Table of ContentsView AllTable of Contents2D versus 3DBenefitsDisadvantagesWhat to ExpectInterpreting ResultsWhen to Screen
Table of ContentsView All
View All
Table of Contents
2D versus 3D
Benefits
Disadvantages
What to Expect
Interpreting Results
When to Screen
There are pros and cons to 3D mammograms used for breast cancer screening when compared to traditional 2D mammograms.
While 3D mammograms (also known as digital breasttomosynthesis, or DBT) can potentially improve cancer detection rates, they are costlier than 2Dmammograms(also known as full-field digital mammography, or FFDM) and have the potential forfalse-positiveresults.
3D mammogram machines have become increasingly common in the United States and are able to generate both DBT and FFDM images. While studies have shown that the combination of 3D and 2D imaging can reduce the need for additional imagining, it remains unclear what impact this newer approach has on overall cancer detection andmortality(death) rates.
What Is 3D Mammography and How Does It Work?
2D mammography was traditionally performed on standard X-ray film (called screen-film mammograms) before switching to FFDM which stores X-ray images on computers (similar to the way that a digital camera takes and stores images).
DBT is similar tocomputed tomography (CT)in that both composite multiple X-ray images. But DBT requires far fewer X-ray beams and exposes you to far less radiation.
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Advantages of 3D Mammograms
Among the findings:
The risks associated with DBT and FFDM are largely the same, and there are no absolute contraindications to either procedure.
Disadvantages of 3D Mammograms
Although it may appear that the benefits of DBT outweigh the risks, 3D mammography has a number of drawbacks that limit its usefulness for breast cancer screening. This includes uncertainties as to whether it is “better” than FFDM in spotting certain signs, such as malignant calcifications, or preventing false-positive results.
Because of these shortcomings, most health authorities recommend the combination of DBT and FFDM for screening purposes. A 2021 review published in theJournal of the National Cancer Institutefound that the combination approach was more than 40% better at detecting breast cancer than either DBT or FFDM alone.
The same review published inHealthcarehighlighted some of these concerns:
3D mammography may be performed in a hospital or outpatient center. Not all facilities offer 3D mammography, so check with the center before booking.
Also, check with your insurer as to whetherprior authorizationis needed as some allow for 2D mammograms without authorization but not for 3D mammography.
Where Are 3D Mammograms Available?As of 2022, 15 U.S. states have mandated the use of 3D mammograms as a standard of care, including Arkansas, Connecticut, Illinois, Kansas, Kentucky, Maryland, Missouri, New Jersey, Pennsylvania, and Texas.In states with no such mandate, the choice between DBT or FFDM may be subject to availability and cost.
Where Are 3D Mammograms Available?
As of 2022, 15 U.S. states have mandated the use of 3D mammograms as a standard of care, including Arkansas, Connecticut, Illinois, Kansas, Kentucky, Maryland, Missouri, New Jersey, Pennsylvania, and Texas.In states with no such mandate, the choice between DBT or FFDM may be subject to availability and cost.
As of 2022, 15 U.S. states have mandated the use of 3D mammograms as a standard of care, including Arkansas, Connecticut, Illinois, Kansas, Kentucky, Maryland, Missouri, New Jersey, Pennsylvania, and Texas.
In states with no such mandate, the choice between DBT or FFDM may be subject to availability and cost.
3D mammograms take around 10 minutes to perform, not including waiting times. This is more or less the same time you would expect with a 2D mammogram.
During the procedure, you will be asked to stand in front of the mammography machine. The technician will position one of your breasts on a platform and help you position your head, arm, and torso. A plastic plate will then press your breast against the platform.
Once your breast is in place, the technician will turn on the machine. It will move from side to side in an arc to take multiple pictures of your breast. You may be asked to hold your breath.
After the first round of pictures is taken, a second round may be taken from a different angle. For this, your breast may be repositioned on the plate. Once the first breast has been imaged, the procedure will be repeated with the second breast.
Mammogram results usually come back within two weeks, although 3D mammograms may take slightly longer.
Mammogram results will contain descriptions of both benign (non-cancerous) and suspicious findings that your healthcare provider can help you understand.
This would include aBI-RADS numberif an abnormality is found. The number indicates the likelihood that a finding is cancerous. Higher numbers indicate a greater suspicion of breast cancer and the need for either immediate follow-up or more frequent follow-ups.
