Breast Tomosynthesis: How to Prepare and What to Expect

If your doctor has recommended a breast tomosynthesis scan (also called a 3D mammogram), you may have questions about the procedure. This guide will explain this imaging technique, what to expect, and how to prepare for your appointment.

For those looking to take proactive control of their breast health, PocketHealth can help. With secure, easy access to your breast imaging records, PocketHealth allows you to better understand your breast health. In addition, PocketHealth offers personalized estimated breast cancer risk scores to help you and your doctor make informed decisions about preventive measures and future screenings.

 

 

What is breast tomosynthesis?

Breast tomosynthesis is also known as DBT (digital breast tomosynthesis) or simply a 3D mammogram. This imaging technique is more advanced than typical 2D mammography, which means it may not be available at every imaging clinic. Both mammogram types can detect breast cancer and other breast conditions.

The scan uses low-dose X-rays (electromagnetic radiation) to capture images of internal structures, similar to other types of X-ray imaging. DBT scans are unique because they take several images (called slices) in an arcing pattern, providing far more detail than other X-ray methods.

2D vs 3D mammograms

Typical mammogram screenings are 2D, with two images taken from different angles for each breast, resulting in only two scans per breast. However, 3D mammograms consist of several images (200 to 300) combined to provide a more detailed view. Because of this, DBT scans result in fewer callbacks, meaning fewer false positives where a finding discovered during the scan is later determined to be benign.

It is not uncommon for 2D mammograms to misidentify normal breast tissue as suspicious for cancer or other conditions. When this happens, patients may require additional scans or biopsies to gather more information. This often proves unnecessary and causes undue stress for the patient. Breast tomosynthesis has lower rates of false positives.

 

What is breast tomosynthesis used for?

Like 2D mammograms, breast tomosynthesis is a method to help detect breast cancer. It’s especially useful in finding early cases, before patients are more symptomatic. It can be used as a general screening method, which is recommended for all patients assigned female at birth (AFAB) between the ages of 40 and 74. It can also be used for diagnosing symptoms, such as breast pain, lumps etc.

 

Who should have a 3D mammogram?

For now, the standard for patients at average risk for breast cancer is still a 2D mammogram. This may change over time, but for most cases, a 2D scan is considered sufficient. A 3D mammogram is recommended in the following conditions:

• Patients with dense breasts: Dense breasts make it more challenging to detect cancer on a 2D mammogram.
• Patients with breast implants: Implants can obscure views on 2D mammograms, making DBT scans a useful alternative to improve imaging.
• Patients with breast abnormalities: If patients are experiencing unusual breast changes, nipple discharge, or lumps, DBT scans can provide a more thorough diagnostic screening.

 

How is a breast tomosynthesis performed?

Breast tomosynthesis scans are performed similarly to a standard 2D scan. The main difference is that the X-ray arm moves in an arc around the breast while capturing images. Here’s what to expect:

1. The patient wears a hospital gown and stands in front of the mammography machine.
2. The technician will position the patient’s breast on a plate platform on the machine, then lower another plate from above to compress the breast. This compression helps provide a clearer view of the breast tissue.
3. There will be pressure during this process, which may cause discomfort. If it’s too painful, the technician should be informed so that adjustments can be made. Many newer mammography machines are less uncomfortable than previous versions.
4. The technician will move to the machine’s controls to perform the scan, asking the patient to hold their breath for short intervals.
5. The compression occurs in multiple periods of 10 to 20 seconds, with the technician readjusting breast positioning before repeating the scan.
6. Once one breast is finished, the scan will be repeated on the other side. The total appointment time is typically 10 to 20 minutes, but most of that time is spent on preparation and positioning, not compression.

 

How to prepare for a 3D mammogram

Preparation for a DBT scan is the same as for a traditional 2D mammogram. Here are some tips to help you prepare for your appointment.

Tips before the scan

• Let your doctor know of any significant breast history: This includes previous surgeries or implants, a personal or family history of breast cancer or the use of certain medications like hormones. This helps the radiologist interpret the mammogram while considering these factors.
• Menstruating patients may consider scheduling the appointment a week after their period: Many patients find this time to be the least sensitive for their breasts, which can reduce discomfort during the mammogram.
• Inform your doctor if you think you may be pregnant: Due to the small amount of radiation exposure from X-rays, most medical professionals recommend avoiding these scans during pregnancy to prevent exposing the fetus.
• Double-check any instructions: If you were given preparatory advice, reviewing it may be a good idea to ensure no important preparations are missed.

Tips the day of the scan

• Avoid wearing lotions, powders or deodorants: Patients should not apply these substances to their breasts, chest or armpits as they can appear similar to calcium deposits on the mammogram images and may lead to misleading diagnoses.
• Bring your requisition form: This saves time if the imaging facility hasn’t received it already. Also bring your health card and ID.
• Bring previous medical breast imaging: It is recommended to bring past imaging to your scan for the radiologist to use as a reference, especially if it was performed at a different facility. PocketHealth provides fast and secure access to these records, making it easy to share with medical providers.
• Wear comfortable clothing: Patients will wear a hospital gown on their upper body, but they can usually remain in their normal attire for their lower body. Wearing comfortable clothes that are two separate pieces makes this easier. Also, avoid wearing metal accessories or jewelry.

