3D mammography is a new technology that produces 3D images of breast tissue by combining multiple x-ray images taken from different angles. Clinical trials have found that 3D mammography increases cancer detection rates by 47% compared to standard 2D mammography. It also reduces unnecessary patient recalls by 28-40% by minimizing issues with dense breast tissue. The enhanced 3D images allow for more precise localization of abnormalities. 3D mammography has the potential to improve outcomes by finding more cancers early while also reducing patient anxiety and healthcare costs from unnecessary additional testing.

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3D Mammography
Breast Cancer Prevention & Detection
ITEC 610, Section 9080
Professor Irene-Wong-Bushby
November 24, 2013

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Abstract
Breast cancer is the second leading cause of cancer death in women, exceeded only by lung cancer.
The (American Cancer Society [ACS], 2013) predictions are:
 About 232,340 newly diagnosed cases of invasive breast cancer
 About 64,640 newly diagnosed cases of carcinoma in situ (CIS), a non-invasive and earliest form
of breast cancer
 About 39,620 women will die from breast cancer
These statistics make early detection screening vital. Mammography is an invaluable tool for
identifying breast cancer close to its onset. However, the tissue intersections portrayed on mammograms
may generate considerable hurdles in the process of detecting and diagnosing irregularities. Park, Franken,
Garg, Fajardo, and Niklason (2007) found initiating diagnostic testing because of a questionable result at
screening mammography frequently causes patients unnecessary anxiety and incurs increased medical
costs. 3D Mammography (aka Digital Breast Tomosynthesis (DBT)) is more successful at detecting and
preventing Breast Cancer than the established 2D method alone. Research has indicated an increase of
47% in cancer detection using 3D Mammography compared to 2D digital mammography alone (Smith,
2012). Additionally a 28% to 40% reduction in non-cancer patient recall rates has been observed (Smith,
2012).
This paper will compare the technology of 2D mammography versus 3D Mammography, and the
benefits of 3D Mammography in early breast cancer detection.
Introduction
Breast cancer is the most frequently detected cancer identified in women today. 2D
mammography is a specific form of mammography which uses digital receiving devices or receptors and
computers to capture images during the screening and diagnosis for breast cancer. The FDA approved the
use of 2D digital mammography in 2000. Since that time 2D mammography has become the established

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method for screening and diagnosis. However, it has been found to have limitations; especially among
women whose breast composition is formed of non-fatty tissue. This is also referred to as women with
dense breast tissue.
The 3D Mammography system was FDA approved for commercial use in 2011. 3D mammography
is an enhancement of the 2D mammographic images. This process involves the combination of two images
captured from varying angles to produce an enhanced detailed three-dimensional view of the breast’s
internal structure
The following portions of this paper will expound upon the background of this technology and
associated application. We will explore clinical trial results, application benefits, and present analytical
evidence that 3D Mammography is more successful at detecting and preventing Breast Cancer than the
established 2D method alone.
Technology Background
2D mammography refers to the image capture of breast tissue. Usually two images of each breast
are captured during the process. 2D mammography involves the process of data compression and x-rays.
Data compression consists of encoding of digital information into fewer bits. This process in conjunction
with x-rays is used to capture images of the breast to a computer. Once the images have been captured
they are then reviewed for the presence of abnormalities. Through computer aided design techniques the
images are analyzed by manipulating or adjusting the light contrast or brightness. The techniques improve
the pixilation, etc. in an effort improve the view of the breast. This process is also referred to as image
segmentation.
The segmentation process is directly impacted by the quality of the image captured. Unwanted
signals (aka noise) randomly produced from the capturing equipment can result in variations in the
brightness or coloring of the image. Mammographic image analysis is a challenging task due to poor
illumination and high noise levels in the image (Singh & Al-Mansoori, 2000). The segmentation techniques

