radiology at Stony Brook University Medical Center, where two tomosynthesis devices are used in research, said the technique is new to routine breast screening but the technology has been used for years in screening for kidney stones. "It can help find some early breast cancers, but more important, people will not have to have biopsies and extra work because of false alarms," he said.
Tomosynthesis vs. mammograms
Slightly less pressure is used with tomosynthesis
Because 15 images are taken, if an abnormality is not seen in one it will likely be detected in the other images
High clarity images help doctors distinguish between cancers and non-cancers, reducing callbacks for additional tests
Tomosynthesis helps radiologists better pinpoint the size, shape and location of abnormalities
Tomosynthesis is not replacing standard mammography, which is still considered the gold standard, but many experts expect it to become the standard in the not-too-distant future.
Sources: Dr. Ephraim Weingarten, Nassau University Medical Center; Hologic; Massachusetts General Hospital
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