2D vs 3D mammogram: How they compare and what to expect

Mammography is a vital imaging test that uses X-rays to assess breast health, capturing detailed images in either 2D or 3D formats. In this article, we’ll explore the key differences and similarities between 2D and 3D mammograms, covering how each is performed, what they can detect, who may benefit from each type, and how to access and interpret your results.

Waiting for mammogram results can be stressful, as they are often shared days later during a follow-up doctor’s appointment. With PocketHealth, you gain faster, secure access to your mammogram images and results, enabling you to approach your doctor’s visit informed and ready.

 

 

What is a mammogram?

A mammogram is an imaging technique that uses low-dose X-rays to view the inside of the breast and provide you and your healthcare team with valuable information about your evolving breast health. You might be referred for a mammogram for either screening or diagnostic purposes.

• Screening mammogram: Regular breast cancer screening mammograms establish a baseline against which your doctor can monitor your breast health. Mammograms can detect any abnormalities long before they can be physically felt. Early detection leads to much better health outcomes.
• Diagnostic mammogram: You might have a diagnostic mammogram if you experience any new or unusual breast symptoms or if your screening mammogram reveals any abnormalities. A diagnostic mammogram is not an automatic indication of cancer.

In both Canada and the USA, health authorities recommend women over the age of 40 with an average risk of breast cancer should have screening mammograms every two years.

2D mammograms

A traditional mammogram produces a 2D image. The technician takes two low-dose X-rays of each breast, one from the top and one from the side. This allows the radiologist to examine the inner breast tissue from two different vantage points.

3D mammograms

A 3D mammogram is also called digital breast tomosynthesis. The X-ray scanner moves in an arc over the breast, taking multiple images from several different angles. Those X-ray images, called ‘slices’, are digitally combined to provide a comprehensive view of the inside of the breast.

2D vs 3D mammogram: what are the differences and when are they recommended?

2D mammogram equipment is much more widely available and is often covered by insurance. Not every imaging clinic has 3D mammogram capability, and it can come with additional upfront costs or fees.

However, 3D mammograms present more detailed images of dense breast tissue and can pick up even tinier signs of cancerous growth. Women with dense breasts and a family history of breast cancer may find them helpful. 3D mammograms also produce fewer false positives, meaning fewer patients must be recalled for a second clarifying mammogram.

PocketHealth’s breast health tools provide patients with personalized breast cancer risk assessments and simplified mammogram management. Designed to increase early detection of breast cancer, these tools enable patients to take control of their breast health. Learn more about PocketHealth’s breast health tools here.

 

What does a mammogram detect?

Mammograms are used for regular screening purposes and to explore any noticeable external breast abnormalities, such as indentations or lumps, nipple discharge, pain, sores, or thickened skin. Mammograms also measure changes in breast tissue over time, which helps doctors monitor and detect:

• Calcifications: Small deposits of calcium amidst breast tissue. Calcifications can vary in size and are not uncommon as women age. They do not automatically indicate breast cancer.
• Density: Mammograms are the best method to measure breast density, the ratio of fatty to fibrous tissue the breast contains. Dense breast tissue can impede visibility, making it harder to detect signs of breast cancer.
• Distortions and asymmetries: A distortion is an area of the breast that appears pulled to a certain point; an asymmetry is an area that looks different from the surrounding breast tissue. These might be due to the physical placement of the breast on the mammogram scanner or an indication that further exploration is needed.
• Masses: An area of breast tissue with abnormal edges or shapes. Masses can include fluid-filled cysts or solid tissue. Not all solid masses are tumors, and not all tumors are malignant (cancerous).

Mammograms are also used if a breast biopsy is required, to help position the needle.

 

How 2D and 3D mammograms are performed

The scanning procedure itself is very similar for both 2D and 3D mammograms. You’ll be asked to remove the top half of your clothing and stand in front of the X-ray machine platform, which will be adjusted to your height.

The technician will ask you to place your breast on the X-ray platform and direct you to position your arms, body, and head. A clear plastic plate will compress your breast to the platform while the X-ray scanner takes images. At this point, the technician might ask you to hold your breath or adjust your position slightly to better capture images.

For a 2D mammogram, you’ll be fully repositioned for another scan at a different angle; during a 3D scan, the X-ray scanner will arc over your breast taking multiple image slices. Then the process will repeat for your other breast.

 

How to prepare for your mammogram

Mammograms are non-invasive imaging exams, but you can do a few things to make your appointment more friction-free.

Before your appointment

• Schedule your scan during the time your breasts are least tender: Many women report having breast tenderness before or during the first week of their menstrual periods. If possible, schedule your mammogram for the first or second week after your period.
• Bring your previous mammogram images: If this is not your first mammogram, obtain your previous mammogram images to bring with you, to help the radiologist track any changes over time. With PocketHealth, you can securely access all your medical imaging to share in diagnostic quality as needed.
• Keep the imaging clinic informed: When you book your appointment, tell the clinic if you have breast implants. Implants require some modifications to the process, so your appointment will likely take longer. Also, inform the clinic if you are pregnant or breastfeeding.
• Try to avoid caffeine: Caffeine can make breast tissue feel tender. Avoiding or reducing caffeine for 4-5 days before your appointment can help.