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use the application of filters to assist with noise removal (L.S.S., Reddy, Madhu, & Nagaraju (2010)). In
contrast to the two-dimension view of the breast provided through 2D mammography, 3D mammography
acquires images from several angles. The individual images are then reconstructed into a series of thin
high-resolution slices which can be displayed individually or in a high-dynamic (Smith, 2005) view which
exaggerates the contrasts in the image for more accurate reading and diagnosis. For this process to be
effective the data retrieved from these images must be viewed linearly or in alignment from point to point.
The alignment of image data is referred to as Image Registration. NWIET (2013) provides an in-depth
study regarding image data relationships and the varying registration techniques. Specific to the medical
industry, Kim, J., Cai, W., Feng, D., & Wu, H. (2006) discusses how the application of this technology can
address the increased demand for better image storage and retrieval processes across various image data
and image collection systems. They also address the opportunities for the development of more effective
image data bases that house historical patient information across varying image structures. This provides
greater statistical analysis of patient imaging records, which is vital in the quest for predictive, preventative,
and diagnostic medicine.
3D mammography technology provides complex image processing. Data retrieved from the
reconstructed images when performed on patients with dense breasts can reduce and or eliminate issues
presented in 2D mammographic result. There are many opportunities and benefits to this technology.
These opportunities will be discussed further under the analysis of 3D mammography section of this paper.
Clinical Trial Results
Limitations of the 2D mammography process can obscure cancer readings, especially within dense
breast tissue. When this occurs normal structures may appear as abnormal and actual cancer structures
can be missed. This results in increased false-positive readings and patient recalls. Researchers have
performed an analysis on cases following their grouping into fatty breast and dense breast sub-groups
(Smith, 2012). Additionally, “Rafferty studied the performance of tomosynthesis in women with dense

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breasts and found an increase in the recall for cancer cases and a reduction in the recall rate for non-
cancer cases” (as cited in Smith, 2012, p. 4).
Ciatto et al. (2013) conducted a comparative study investigating the screening results of 2D vs 3D
mammography in population breast-cancer screening. “Standard double-reading by breast radiologists
determined whether to recall the participant based on positive mammography at either screen read” (Ciatto,
2013). Results of this comparative study were based on a 95% confidence interval identified from a
population of 7292 participants 59 cancer detections (8.1%) were achieved from both 2D and 3D screening
methods as compared to 39 cancer detections (5.3%) from 2D methods alone. Additionally, of the 7292
participants studied 395 (5.5%) yielded false-positive results. Employing both detection methods 181 false-
positives (2.5%) were observed and 2D screenings alone yielded 141 false-positives (1.9%), as compared
to 3D screenings which yielded 73 false-positives (1%). These results present a strong argument which
suggests that adopting 3D mammography technology would provide a definitive reduction of false patient
recalls and an overall increase of true cancer detections would be observed.
Analysis of 3D Mammography
The evidence demonstrates the performance of 3D mammography technology should significantly
decrease and minimize existing reading difficulties present in 2D mammography screening and diagnosis;
thus reducing the need to perform needle biopsies on noncancerous masses. Furthermore, the 3D
mammography process of point to point mapping affords more precise abnormality location for required
needle biopsies for cancerous anomalies. Moreover, data reveals that 3D exams can increase the patient
recall for true cancer bearing masses found in the breast and can reduce patient recalls for noncancerous
abnormalities.
Beyond the potential clinical benefits mentioned, 3D mammography also presents the opportunity
to reduce patient radiation exposure. With increased image enhancement activity the need for additional
scans to properly identify suspicious abnormalities is eliminated. This same enhancement also provides

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needed images through the reduction of noise presence, which allows for quicker imaging review and
patient response time. 2D mammography can be painful because of the high breast compression required
to ensure tissue structures are captured accurately. The high amount of compression is not needed in 3D
mammography exams.
3D mammography also provides emotional and financial benefits for the patients as well as the
radiologist. With reduction of false call back patent anxiety is eliminated. However, potential patient
expenses presented from additional examinations and tests become nonexistent. Furthermore, radiologist
accuracy levels are substantiated from their generation of more precise data readings. The litigation
potential resulting from false-positive diagnoses are also thwarted.
Conclusion
The introduction of 3D mammography technology is a ground-breaking industry development in
breast cancer screening processes. This technology has positioned the medical industry for an opportunity
to achieve a competitive advantage in the quest to identify and eradicate the causes of breast cancer. The
future state of this technology includes the development of more precise computer-aided design (CAD)
algorithms to improve noise filtration, and image clarity. Success in this arena also enlarges the platform
for 3D image applications in other areas of medical diagnosis, as well as a more refined image storage and
reference databases. This is required for preventative patient medicine processes across the entire image
capturing spectrum.
3D mammography offers strategic solutions for patients with fatty and dense breast compositions
by providing fast accurate detection, biopsy reduction requirements and patient recalls, reduced patient
anxiety towards radiation exposure, painful examinations and overall survivability. 3D Mammography (aka
Digital Breast Tomosynthesis (DBT)) is a viable option for more successful detection and prevention of
Breast Cancer than the established 2D method alone.

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References
American Cancer Society (ACS). (2013, October 1). Breast Cancer. Retrieved from
http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-what-is-breast-cancer
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Kim, J., Cai, W., Feng, D., & Wu, H. (2006). A new way for multidimensional medical data management:
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