For example, a BI-RADS score of 3 means that your breasts are probably healthy, but you should return for a follow-up in six months. With a BI-RADS score over 3, you may be referred for abiopsy.
The report will also include information about your breast density. All states require providers to inform their patients if they havedense breastsas this can make a mammogram more difficult to read and contribute to an increased risk of cancer if a tumor or lesion is missed.That said, your report will say whether your breasts are “dense” or “not dense.”
3D Mammogram Screening Recommendations
There are no specific recommendations concerning the use of 3D mammography from either the U.S. Preventive Services Task Force, the American Cancer Society, the American College of Obstetricians and Gynecologists (ACOG), or the American College of Physicians.
Whether FFDM or combination DBT/FFDM is used, the same mammogram screening guidelines apply.
Women of Average RiskUSPSTFAmerican Cancer SocietyACOGAmerican College of PhysiciansAges 40-49Recommended every two years.People should have the choice to start yearly screenings at age 40. People ages 45-49 should be screened yearly.After counseling, having screenings annually or every other year should be offered.Clinicians should discuss benefits and harms. Potential harms outweigh the benefits for most people.Ages 50-74Recommended every two yearsAges 50-54 annually; 55+ every two years or annuallyAnnuallyorevery two years, after counselingShould be offered every two yearsAges 75+Insufficient evidence to balance benefits/harmsPeople should continue as long as in overall good health and have a life expectancy greater than 10 years.The decision to stop should be based on shared decision-making.Discontinue, especially for people with less than 10-year life expectancyWomen with dense breastsInsufficient evidence for/against additional screeningInsufficient evidence for/against annual MRIRoutine mammography; comply with state density disclosure lawsInsufficient evidenceThis table does not include information about alternative screening choices, including clinical breast exams.Recommendations for Transgender PeopleTransgendermen who have not undergonetop surgeryare generally advised to screen at the same frequency ascisgenderwomen.Transgender women who have experienced breast growth onestrogenare advised not to commence screening until after a minimum of five years of feminizing hormone use. Thereafter, screening recommendations would remain the same as for cisgender women.Summary3D mammography has pros and cons. Among the pros, it can better detect signs of cancer (especially in dense breasts) and reduce the likelihood of repeat imaging. On the con side, it is costlier, exposes you to higher doses of radiation, and may be no better than a standard mammogram in women with low-density breasts.3D mammograms are standardly performed with 2D mammograms to improve the accuracy of breast cancer screening.
Recommendations for Transgender PeopleTransgendermen who have not undergonetop surgeryare generally advised to screen at the same frequency ascisgenderwomen.Transgender women who have experienced breast growth onestrogenare advised not to commence screening until after a minimum of five years of feminizing hormone use. Thereafter, screening recommendations would remain the same as for cisgender women.
Recommendations for Transgender People
Transgendermen who have not undergonetop surgeryare generally advised to screen at the same frequency ascisgenderwomen.Transgender women who have experienced breast growth onestrogenare advised not to commence screening until after a minimum of five years of feminizing hormone use. Thereafter, screening recommendations would remain the same as for cisgender women.
Transgendermen who have not undergonetop surgeryare generally advised to screen at the same frequency ascisgenderwomen.
Transgender women who have experienced breast growth onestrogenare advised not to commence screening until after a minimum of five years of feminizing hormone use. Thereafter, screening recommendations would remain the same as for cisgender women.
Summary
3D mammography has pros and cons. Among the pros, it can better detect signs of cancer (especially in dense breasts) and reduce the likelihood of repeat imaging. On the con side, it is costlier, exposes you to higher doses of radiation, and may be no better than a standard mammogram in women with low-density breasts.
3D mammograms are standardly performed with 2D mammograms to improve the accuracy of breast cancer screening.
