Mammograms continue to be the go-to screening tool for breast cancer, despite several issues with the technology. Besides the acute discomfort for the patient during a mammogram, they are also associated with too many false negatives, especially for women with dense breasts [1]. In this article, I will share with you an emerging technology that each of us should be asking for when we go for our breast exams, called Cone Beam Breast Computed Tomography, or CBBCT.

First of all this technology is not available everywhere yet. In fact, many doctors aren’t even aware of it. I say we should ask for it – to help make them aware. At your next doctor’s appointment when you know breast screening is going to be discussed, take along some of the research articles listed under References here.

I’m excited about CBBCT for a couple of reasons. It’s an advanced imaging technology that provides high-resolution, 3D images of the entire breast without the need for the ultra-uncomfortable breast compression that we experience in mammography.

Did you know that the pressure applied to the breast during a mammogram is around 20 pounds/9 kilograms? If there is a large tumor in there, that kind of pressure… makes me shudder to think about it.

The first unit to receive US FDA approval for diagnostic use was in 2015, some 11 years ago. It was developed by the Koning Corporation of Norcross, Georgia. I see from their website that they have a cute name for the latest version of the scanner – Vera.

CBBCT offers several advantages over traditional mammography, particularly for women with dense breast tissue.

Key Advantages of CBBCT

No Compression: The breast is not compressed during the scan, which eliminates the significant discomfort and pain associated with traditional mammography.

True 3D Imaging: It produces true 3D images, which eliminates the problem of overlapping tissue that can obscure abnormalities in 2D mammograms (a common issue in dense breasts). The benefits of this is fewer false positives and false negatives.

Better for Dense Breasts: Because it provides detailed 3D images, CBBCT offers improved sensitivity for cancer detection in women with dense breast tissue compared to mammography.

High Resolution: CBBCT offers a very high resolution, superior even to MRI, allowing for better visualization and assessment of breast tissue.

Faster Scan Time: A complete scan of both breasts can be performed quickly, much faster than a diagnostic MRI, which can take 30 minutes or more.

Biopsy Capability: The machine can be equipped with a device to perform targeted biopsies of suspicious lesions if necessary. This would require your consent.

Accuracy: A small 2024 study [2] including 115 confirmed breast cancer patients found that “CBBCT and MRI have comparable accuracy in measurement of tumor size, and CBBCT is advantageous in assessing the size of calcified lesions.” The study went on to say that “CBBCT might serve as an alternative imaging technique to assess tumor size when patients do not tolerate MRI.”

Further, a 2024 meta-analysis and review of studies [3] concluded that the diagnostic performance of CBBCT for primary breast cancer was better than that of mammography. The study’s authors also stated that the results of both the CBBCT and mammography were based on studies with small sample sizes, and that further studies with larger sample sizes and more comprehensive designs would be advantageous.

What to Expect with CBBCT

Patient Positioning: The patient lies on their stomach on a specially designed table, and one breast at a time is placed by the patient through an opening. No squishing or painful compression!

Scanning Process: The machine’s C-arm, which holds an X-ray source and a flat-panel detector, rotates around the pendant breast in a full 360-degree rotation, capturing hundreds of low-dose 2D images in a single, rapid sweep – it typically takes only about 7-10 seconds per breast. So how much of a dose of radiation is it? A 2021 study [4] stated that it is “on par with diagnostic mammography.”

Image Reconstruction: A computer uses sophisticated algorithms to combine the 2D images into a detailed, comprehensive 3D “picture” of the breast tissue under examination. This set of images has what is termed “isotropic resolution” (it means equal sharpness in all planes: sagittal, coronal, and axial), which can be viewed from any angle.

Contrast Enhancement: If the physician deems it necessary, an intravenous (IV) contrast agent (dye) may be administered to highlight areas of increased blood flow, which can indicate malignancy, similar to how contrast MRI works. However, the contrast dye utilized is the same type of iodine-based contrast used in standard CT scans, rather than the gadolinium-based agents used in MRIs (which I’ve previously written about) https://marnieclark.com/how-to-detox-after-mri-scans/  A 2018 meta-analysis of studies [5] did indicate that CBBCT with contrast showed superior diagnostic performance over CBBCT without contrast.

Current Status of CBBCT

CBBCT is FDA-approved for diagnostic breast imaging in the United States and is available in a few cities. It is also available in other parts of the world, including one city in Australia (Brisbane). You can see other locations here. Please note it is not yet widely available.

While CBBCT is not yet universally recommended for routine screening (one article said that was due to ongoing research), its use for diagnostic purposes, especially in women with dense breasts or those who cannot tolerate MRI, is growing.

Note: I have always been a proponent of thermal imaging together with ultrasounds for diagnostic imaging for breasts, due to their non-invasive and non-toxic technology. However, after working with hundreds of women going through breast cancer, I have met more than a few who said that thermal imaging did not pick up their tumors, sometimes due to breast size or the small size of the tumor, and sometimes due to the inexperience of the technician. No diagnostic procedure is fool-proof. Sometimes it takes a few different technologies to pick up a tumor, especially if you have dense breasts or if calcifications are present. See my article on calcifications here: Are Breast Calcifications a Sign of Cancer?

I hope this was helpful, and I hope that you will ask for CBBCT at your next doctor’s appointment. Let’s at least make them aware of it.