 

Getting my results

The mammogram technician is not legally allowed to discuss results during the scan. They can answer questions about the appointment itself, but not about the imaging results. Here are some common questions regarding getting breast imaging results back.

When will I get my results?

Turnaround times for mammogram results can vary widely depending on the facility and your doctor’s availability. Often, patients wait a week or more and receive their results during a follow-up appointment. With PocketHealth, you don’t have to wait as long—your results are available securely as soon as they’re uploaded, allowing you to review them often before your follow-up visit.

 

 

Who interprets my results?

A radiologist—an expert in interpreting medical images—will carefully review your breast tomosynthesis and provide a detailed report of any findings. This report is then sent to your referring doctor, who, with a deeper understanding of your medical history, can offer additional insights and recommendations based on the results.

 

Understanding your results

It’s common to find medical terminology somewhat confusing, but Report Reader helps you to better understand your report by offering clear, straightforward definitions for medical terms—simply tap or click on any underlined words to reveal their meaning. Meanwhile, this guide will briefly cover common terminology found in DBT scans.

Common findings and what they mean:

Common breast conditions that mammograms may reveal include:

• Calcifications: Small collections of calcium that appear as tiny white spots on the mammogram. These are common, especially as patients age, but certain patterns can be a sign of breast cancer. However, most calcifications are benign.
• Breast cancer signs: These could be irregular masses or patches. A biopsy is usually performed for confirmation, although many of these are benign.
• Breast cysts and lumps: Breast cysts are fluid-filled sacs that can form within the breasts. Most of the time, they are benign, as are many lumps and tumors, though they may be biopsied to be certain.
• Breast density: Most mammograms will indicate the patient’s breast density, which can affect how easily breast cancer is detected.

 

BI-RADS scores and what they mean

Patients who have undergone 2D mammograms may already be familiar with the Breast Imaging Reporting and Data System (BI-RADS). 3D mammograms use the same system to describe breast imaging results on a scale from 0 to 6, with each level indicating different possible findings or conditions:

• 0 (incomplete): This score indicates that additional imaging is necessary, often due to unclear images or the need for a more detailed view.
• 1 (negative): This means both breasts appear symmetrical, and no abnormalities were detected.
• 2 (benign finding): This means a non-cancerous finding, such as a calcification or cyst, was detected.
• 3 (probably benign finding): This means the finding has a 2% or less chance of being cancerous. To be safe, another scan is typically done within 6 to 12 months to check again.
• 4 (suspicious abnormality): There is a possibility that the finding is cancerous, but it does not definitively look like cancer. A biopsy and further testing are usually the next steps.
• 5 (highly likely to be cancerous): The finding has a 95% or higher chance of being cancerous. A biopsy and further testing are recommended.
• 6 (proven malignancy): This is used for patients who have already been diagnosed with breast cancer. The mammogram is used to evaluate the spread of the disease or the effectiveness of treatment.

 

Frequently asked questions

Here is a brief overview of frequently asked questions regarding breast tomosynthesis.

Are there any disadvantages of breast tomosynthesis?

Breast tomosynthesis is generally considered an improvement over 2D mammograms. However, because it is relatively new, many facilities do not yet offer it to patients. It can also be more expensive, sometimes involves slightly higher radiation exposure, and may not always be covered by insurance.

What is the tomosynthesis vs mammography radiation dose?

3D mammograms can produce higher or lower radiation levels than 2D versions, depending on the equipment being used. As advancements in DBT technology progress, these levels are expected to decrease over time. Regardless, the current radiation exposure is low and considered to be low-risk.

How is tomosynthesis different from a breast ultrasound?

A breast ultrasound does not use X-rays; instead, it uses high-frequency sound waves to create echoes that bounce off internal structures and capture images. Ultrasounds and mammograms work well together, providing additional imaging when needed. 3D mammograms are effective at detecting early signs of breast cancer or other symptoms. However, if more clarity is required on DBT findings, breast ultrasounds can provide better details, such as determining whether a lump is a fluid-filled cyst or a solid mass.

How is a 3D mammogram different from a breast MRI?

Like breast ultrasounds, breast MRIs (magnetic resonance imaging) are a useful complement to a 3D mammogram. This technique uses magnets and radio waves to produce 3D images of the patient’s internal anatomy. Some patients may require an MRI instead of a mammogram, particularly those at higher risk for breast cancer who need more sensitive imaging. However, more commonly, MRIs are used as a supplement to mammograms. This can include situations where more detail is needed on an abnormal finding, when the patient has breast implants that may obstruct views and when the patient has very dense breasts. Breast MRIs are highly detailed, making them a strong screening and diagnostic tool, but they can also lead to false positives, as they may detect benign findings more frequently than other imaging methods.

 

Take control of your breast health journey

Given the routine nature of breast imaging, tracking changes over time is essential. Having secure access to all your imaging records in one place allows you to be actively involved in your health journey. You can compare breast changes, send records to other medical providers, and even print and store these reports for your own use. For Mary, accessing her breast imaging through PocketHealth helped her catch the medical recommendation for more frequent mammogram screenings, something her clinic had missed.

Another tool for your breast health is MyCare Navigator, which provides personalized insights to your health and identifies any recommended follow-up steps. This feature can also generate individualized questions to ask your doctor based on the findings in your report, ensuring you make the most of your consultation.