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kleinknecht JH, Ciurea AI, Ciortea CA.Pros and cons for breast cancer screening with tomosynthesis – a review of the literature.Med Pharm Rep.2020 Oct;93(4):335–341. doi:10.15386/mpr-1698Lowry KP, Trentham-Dietz A, Schechter CB, et al.Long-term outcomes and cost-effectiveness of breast cancer screening with digital breast tomosynthesis in the United States.J Natl Cancer Inst. 2020 Jun;112(6):582–589. doi:10.1093/jnci/djz184U.S. Preventive Services Task Force.Screening for breast cancer: US Preventive Services Task Force recommendation statement.Henderson JT, Webber EM, Weyrich M, et al.Table 2. Breast cancer screening guidelines from other organizations. In:Screening for Breast Cancer: A Comparative Effectiveness Review for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2024 Apr.Nicosia L, Gnocchi G, Gorini I, et al.History of mammography: analysis of breast imaging diagnostic achievements over the last century.Healthcare (Basel). 2023 Jun;11(11):1596. doi:10.3390/healthcare11111596American Cancer Society.What does the doctor look for on a mammogram?National Institute on Biomedical Imaging and Bioengineering.Mammography.Rauscher GH, Murphy AM, Qui Q, et al.The “sweet spot” revisited: optimal recall rates for cancer detection with 2D and 3D digital screening mammography in the Metro Chicago Breast Cancer Registry.AJR Am J Roentgenol.2021 Apr;216(4):894–902. doi:10.2214/AJR.19.22429Nelson HD, Pappas M, Cantor A, Griffin J, Daeges M, Humphrey L.Harms of breast cancer screening: systematic review to update the 2009 U.S. Preventive Services Task Force recommendation.Ann Intern Med. 2018 Nov 20;169(10):740. doi:10.7326/M15-0970Alabousi M, Wadera S, Al-Ghita MK, et al.Performance of digital breast tomosynthesis, synthetic mammography, and digital mammography in breast cancer screening: a systematic review and meta-analysis.J Natl Cancer Inst.2021 Jun;113(6):680–690. doi:10.1093/jnci/djaa205American Society of Breast Surgeons.Radiation safety and physics.Pace LE.False-positive results of mammography screening in the era of digital breast tomosynthesis.JAMA Netw Open.2022;5(3):e222445. doi:10.1001/jamanetworkopen.2022.2445National Center for Health Research.Should I “upgrade” to digital or 3D? A mammography guide.National Breast Cancer Coalition.Mammography for breast cancer screening: harm/benefit analysis.Richman IB, Long JB, Kyanko KA, Xu x, Gross CP, Busch SH.Insurance coverage mandates and the adoption of digital breast tomosynthesis.JAMA Netw Open.2022;5(3):e224208. doi:10.1001/jamanetworkopen.2022.4208American Cancer Society.Understanding your mammogram report.U.S. Food and Drug Administration.Important Information: Final Rule to Amend the Mammography Quality Standards Act (MQSA).Parikh U, Mausner E, Chhor CM, Gao Y, Karrington I, Heller SL.Breast imaging in transgender patients: What the radiologist should know.Radiographics. 2020;40(1):13-27. doi:10.1148/rg.2020190044University of California San Francisco.Screening for breast cancer in transgender women.
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kleinknecht JH, Ciurea AI, Ciortea CA.Pros and cons for breast cancer screening with tomosynthesis – a review of the literature.Med Pharm Rep.2020 Oct;93(4):335–341. doi:10.15386/mpr-1698Lowry KP, Trentham-Dietz A, Schechter CB, et al.Long-term outcomes and cost-effectiveness of breast cancer screening with digital breast tomosynthesis in the United States.J Natl Cancer Inst. 2020 Jun;112(6):582–589. doi:10.1093/jnci/djz184U.S. Preventive Services Task Force.Screening for breast cancer: US Preventive Services Task Force recommendation statement.Henderson JT, Webber EM, Weyrich M, et al.Table 2. Breast cancer screening guidelines from other organizations. In:Screening for Breast Cancer: A Comparative Effectiveness Review for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2024 Apr.Nicosia L, Gnocchi G, Gorini I, et al.History of mammography: analysis of breast imaging diagnostic achievements over the last century.Healthcare (Basel). 