Radiologists are asking Quebec to increase access to 3D mammography, a technology that detects more breast cancers than conventional x-rays. This technique, already performed in more than half of mammograms, is however not yet recognized by the Ministry of Health and Social Services.
Posted at 1:23 a.m.
Updated at 5:00 a.m.
What you need to know
- 3D mammography makes it possible to detect more cancers and reduces the number of callbacks for additional examinations.
- This new approach is not yet recognized in the Quebec breast cancer screening program.
- Radiologists want women aged 40 to 49 to be included in the screening program.
“Not doing 3D mammography systematically is like saying that we are going to miss a third of cancers,” says straight away the president of the Association of Radiologists of Quebec (ARQ), Dr.r Grégoire Bernèche.
Radiologists usually detect 5 to 8 breast cancers per 1000 patients with the conventional method, called 2D. With 3D mammography, this number increases to 8 to 11 cancers detected. “We miss a lot less,” says the radiologist.
A little more than half of the mammograms performed in Quebec already include a 3D mammogram, combined with 2D, according to the most recent RAMQ data as of March 31, 2023, indicates the Dr Bernèche.
PHOTO ALAIN ROBERGE, THE PRESS
The Dr Grégoire Bernèche, president of the Association of Radiologists of Quebec, who asks that a new way of detecting breast cancer more effectively, tomosynthesis, be implemented in the province.
The patient does not see any difference. It’s not longer. It’s the same dose of radiation. And it’s just as uncomfortable.
The Dr Grégoire Bernèche, president of the Association of Radiologists of Quebec
The majority of patients do not even know that they have had a 3D mammogram.
“We couldn’t afford to wait”
Radiologists want to expand access to this new technique so that everyone in Quebec can benefit from it, regardless of the region. However, 3D mammography is not yet recognized in the Quebec breast cancer screening program.
Currently, the Ministry of Health and Social Services follows the recommendation of INESSS, which considers 2D mammography as the standard for breast cancer screening. The Ministry, however, asked INESSS and INSPQ to continue its analysis.
“The MSSS will reassess its position regarding the use of [mammographie 3D] for breast cancer screening in light of this new analysis,” said The Press Francis Martel, media relations.
Radiologists across Quebec still decide to offer it to their patients. “We couldn’t afford to wait for the INESSS report,” said the Dr Bernèche.
The first 3D mammograms were performed in a private clinic in Quebec City in 2018. Today, most large hospitals have the technology necessary to perform them. On the other hand, remote regions are often less well equipped with 3D mammography.
Reduce the number of reminders
3D mammography captures around a hundred images per breast, compared to only two for traditional mammography. These numerous images facilitate the detection of cancerous tumors, which, in the classic approach, are often masked by merging with the mammary glands, both of which appear white on the x-ray.
3D mammography thus reduces the number of call-backs for additional examinations. “The patient will be called back when we are not able to say with certainty whether the patient has cancer or not,” explains the Dr Bernèche.
In classic 2D mammography, 90 to 100 patients out of 1000 are recalled, while in 3D, this figure drops to 60-70.
This new approach, however, requires investments to modernize the machines so that they can perform 2D and 3D mammography simultaneously. Analyzing patient images also takes much longer for radiologists. “Before, we analyzed 4 images, now we have 230,” he explains. He still believes that this extra time is worth it.
For screening from age 40
Radiologists also want the Quebec breast cancer screening program to include women aged 40 to 49. Currently, the program is only for women aged 50 to 74. “The science is pretty clear that it’s worth it,” says Dr.r Bernèche.
Several Canadian provinces, namely British Columbia, Ontario, Nova Scotia and Prince Edward Island, have already reduced the screening age to 40 years. “We are really going against the grain on this. We are clearly behind schedule,” he laments.
The MSSS says it is awaiting recommendations from INESSS on the risks and benefits of screening in women under 50 before taking a position. Physicians and specialist nurse practitioners (SNPs) still have the option of ordering a screening mammogram for a woman of this age or younger, based on individual risk assessment or in the presence of symptoms.
To avoid a massive influx of patients, the Dr Bernèche suggests first granting access to women aged 45 to 49, then expanding to those aged 40 to 44.
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