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A standard 2D mammogram can sometimes miss breast cancer, especially in people with dense breast tissue. According to a study published in Radiology, conventional 2D mammogramcan fail to detect about 30 percent of breast cancers.
One MyBreastCancerTeam member said, “I had a mammogram one year before the discovery of my cancer, and there was no indication it had broken through.”
This is where tomosynthesis — also called a 3D mammogram or digital breast tomosynthesis (DBT) — comes in. This type of mammogram takes images of the breast from different angles to create a more detailed picture. 3D mammograms are available at many breast imaging centers across the U.S.
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When you schedule a mammogram, you may find yourself wondering how a 3D mammogram is different from a regular scan, whether it’s more uncomfortable, and whether your insurance will cover it.
In this article, we explain what tomosynthesis is and how it compares to a standard 2D scan. You’ll also learn who may benefit from the test, what to know about insurance coverage, and questions to ask before your appointment.
What Is Tomosynthesis and How Does It Work?Breast tomosynthesis is a breast imaging tool. It uses low-dose X-rays to create detailed pictures of breast tissue and check for abnormalities.
During the exam, a mammography technologist positions your breast between two flat plates that press down briefly to spread out the tissue. Then, the machine takes multiple images from different angles.
A computer combines those images into detailed, three-dimensional pictures. Think of it like shining a flashlight around an object from different sides, which can help bring hidden areas into view.
This is different from a standard 2D mammogram, which takes only two flat images of each breast — one from the top and one from the side.
Imagine taking a photo of a sandwich from the side and seeing all the layers overlap in one image. The layers could overlap and hide small details.
With a 2D mammogram, breast tissue can overlap, especially in people with dense breasts. Dense breasts have more fibrous and glandular tissue than fatty tissue. The overlap can hide abnormalities or create shadows that make normal tissue look suspicious. This may lead to more testing.
Tomosynthesis mammography reduces that problem by showing the breast in thin “slices,” allowing the radiologist — a doctor who reads imaging tests — to examine the images layer by layer.
According to the Cleveland Clinic, DBT may eventually become the new gold standard in breast cancer screening.
3D mammograms are especially helpful for people with dense breast tissue. This is because they allow the radiologist to look through breast tissue layer by layer for anything unusual.
The exam itself feels nearly identical to a standard mammogram. The compression, positioning, and the time it takes are usually about the same. The one difference you may notice is that the X-ray machine moves in an arc over your breast.
There are quite a few possible benefits to 3D mammograms for breast cancer screening.
The case for tomosynthesis over a standard 2D mammogram comes down to one thing: It may help find some cancers that standard 2D mammograms can miss.
Studies have shown that mammograms with tomosynthesis can increase breast cancer detection by approximately 25 percent.
When something suspicious is found, time matters. Detailed images allow for quicker decision-making in terms of the need for further testing, such as a biopsy (removing a small tissue sample to check for cancer). This can lead to faster diagnoses and beginning treatment sooner, if necessary.
About half of women 40 and older have dense breasts, according to the Centers for Disease Control and Prevention (CDC). If your doctor has told you that you have dense breasts, a 3D mammogram may make a difference for you.
Typically, both dense tissue and cancer can look white on a mammogram, making the two harder to tell apart on a 2D scan.
DBT is better at detecting cancer in people with dense breast tissue and reducing repeat tests caused by false-positive results (results that look suspicious but aren’t cancer). This is because the layer-by-layer view helps reduce the overlap of breast tissue that can hide abnormalities.
Getting a callback after a mammogram can feel stressful. Most callbacks do not mean breast cancer was found, but they do mean more imaging is needed.
Research shows that about 90 percent of women called back for follow-up testing after a screening mammogram do not end up having cancer.
Tomosynthesis offers more detailed images, which may reduce the need for repeat testing due to false-positive results.
Research shows tomosynthesis has a greater likelihood of detecting multiple breast tumors, which occur in about 15 percent of people living with breast cancer.
Finding multiple tumors at once may help your healthcare team choose the most appropriate treatment plan.
Before getting a 3D mammogram, it’s important to understand its limitations so you can ask the right questions when booking an appointment.
Radiation exposure with DBT is still low, though it can be higher than a standard 2D mammogram in some situations. For example, the dose may be higher if a person gets both a full 3D scan and a separate full 2D mammogram during the same visit.
Many newer systems can generate a synthetic 2D mammogram — a 2D image from a 3D scan. This can reduce the overall radiation exposure compared with getting both a full 2D and a full 3D mammogram separately.
If you have concerns about radiation, talk with your radiologist or the doctor who ordered the test. They can help you weigh the low radiation dose against the potential benefits for your specific situation.
Because tomosynthesis creates many more images than a standard mammogram, it may take radiologists longer to review the results. This doesn’t affect you during the exam itself, but it may mean a longer wait for your results, which can increase anxiety for some people.
Tomosynthesis often costs more than a standard 2D mammogram. Prices vary a lot depending on the facility, where you live, and your insurance coverage.
If cost is a concern, ask the imaging center for an estimate and check with your insurance plan about what you may owe.
This higher upfront cost may be offset over time through fewer callbacks, reduced follow-up appointments, and the added reassurance and peace of mind it provides.
Insurance coverage for tomosynthesis varies depending on where you live and the insurance plan you have. Medicare covers digital breast tomosynthesis as part of breast cancer screening for people who meet its screening guidelines. Some private insurers may not cover it, or they may charge out-of-pocket costs.
Speak with your insurance company before your appointment to confirm your coverage and determine any potential out-of-pocket costs.
Mammogram screening guidelines have evolved in recent years. In 2024, the U.S. Preventive Services Task Force updated its breast cancer screening recommendations to include digital breast tomosynthesis as an effective option for breast cancer screening.
The American College of Radiology recognizes that, compared with 2D mammograms, DBT may find more cancers and lead to fewer callbacks, particularly for people with dense breasts.
However, it’s not clear whether a 3D mammogram can provide more benefit in regard to life expectancy than a 2D mammogram. Ongoing research may answer this question.
Although there are benefits to a 3D mammogram, more research needs to be done to know whether it has greater long-term benefits than a 2D mammogram for routine screening.
Your doctor’s recommendation will largely depend on your breast health, risk factors, and what’s available at your imaging center.
Many people still get effective screening with the standard 2D mammograms. Whether a 3D mammogram may be helpful for you can depend on several factors, including your breast density and personal risk of breast cancer.
If you’re unsure, ask your doctor or imaging center whether they offer 3D mammograms, whether the test may be helpful for you, and whether your insurance will cover it.
The goal is to get the screening that makes the most sense for you.
On MyBCTeam, people share their experiences with breast cancer, get advice, and find support from others who understand.
Have you ever had to choose between digital breast tomosynthesis and a standard mammogram, and what factors mattered the most to you? Let others know in the comments below.
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