2023 Jun;11(11):1596. doi:10.3390/healthcare11111596American Cancer Society.What does the doctor look for on a mammogram?National Institute on Biomedical Imaging and Bioengineering.Mammography.Rauscher GH, Murphy AM, Qui Q, et al.The “sweet spot” revisited: optimal recall rates for cancer detection with 2D and 3D digital screening mammography in the Metro Chicago Breast Cancer Registry.AJR Am J Roentgenol.2021 Apr;216(4):894–902. doi:10.2214/AJR.19.22429Nelson HD, Pappas M, Cantor A, Griffin J, Daeges M, Humphrey L.Harms of breast cancer screening: systematic review to update the 2009 U.S. Preventive Services Task Force recommendation.Ann Intern Med. 2018 Nov 20;169(10):740. doi:10.7326/M15-0970Alabousi M, Wadera S, Al-Ghita MK, et al.Performance of digital breast tomosynthesis, synthetic mammography, and digital mammography in breast cancer screening: a systematic review and meta-analysis.J Natl Cancer Inst.2021 Jun;113(6):680–690. doi:10.1093/jnci/djaa205American Society of Breast Surgeons.Radiation safety and physics.Pace LE.False-positive results of mammography screening in the era of digital breast tomosynthesis.JAMA Netw Open.2022;5(3):e222445. doi:10.1001/jamanetworkopen.2022.2445National Center for Health Research.Should I “upgrade” to digital or 3D? A mammography guide.National Breast Cancer Coalition.Mammography for breast cancer screening: harm/benefit analysis.Richman IB, Long JB, Kyanko KA, Xu x, Gross CP, Busch SH.Insurance coverage mandates and the adoption of digital breast tomosynthesis.JAMA Netw Open.2022;5(3):e224208. doi:10.1001/jamanetworkopen.2022.4208American Cancer Society.Understanding your mammogram report.U.S. Food and Drug Administration.Important Information: Final Rule to Amend the Mammography Quality Standards Act (MQSA).Parikh U, Mausner E, Chhor CM, Gao Y, Karrington I, Heller SL.Breast imaging in transgender patients: What the radiologist should know.Radiographics. 2020;40(1):13-27. doi:10.1148/rg.2020190044University of California San Francisco.Screening for breast cancer in transgender women.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Kleinknecht JH, Ciurea AI, Ciortea CA.Pros and cons for breast cancer screening with tomosynthesis – a review of the literature.Med Pharm Rep.2020 Oct;93(4):335–341. doi:10.15386/mpr-1698Lowry KP, Trentham-Dietz A, Schechter CB, et al.Long-term outcomes and cost-effectiveness of breast cancer screening with digital breast tomosynthesis in the United States.J Natl Cancer Inst. 2020 Jun;112(6):582–589. doi:10.1093/jnci/djz184U.S. Preventive Services Task Force.Screening for breast cancer: US Preventive Services Task Force recommendation statement.Henderson JT, Webber EM, Weyrich M, et al.Table 2. Breast cancer screening guidelines from other organizations. In:Screening for Breast Cancer: A Comparative Effectiveness Review for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2024 Apr.Nicosia L, Gnocchi G, Gorini I, et al.History of mammography: analysis of breast imaging diagnostic achievements over the last century.Healthcare (Basel). 2023 Jun;11(11):1596. doi:10.3390/healthcare11111596American Cancer Society.What does the doctor look for on a mammogram?National Institute on Biomedical Imaging and Bioengineering.Mammography.Rauscher GH, Murphy AM, Qui Q, et al.The “sweet spot” revisited: optimal recall rates for cancer detection with 2D and 3D digital screening mammography in the Metro Chicago Breast Cancer Registry.AJR Am J Roentgenol.2021 Apr;216(4):894–902. doi:10.2214/AJR.19.22429Nelson HD, Pappas M, Cantor A, Griffin J, Daeges M, Humphrey L.Harms of breast cancer screening: systematic review to update the 2009 U.S. Preventive Services Task Force recommendation.Ann Intern Med. 2018 Nov 20;169(10):740. doi:10.7326/M15-0970Alabousi M, Wadera S, Al-Ghita MK, et al.Performance of digital breast tomosynthesis, synthetic mammography, and digital mammography in breast cancer screening: a systematic review and meta-analysis.J Natl Cancer Inst.2021 Jun;113(6):680–690. doi:10.1093/jnci/djaa205American Society of Breast Surgeons.Radiation safety and physics.Pace LE.False-positive results of mammography screening in the era of digital breast tomosynthesis.JAMA Netw Open.2022;5(3):e222445. doi:10.1001/jamanetworkopen.2022.2445National Center for Health Research.Should I “upgrade” to digital or 3D? A mammography guide.National Breast Cancer Coalition.Mammography for breast cancer screening: harm/benefit analysis.Richman IB, Long JB, Kyanko KA, Xu x, Gross CP, Busch SH.Insurance coverage mandates and the adoption of digital breast tomosynthesis.JAMA Netw Open.2022;5(3):e224208. doi:10.1001/jamanetworkopen.2022.4208American Cancer Society.Understanding your mammogram report.U.S. Food and Drug Administration.Important Information: Final Rule to Amend the Mammography Quality Standards Act (MQSA).Parikh U, Mausner E, Chhor CM, Gao Y, Karrington I, Heller SL.Breast imaging in transgender patients: What the radiologist should know.Radiographics. 2020;40(1):13-27. doi:10.1148/rg.2020190044University of California San Francisco.Screening for breast cancer in transgender women.
