Preparing for first annual mammogram - 2D vs 3D


I am in the midst of preparing for my annual mammogram appointment with my consultant after diagnosis last December & subsequent treatment this year.

When my first mammogram/biopsies were done one of the things that came up repeatedly was that I had dense breasts, making it difficult to take biopsies. It also resulted in the need for an MRI, which ended up changing my surgical treatment plan from a lumpectomy to mastectomy.

I’m now one year on & preparing for my first annual screening appointment and have recently become aware that there are two types of mammogram (2D vs. 3D). I understand that a 2D mammogram is what is used for routine screening.

My question now is whether having a 3D (DBT = Digital Breast Tomosynthesis) mammogram this time around would be more appropriate given the known breast density reported last time?

Or would a 2D Mammogram+Ultrasound with an MRI be better suited for someone with dense breasts? I would like to have an informed discussion with my surgeon when I’m seen, rather than just having a 2D mammogram, which may or may not be effective at detecting early stage abnormalities in dense breast tissue.

I understand a 3D Tomosynthesis mammo will result in more radiation, so expect that there may be pro’s and con’s of both, as well as criteria which drive the decision on which type of mammogram to offer.

Has anyone had a similar discussion with their surgeon and if so do you have any information/advice that you can share. It would be much appreciated.

I hope I’ve posted this in right place, please let me know if I should move it as I wasn’t sure which sub-forum it would be more applicable under.


1 Like

May also be worth either posting in the Ask our Nurses your questions section or giving them a ring for their perspective on this ?

1 Like

0808 800 6000

In the US, 3-D mammograms are now the norm in screening because they are statistically speaking more successful at detecting abnormalities in dense breasts. There are also not all that many false positives anymore which makes it that much of a better screening tool even with the little bit of extra radiation. I think it would be very reasonable to see if you can upgrade for your screening mammograms if allowed.

Thanks Jill. I will give them a call tomorrow.

Thanks for sharing that Kay0987. Hope you are well, this is my first post in several months, took a break from the forum while trying to find my new norm.

Its good to know what the standards are elsewhere in the world & also that there aren’t many false positives with a 3D mammogram; in the UK the norm does still appear to be 2D for routine screening, and I hadn’t even heard of the 3D option until I heard another lady mention having one at a wellness session I was attending a week ago.

I know when I had an MRI as part of my diagnosis last year, I was warned that it can open up a can of worms with false positives; which in my case didn’t happen as the only additional spot identified ended up being positive.

Given that there is no radiation with an MRI I was also wondering whether that would be an alternative anyone else with dense breasts has been offered as part of annual check, along with 2D Mammogram here in the UK.

1 Like

Hi, my surgeon has also mentioned that I have dense breasts. At this year’s screening I had the usual mammogram, then an ultrasound with biopsy, then an MRI due to difficulties being sure what they were seeing. Because of this they have arranged to do an MRI next year up front as well as the usual mammogram and ultrasound. I am claustrophobic so am already dreading the MRI, but I’d rather they were thorough than missed something.

Lisa xx

1 Like

Hello, I was also told I had dense breasts and lumpy breast tissue. I was wondering the same things as you (about the annual checks) as the mammogram and ultrasound didn’t pick up my lobular BC. I had a lumpectomy and it was only the pathology results from that that alerted them. I then had an MRI and ultrasound on the other breast before having a single mastectomy. I think it is very worrying that none of the screening methods are conclusive. That’s why we have to be so vigilant in checking for any changes ourselves. I had a clear routine mammogram only 6 months before my initial diagnosis - I felt the lump!

1 Like

Thank you for sharing your experience @Lisa65, @laneycass.

I’ll post an update with what I find out after my appointment.

For me the concern is primarily around the fact that there was no palpable lump when I was first diagnosed. The diagnosis was effectively incidental as I went in for precautionary check with underarm tenderness on the opposite side to where the non-palpable tumour was found. An MRI then detected a further small area which wasn’t found on the mammogram. I’m going to ask if 2D Mammo + MRI or 3D Mammogram would be recommended this time given my history.

Just posting an update to let you know I had a 3D mammogram today. The surgeon ultimately left it to the radiologist to decide whether it would be 2D or 3D, and wasn’t particularly keen about requesting an MRI when I queried that option, citing higher chance of false positives.

Either way I had to make my case for a 3D with the radiographer who was going to do a 2D, but then went on to speak to the radiologist with the background I gave on breast density. So I’d say it certainly requires you as the patient to advocate for yourself with rationale and I did enquire whether they had 3D (tomosynthesis) mammogram capability at the hospital (not all breast units do) before I went.

It is a relief to have the first clear mammogram after diagnosis. Given the knowledge I have gained since diagnosis I was able to have a more informed conversation with the radiographer/radiologist who asked me whether I had a medical background :slight_smile: when I said I didn’t she went on to say then you are well read on the subject of mammograms.