Robert Wood Johnson Somerset offers 3D Mammography

• American Cancer Society advises women over 40 to get an annual mammogram
• Drs. Kirstein and Wedmid believe that 3D mammography is the %22wave of the future%22
• The facility in Somerset has a spa-like atmosphere that comforts patients receiving mammograms

SOMERVILLE – Since June, Robert Wood Johnson University Hospital (RWJUH) Somerset has been offering women 3D mammography, the latest and most advanced technology in screening and detecting breast cancer, which is the second-leading cause of cancer death.

The imaging, which is available at the hospital's Sanofi US Breast Care Program in the Steeplechase Cancer Center at 30 Rehill Ave., has been a game-changer for women in preventing the disease, according to breast and imaging specialists at RWJ and Rutgers Cancer Institute of New Jersey.

The American Cancer Society advises women over 40 to get an annual mammogram and estimates that over 231,000 new cases of invasive breast cancer in women in the United States will be diagnosed this year alone.

Traditional mammography is only two-dimensional, taking images of the breast from two angles. 3D mammogram, also known as a digital breast tomosynthesis exam, moves in an arc over the breasts to capture multiple images of the breast from various angles that create a clear, 3D reconstruction of the breast, which allows radiologists to examine the patient's breast tissue in far greater detail.

Dr. Laurie Kirstein, breast surgical oncologist at Rutgers Cancer Institute of New Jersey and RWJUH in New Brunswick, explained that 3D mammography decreases the rate of call-backs to patients requiring additional imaging.

"Often, with 2D (two-dimensional mammograms), you may not really be sure if there is something there or it looks fuzzy, and the radiologist has you come back and compress again," Kirstein said. "With 3D, you can see if it is really a mass or not. Also, if there is something there, the radiologist can see the mass better and determine if something might be benign or suspicious.

"With a 2D mammogram, patients have to face biopsies and 3D mammography decreases anxiety associated with biopsies, pain and healing rate and also the money that is involved in follow-ups and biopsies. It's the wave of the future."

She added that, in 2014, a law was passed in New Jersey that a woman with dense breasts would have a screening ultrasound as well as a screening mammogram.

"It's a lot of work for the radiologist and can produce a lot of false positives," Kirstein said. "It was important for RWJ to be on the cutting edge and to offer 3D mammography as soon as possible.

"More and more patients are coming in for the 3D mammogram already. When a doctor explains why it is so important, they don't understand the difference between mammograms initially. I find that when people come in and ask me what they should be doing, they are really beginning to want to be educated about why it is a great tool."

The facility has a very calming environment with soothing colors, and attractive décor to make patients feel comfortable and at ease. From warm, terrycloth robes to individual private waiting areas, the Breast Care Program is specially designed to ensure comfort and privacy for patients.

"RWJ has put a lot of money in to make sure that the facility is a beautiful, spa-like atmosphere. We are very aware of anxiety associated with getting mammograms," Kirstein said.

Life-changer, game-changer

A religious Sister of Mercy residing at the Church of Saint Ann convent in Keansburg, Sister Sharon Kelly of Keansburg learned about her breast cancer diagnosis through a 3D mammogram in May while accompanying a friend to her mammogram at a local imaging facility.

The New York native who had previously grappled with uterine cancer was referred to Dr. Darlene Gibbons at Rutgers Cancer Institute of New Jersey who recommended that Kelly turn to Kirstein at RWJUH in New Brunswick, where she was to have a lumpectomy on July 21.

"I do feel that because the cancer was caught so early it will be at Stage 1 as I am being told it should be," said Kelly. "It was by the absolute grace of God and truly serendipitous that I chose to have the 3D mammography. The radiologist said that it wouldn't have been caught without the 3D, which is something that Dr. Kirstein echoes."

Kelly believes that having the 3D mammogram will eventually make breast cancer more of a chronic disease rather than one that is as severe and serious as it is now.

Dr. Myra Wedmid, a board-certified radiologist and co-director of the Sanofi US Breast Care Program at the Steeplechase Cancer Center, offered some history behind the latest imaging available to women.

"3D mammography or tomosynthesis is a modified type of mammogram that has been years in development largely under the guidance of Dr. Kopans of Harvard Massachusettes General — a wonderful physician scientist whose specialty is breast imaging," she explained.

"We have been hearing about its usefulness for quite some time but as with all things medical, doctors rely on robust research to vet new technology," she added.

According to Wedmid, JAMA (The Journal of the American Medical Association) published a large multicenter trial in June 2014 demonstrating that 3D mammography in addition to routine 2D mammography had significant benefits.

"This is the data that we had been waiting for patiently," she said. "Once the study was published, Steeplechase immediately began the process to acquire the technology and we have it installed and in use just under a year later."

The research study, said Wedmid, demonstrated a 41 percent increase in detected invasive cancer; 29 percent increase in detection of all types of breast cancer; 15 percent decrease in recall rate; and a 49 percent increase in positive predictive value for a screening mammogram.

"These numbers are supportive that 3D Mammography has a significant role in cancer detection," she said. "So at the outset, data has shown us that tomosynthesis is robust.

"As a community cancer center, our goal is to provide excellent care to all our patients. This type of technology should be available to our community not just to those patients who live in big cities. Now that we have merged with RWJ, we have the benefit of being part of large academic center. I am very excited that this has allowed us to stay on top of our game. The best part is all of our patients are VIPs — as they should be."

She noted that many of their patients have specifically requested tomosynthesis and "are very savvy given that internet information is at our fingertips."

"I love that our patients are advocates for their health," she said. "They appropriately demand the best."

According to Wedmid, tomosynthesis still uses compression of the breasts, however, patients will notice "little difference compared to regular mammography."

"Our system automatically releases the patient from compression after a three- to four-second exposure," she said.

"From an MD viewpoint, I appreciate that the statistics support tomosynthesis but I can also say, that having those images available makes me feel more comfortable when I am reading mammograms. When reading mammograms, I really only have one question to ask myself: 'Is that cancer? Yes or no?' However, to get to that answer can be difficult. I welcome technology that helps me do my job better."

Within the first month of having tomosynthesis, Wedmid saw two invasive cancers that she said she might not have appreciated with a two-dimensional conventional mammogram.

"That is more than good enough for me. Let's diagnose and treat our patients so they can live their lives to the fullest," she said. "I think 3D Mammography will replace 2D. Methods of reconstructing data will continue to improve and will make it feasible and allow us to decrease radiation.

"I will definitely be getting tomosynthesis on my next mammogram. I love where I work. We all understand the seriousness of what breast cancer means and respect the amazing women that come through our doors but we are by no means a somber place — smiles abound."

To schedule an appointment for a 3D mammogram at the Sanofi US Breast Care Program in the Steeplechase Cancer Center at RWJ Somerset, call 908-704-3740. To learn more about the facility, visit www.rwjuh.edu.