Kleinknecht JH, Ciurea AI, Ciortea CA.Pros and cons for breast cancer screening with tomosynthesis – a review of the literature.Med Pharm Rep.2020 Oct;93(4):335–341. doi:10.15386/mpr-1698
Lowry KP, Trentham-Dietz A, Schechter CB, et al.Long-term outcomes and cost-effectiveness of breast cancer screening with digital breast tomosynthesis in the United States.J Natl Cancer Inst. 2020 Jun;112(6):582–589. doi:10.1093/jnci/djz184
U.S. Preventive Services Task Force.Screening for breast cancer: US Preventive Services Task Force recommendation statement.
Henderson JT, Webber EM, Weyrich M, et al.Table 2. Breast cancer screening guidelines from other organizations. In:Screening for Breast Cancer: A Comparative Effectiveness Review for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US); 2024 Apr.
Nicosia L, Gnocchi G, Gorini I, et al.History of mammography: analysis of breast imaging diagnostic achievements over the last century.Healthcare (Basel). 2023 Jun;11(11):1596. doi:10.3390/healthcare11111596
American Cancer Society.What does the doctor look for on a mammogram?
National Institute on Biomedical Imaging and Bioengineering.Mammography.
Rauscher GH, Murphy AM, Qui Q, et al.The “sweet spot” revisited: optimal recall rates for cancer detection with 2D and 3D digital screening mammography in the Metro Chicago Breast Cancer Registry.AJR Am J Roentgenol.2021 Apr;216(4):894–902. doi:10.2214/AJR.19.22429
Nelson HD, Pappas M, Cantor A, Griffin J, Daeges M, Humphrey L.Harms of breast cancer screening: systematic review to update the 2009 U.S. Preventive Services Task Force recommendation.Ann Intern Med. 2018 Nov 20;169(10):740. doi:10.7326/M15-0970
Alabousi M, Wadera S, Al-Ghita MK, et al.Performance of digital breast tomosynthesis, synthetic mammography, and digital mammography in breast cancer screening: a systematic review and meta-analysis.J Natl Cancer Inst.2021 Jun;113(6):680–690. doi:10.1093/jnci/djaa205
American Society of Breast Surgeons.Radiation safety and physics.
Pace LE.False-positive results of mammography screening in the era of digital breast tomosynthesis.JAMA Netw Open.2022;5(3):e222445. doi:10.1001/jamanetworkopen.2022.2445
National Center for Health Research.Should I “upgrade” to digital or 3D? A mammography guide.
National Breast Cancer Coalition.Mammography for breast cancer screening: harm/benefit analysis.
Richman IB, Long JB, Kyanko KA, Xu x, Gross CP, Busch SH.Insurance coverage mandates and the adoption of digital breast tomosynthesis.JAMA Netw Open.2022;5(3):e224208. doi:10.1001/jamanetworkopen.2022.4208
American Cancer Society.Understanding your mammogram report.
U.S. Food and Drug Administration.Important Information: Final Rule to Amend the Mammography Quality Standards Act (MQSA).
Parikh U, Mausner E, Chhor CM, Gao Y, Karrington I, Heller SL.Breast imaging in transgender patients: What the radiologist should know.Radiographics. 2020;40(1):13-27. doi:10.1148/rg.2020190044
University of California San Francisco.Screening for breast cancer in transgender women.
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