In our culture’s ongoing conversation about disease prevention and detection, disagreements about the benefits of hyper-vigilance persist, even among experts. When it comes to routine mammogram screening, Diane LoRusso, MD, of Rye Radiology Associates, says simply more or less frequency is not the answer—better technology is.
LoRusso’s Rye facility is the first in the Westchester area to offer 3D mammography, an imaging innovation the 40-year veteran diagnostic radiologist calls “the most remarkable improvement I have seen in all my years of practice.”
The FDA cited that same progress in February 2011, approving the Silenia Dimensions 3D digital breast tomosynthesis system by Hologic. The system was noted for its measurable improvement in clinical performance over 2D mammography in ruling out cancer without patient callback and specificity in localizing breast abnormalities and detecting invasive breast cancer earlier.
Time and again, LoRusso says, she has confidently dismissed questionable areas scanned with 2D technology after seeing them in 3D.
Any mammogram requires that the breast tissue be compressed—the conventional shortcoming being overlap of tissue and shadowing in 2D modelings. The 3D tomosynthesis image works in combination with a 2D image to reconstruct the architecture of the breast in one-millimeter slices, with no overlap.
“3D finds early invasive cancers that distort the breast tissue only a little,” says LoRusso. “Some of them are only a few millimeters. You’re saving lives by finding this early.” LoRusso speaks from experience, having identified subtle cancers in both fatty and dense breasts that she says were not visible on the traditional 2D mammogram.
Always an early technology adopter, LoRusso purchased her first mammography machine in 1975. “We’re very proactive,” she says. “I have a high-risk practice.” Seven years ago, they transitioned from film-screen mammography to digital; and after its FDA approval, LoRusso actively followed the research about 3D mammography.
“A 2011 study in Norway showed that by adding 3D to 2D imaging, you could find 40 percent more invasive breast cancers and 17 percent less false positives.” An Italian study with 7,200 women that came out this May had even more successful results. “I never thought I would see this kind of improvement in my lifetime,” she says.
By July 2012, LoRusso’s office had upgraded, joining Mount Sinai and a smattering of other clinics around the country, and some 30 countries internationally, already using 3D mammography. While the new machine, which costs close to a half-million dollars, may be more effective as far as accurate and early detection, it remains a rarity—as it is not currently covered by insurance in the US.
“What we do is charge the patient $100 in addition to the regular mammogram their insurance covers. They have the right to choose if they want 3D or not,” LoRusso says. But after speaking with the office’s chief technologist, she reports, “most choose to have it.”
Despite her enthusiasm for advances in screening technology, the holistic practitioner is under no illusions. “It’s the best mammogram that we’ve ever seen, but it doesn’t replace the other tests we do for breast cancer. You will still find more by adding ultrasounds and MRIs with very high-risk patients. None of these are 100 percent.”
What LoRusso remains positive about is this: With women over 40, “we have to screen every year.”