Posts Tagged ‘breast cancer prevention’

Tomosynthesis a.k.a “3D Mammography”

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Dr. Benjamin Pettus

As the first Breast Center of Excellence on the Peninsula, Riverside is committed to providing the highest level of care available within the bounds of current technology.

Mammography remains the “gold standard” method, proven to detect the majority of cancers at the earliest stages.  The best data available supports a 30-60% reduction in woman’s chances of dying of this horrible disease (based on changes in the whole population including women not being screened – effect for screened women is likely greater). This means that 3-6 out of every 10 women with breast cancer in our entire population would not be alive if it were not for the advent of screening!

Despite this, only 6 out of 10 women choose to undergo recommended ANNUAL screening.  Sadly, the majority of women dying of breast cancer were not getting annual screening at the time of diagnosis.  While no test is perfect, mammography remains the only test proven to reduce the risk of dying from breast cancer.  One in eight women get breast cancer at some point in their lives, please get screened somewhere.

Among women getting screened annually, we believe in a personalized approach to care.  We believe in providing access to testing and we believe in education so women can make decisions with which they are most comfortable.  We are sympathetic to the tremendous anxiety generated by the process of screening and early cancer detection.  Part of this simply has to do with the nature of the disease.  As a progressive disease, a woman’s chances of survival are dramatically improved the earlier the disease process is arrested.  Cancer starts as normal tissue that then changes.  Every woman’s tissue is unique and not all cancers look the same.  Many cancers are difficult to detect until they look different from normal tissue.  This means that there is a threshold below which detection is possible.  Our efforts to detect very subtle changes can result in many “false positives” requiring additional workup i.e. “call backs”, and even biopsies.   This is particularly true with the more sensitive/more costly tests such as breast MRI which is why we use them judiciously and predominantly in the most high risk women most likely to obtain benefit. Read more.

Screen Shot 2013-10-17 at 11.30.44 AMBut we all still agree: this is not “good enough”.  The women under our care are precious.  We have to look them in the eye when we tell them the “news”.  We all want to know in our hearts that we provided every possible tool and the best care possible.  Who you trust to read your mammogram is every bit as important as the tool itself.

Of all the options under active investigation, Tomosynthesis holds the most promise and is increasingly available. But we do a tremendous disservice to women by overstating this promise.  A more honest assessment is necessary so that women can make an informed decision. Read more

Tomosynthesis is an imaging technique that has been used since the 1930s but only recently applied to the breast because of radiation exposure issues that required significant retooling.  It does not generate “3D” images in the strictest sense though that description has gained favor due to ease of description/corporate marketing.  An x-ray beam sweep generates an image “slice” in the tissue of interest by blurring surrounding tissue with the exception of the focal point of the arc.  As one of the difficulties with breast imaging detection is “superimposition” of tissue, this technique has the most theoretical potential for women with denser tissue.

Initial studies, however, failed to show an improvement over conventional “2D” mammography, particularly for detection of calcifications that often are scattered through imaging planes.  “Change from prior studies” is also more difficult to assess – as some cancers do not look “mass-like” or have “spiculations”, there is a risk that the readers may have even more trouble detecting some cancers if they over-rely on the “tomo” images. Read more

Subsequent research efforts since this initial set-back have focused more on using this test as a supplement to regular mammography.  When utilized in a “combo mode” both images are generated at a single compression such that women may feel that only one exam was performed, but in fact a supplemental test was added to their examRiverside breast cancer screening.

Newer advances have improved the technology such that an equivalent dose can now be expected and prior pitfalls avoided by use of reconstructed 2D images.

Several studies have shown an increase in cancer detection and some have shown a decrease in call-back rates when used this way, but these are not always the same study.

In our hands we are seeing a decrease in the call-back rates, further confirming this in an incremental step forward.

In summary:

1) Tomosynthesis is still mammography.  It does not replace mammography, rather it is a supplemental test acquired at the same time as a conventional “2D” mammogram.

2) It is not “more gentle” – compression is still required and if not performed will reduce the quality of the exam.

3) It is not “faster”- the length of time in compression is longer for both tests.

