This past June, Governor Greg Abbott signed a new Texas House bill into law. House Bill 1036 mandates Texas private insurance companies cover the cost of 3-D mammography (also known as digital breast tomosynthesis). On Jan. 1, 2018, all Texas insurance health benefit plans that are delivered, issued for delivery or renewed in the state of Texas must cover the full cost of an annual 3-D screening mammography with no copay for women over the age of 35. Texas became the sixth state to have such a law.
James Polfreman, president and CEO of Solis Mammography says, "Today, in many states, a woman's ability to benefit from the advances of 3-D mammography is not based on education or physician recommendation, but rather upon her financial means. This can and is changing with active support from many, including our Texas state representatives."
THE History
The technology of 3-D mammography has been around for nearly a decade. In 2010, Solis Mammography's Chief Medical Officer Dr. Stephen Rose presented the very first patient in the country diagnosed with 3-D mammography to a Food and Drug Administration medical panel. The following year in 2011, the FDA approved 3-D mammography. Peer-reviewed research, co-authored by Dr. Rose, published in the American Journal of Roentgenology in 2013, demonstrated that 3-D mammography increases early detection of breast cancer by 54 percent and decreases recall rates by 37 percent. In 2015, Medicare announced full coverage for 3-D mammography, and in 2016, CIGNA became the first national private insurer to cover 3-D mammography. Since then, various private insurers have followed suit.
How IT WORKS
From a patient's point of view, there is no noticeable difference between a 2-D exam and a 3-D exam. The procedure takes the same amount of time, compression and positioning. The only change a woman will see is that instead of the camera arm of the machine remaining stationary, as in a 2-D mammogram, the arm will swing around the breast as it takes the multiple 3-D images.
However, from a radiologist's point of view, the difference in images is night and day. Providing the equivalent of 60 images of breast tissue, divided into 1-millimeter slices, 3-D mammography allows the radiologist to see cancers as early as stage zero and to find masses that might otherwise be hidden within dense breast tissue. The conventional 2-D mammography offers the radiologist just two images of each breast through compressed breast tissue.
In layman's terms, imagine a closed book with clear covers and pages. With 2-D, the radiologist must peer through the front or back cover, looking for a single word that does not have the same characteristics as the other words. With 3-D, the breast becomes like an open book - with the 60 images giving the radiologist an ability to look for that abnormal word, one "page" at a time.
Dense Breast Tissue
Women who have denser breast tissue tend to be younger. Of the women diagnosed with invasive breast cancer in 2015, 22 percent were under the age of 50.
Mammogram images are black and white. Breast cancer and dense glandular tissue appear white, while fatty tissue appears gray on a mammogram. Radiologists can better differentiate cancer from overlying glandular tissue with 3-D mammography.
Additionally, medical research shows that annual mammograms (2-D and 3-D) for women between the ages of 40 and 64 are key to early detection. Self-exams are great - but per the Mayo Clinic - the mass needs to be 1.5 centimeters (a little over the size of a pea) to be felt. The average anomaly found by a woman doing breast self-exams is the size of a walnut. The advantages of early detection include the possibility of avoiding chemotherapy, radiation, surgery or other invasive treatments.
With all of the advances in treatment for breast cancer, mammography remains the gold standard for detecting it, and 3-D mammography is the best technology available. Simply put, early detection saves lives, improves quality of life, and reduces the costs and risks associated with late-stage diagnosis.
To sum up, it's quite simple. Peace of mind and overall wellness come from getting the facts about your breast health - starting with your annual mammogram. This October, remember that the best offense is a good defense.
Dr. Happ is a board-certified radiologist with Dallas-based Solis Mammography.