The day of your appointment

Here are some suggestions to make your mammogram appointment go more smoothly.

• Bring your requisition: Your requisition form has important information for the clinic and technician. Be sure to bring your ID or health card.
• Wear clothes you can comfortably remove: You’ll have to remove the entire top part of your clothing, so consider wearing a separate top and bottom.
• Don’t wear deodorant, antiperspirant, lotion or powder: These substances can interfere with your images. You can apply them after your appointment.
• Remove any jewelry: Necklaces and earrings can disrupt your images.

 

Getting your results

Getting your mammogram is the first step. Next comes obtaining and understanding your results.

How long does it take to get my mammogram results?

The mammogram technician sends your images to a radiologist for interpretation, who will forward the images and a report to your referring physician. Then your doctor will discuss the results with you at a follow-up appointment. Depending on the clinic, this process can take anywhere from a few days to more than a week.

If you’d rather not wait anxiously for your results, PocketHealth gives you access to your mammogram images and report as soon as the radiologist releases them. My Care Navigator flags any follow-up recommendations, such as biopsies or further imaging, and can also provide you with a list of personalized questions to help you frame your discussion with your doctor.

 

 

Understanding my results

Your doctor will discuss your mammogram results with you at a follow-up appointment. This section explores the categories used to describe mammogram findings and their meanings.

What is a BI-RADS score?

Medical professionals use the Breast Imaging Reporting and Data System (BI-RADS) to sort and describe the findings in mammograms. BI-RADS has 7 categories:

• Category 0: Your mammogram was either incomplete or otherwise unclear, and you’ll need to have further imaging.
• Category 1: This is a normal result. It is considered ‘negative’ in a good way, because nothing new or abnormal was found.
• Category 2: This is also a negative result, which includes a finding of some sort that is NOT cancer, such as a benign cyst.
• Category 3: This category includes an abnormal finding which is not likely to be cancer. Findings at this stage are rarely biopsied, but usually monitored with further imaging 6, 12, or 24 months later.
• Category 4: The findings in this category are considered potentially cancerous. A biopsy will likely be recommended.
• Category 5: Findings in this category are highly suspicious and suggestive of cancer. A biopsy will be strongly recommended.
• Category 6: This category is reserved for findings in images taken after cancer has already been proven.

 

Frequently asked questions

Getting a mammogram can be stressful and uncomfortable, but knowing what to expect can help. Here are a few of the most pressing questions people have about mammograms.

What age should I get a mammogram?

North American health authorities recommend women aged 40 and over who have an average risk of breast cancer, should have screening mammograms every two years. Those with a higher cancer risk might be referred for mammograms more often.

Does insurance cover 3D mammograms?

Your insurance might cover most or some of the cost of a 3D mammogram. The exact answer depends on your insurance plan and your location. Ask your insurance provider for details.

Is a 3D mammogram more painful than a 2D mammogram?

No. In both 3D and 2D mammograms, your breast will be pressed between two plates. The pressure will cause some discomfort. If you’re worried about managing pain, ask your doctor about potential pain-reducing options.

How common is it to get called back from a mammogram?

It’s not uncommon to be called back for a follow-up mammogram. Being recalled does not mean you have cancer, only that more exploration is required. In fact, less than 10% of patients recalled for another mammogram have signs of cancer. Some of the reasons for mammogram recall include:

• Abnormal findings: If the mammogram found a cyst, or calcification or other abnormality, you’re more likely to be recalled in order to monitor and assess any changes.
• Unclear images: If your mammogram images were unclear or distorted, another mammogram will provide more clarity and visibility. You might also be recalled if you have dense breasts, to ensure thorough examination.
• Medical history: If your personal or family health history puts you at higher risk for breast cancer, you’ll be recalled more often so your doctor can track any development.

A recent radiology study showed that 3D mammograms had a lower recall rate (8.9%) than 2D mammograms (10.3%).

 

Stay on top of your health with PocketHealth

While mammograms are the standard imaging test to monitor breast health, depending on your results you might be sent for other types of imaging, such as a breast MRI, breast ultrasound, or molecular breast imaging. This could mean you end up with several different types of breast images to keep track of.

Aileen found it helpful and reassuring to have all her medical images in one secure location, accessible on any device. Having been diagnosed with metastatic breast cancer during the COVID-19 lockdowns, PocketHealth allowed her to share her images and progress when her husband couldn’t accompany her, and gave her a more comprehensive view of her health and progress.

When you can see and share your mammograms in diagnostic quality, you can confidently advocate for yourself. PocketHealth gives you the easy, secure access to your breast images you need to take control of your breast health journey and enjoy peace of mind.