4) Secondary to recent advances including the ability to reconstruct 2D data from 3D data, it is now the “same dose” as a mammogram though possibly higher in women with larger breasts if additional pictures need to be taken for full coverage.

5)  It is not really “3D” people say that to make description easy.

6) Even if not a “revolutionary” step forward it is at least an “incremental” improvement.

7) It is sometimes covered by insurance so out-of-pocket expenses may be higher.

Read more here.

We believe this is an incremental step forward.  Consider choosing this option especially if you are a woman with dense tissue, complex breast pattern, and intermediate to high risk. 

Virginia mammography

To your health!

Benjamin J. Pettus MD, PhD Fellowship Trained Mammographer for Riverside

Schedule your Annual Mammogram Online

mammogram scheduler Have you scheduled your annual Mammogram for 2018? The fact is that mammography is the best tool available to screen for breast cancer. Mammography has helped reduce the breast cancer death rate in the United States by 30 percent.

The American Cancer Society recommends women 40 years and older have an annual screening mammogram to aid in early detection of breast cancer. If you are under 40 years old, talk to your doctor to see what screening program will work best for you, especially if you have a personal or family history of breast cancer.

We make it easy and convenient for you to schedule your annual Mammogram. Thanks to Riverside’s Self-Scheduler, you can now schedule your screening mammogram from any computer, at any time. The Self-Scheduler is simple and quick to use. You will first need to create and account by selecting a user name and password. Once your account is set up, you will be able to schedule, re-schedule or cancel your appointment at your convenience.

Another great feature about the Self-Scheduler is that it provides instructions on how to prepare for your appointment. Following these guidelines will help to ensure that you will get the most out of your breast cancer screening appointment.

Annual mammograms can detect cancer early — when it is most treatable. In fact, mammograms show changes in the breast up to two years before a patient or physician can feel them. Mammograms can also prevent the need for extensive treatment for advanced cancers.

To schedule your annual mammogram through Riversides’ state-of-the-art Women’s Imaging Center, visit the Online Scheduler today.

Once you have your appointment scheduled, you can visit the Peninsula Radiology website to find maps and directions to your breast imaging center.

 

Riverside Shore Memorial Hospital Offers Ultrasound-Guided Breast Biopsy

Screen Shot 2015-07-27 at 4.22.20 PMRiverside Shore Memorial Hospital now offers ultrasound-guided breast biopsy to patients on the Eastern Shore. Ultrasound-guided breast biopsy is a quick, nonsurgical office procedure for obtaining tissue samples from suspicious breast abnormalities.

A suspicious area in the breast may be found by mammogram or may be large enough to be felt upon examination.  In order to determine if the mass is benign or malignant, a sample of the mass must be obtained.  Ultrasound-guided breast biopsy uses a hollow needle to obtain a tissue sample.

This method is a safe, effective and accurate way to diagnose breast problems, and in some instances is preferred over surgical biopsy.

“The procedure is less invasive than surgical biopsy, leaves little or no scarring and can be performed in about an hour”, explained Dr. William Marshall, Medical Director of Radiology at Riverside Shore Memorial Hospital.   “By offering this advanced procedure, we eliminate the need for Eastern Shore residents to travel to multiple centers to receive their diagnosis.  We have the capabilities right here, close to home.”

In ultrasound-guided biopsy, a radiologist will first numb the skin and the affected area of the breast with a local anesthetic.  Using radiation-free sound waves, the ultrasound device produces a real-time image of the mass inside the breast.  The image allows the radiologist to guide the needle to the exact spot of the mass.

The collected tissue sample will then be reviewed under a microscope by a pathologist to determine if the suspicious area is malignant or benign.  Because most breast masses are benign, this low-impact biopsy method is often the last procedure that is needed for a suspicious mass, and patients can avoid more invasive surgery.  Aftereffects of the biopsy are minor and might include slight bruising or bleeding;  most patients can resume normal activities in 24 hours.

“This advanced diagnostic technology lets us quickly and accurately diagnose conditions and diseases.  The sooner a diagnosis is made, the sooner treatment can begin,” stated Dr. Marshall.