Breast cancer can hide — in darkness, by chest walls, amid dense tissue — leaving women with a false sense of security. But new and evolving technologies zero in on breast cancer’s hiding spots and can lead to life-saving treatment.
Derry Twp. police officer Laura A. Pavone had her first mammogram one month after her 40th birthday and discovered she had breast cancer. “Having a mammogram when I was 40 was the best decision of my life,” said Pavone, a mother of three. “I was healthy, had no family history and never felt anything abnormal.”
Yet, last year, she was diagnosed with DCIS, or ductal carcinoma in situ, where cancer cells invade the lining of the duct. These tiny tumors are not usually discovered by a self-exam.
Area technicians and radiologists rely on an expanding number of high-tech diagnostic tests to find a lump, pinpoint its size and location, determine malignancy and work with breast surgeons to map out treatments. Soon, they will even have a 3-D option for mammograms.
While mammograms are often viewed as the gateway test for detecting all breast cancers, that is not always the case, said Dr. Todd Campbell of Holy Spirit Hospital’s Oakwood Breast Care Center in Mechanicsburg.
In most cases, if a screening mammogram indicates something suspicious, a more detailed mammogram or ultrasound will be ordered. However, if a 30-year-old woman comes in with a lump already, an ultrasound might come first.
“It usually depends on the patient’s age,” said Tracy Reed, mammography supervisor at PinnacleHealth System, which has two diagnostic sites — at the Medical Science Pavilion of Community General Osteopathic Hospital and Fredericksen Outpatient Center — and three screening sites — at Harrisburg Hospital, Dillsburg Imaging and Millersburg Imaging.
Yet, “a screening mammogram is still the most important tool we have for the early detection of breast cancer,” Campbell said.
While not perfect, this “dedicated X-ray of the breast” is precise, picking up about 85 percent of all cancers, said Dr. Scott Wise, a radiologist and director of the Women’s Imaging Center at Tristan Associates, which has locations in Camp Hill, Hershey, and Susquehanna and Lower Paxton townships. That accuracy rate drops to about 50 percent in women with dense breasts, where fatty tissue is scarce and problems appear as white spots on a white background.
“But far and away, it is the best study to show early calcifications,” Wise said. Although most calcium deposits are benign, a cluster of tiny calcium specks — called “microcalcifications”— might be an early sign of breast cancer, he added.
The wide variety of tests available each have their own strengths and weaknesses:
Screening Mammograms — A mammogram delivers a controlled beam of low-dose radiation to create a shadow on film. Soft tissue appears darker, and dense tissue appears white. Calcifications also appear white.
Views of the compressed breast are usually taken from the top and the side, while the patient stands in front of a tall rectangular machine. The compression only last about 10 seconds each time. The entire test, from the moment a patients strips down to the waist and dons a gown to the time she leaves with results, typically only takes about 35 to 45 minutes, Wise said.
Area imaging centers often read the exams while women wait, so they can deliver results, and peace of mind, right away. In unclear cases, radiologists might ask for more views.
“The interpretation takes more time than the test,” Campbell said.
To allay any confusion about changing guidelines for mammograms, area radiologists agree that a baseline exam should be done between the age of 35 and 40, and a yearly mammogram should be done starting at age 40. In 2009, the U.S. Preventive Services Task Force ignited a national debate when they recommended that mammograms start at 50, not 40, and be conducted every two years, instead of every year. The American Cancer Society has remained firm in recommending that women get an annual mammogram starting at 40, as have other organizations.
Experts admit that while the mammogram is not 100 percent accurate, it is still the best view in town — especially when used in tandem with other tools.
Diagnostic mammograms — These more comprehensive mammograms are performed when a patient is having a problem or has had a problem in the past that doctors are following, Reed said.
Tomosynthesis — This 3-D mammogram uses a rotating exposure that lasts about 10 seconds during breast compression to produce a stack of images similar to a CT scan’s sliced images. The machine is expected to cut down on false positive readings. It was just approved by the U.S. Food and Drug Administration in February, and PinnacleHealth expects to offer it soon at their Lower Paxton Twp. location.
Breast ultrasounds — These exams are typically done when a patient is feeling a lump, or a nodule that cannot be felt is detected on the mammogram, Reed said. An ultrasound can determine whether the lump is a fluid-filled cyst or a solid nodule, employing sound waves to create a picture of breast tissues. It is done with the patient lying down in a darkened room, situated by a technician at a monitor.
Breast MRI — Breast MRIs “have really exploded,” Campbell said. Because MRIs are “an extremely powerful study,” they are excellent at determining the size of breast cancer and seeing multiple spots, Wise said.
If an abnormality is detected on a mammogram, an MRI is sometimes recommended, Reed said. If a patient has a strong family history and is deemed high-risk, it might also be done. Breast MRIs are also the go-to screen after a breast cancer diagnosis to look at other possible abnormalities before surgery. However, Campbell said, in women with no prior problems, the breast MRI “may not always be clinically relevant.”
“It is sensitive but not very specific,” so it can show suspicious areas that might not be abnormal, he said.
Thermography — Thermography takes a compression-free photograph of the heat produced by the body, with areas of more blood flow producing more infrared rays on a thermogram. This screening is not utilized locally, as it is judged to be “experimental at this point,” Campbell said. In June, the FDA issued a warning to consumers that it should not be used as a mammogram substitute.
Stereotactic, ultrasound, or MRI breast biopsy — As a higher-level screening tool, breast biopsies, or needle core biopsies, take samples of suspicious breast tissue for analysis by a pathologist. The biopsy can be performed with stereotactic (a mammogram), ultrasound or MRI pictures, Reed said, with the method determined by the radiologist.
Most women cannot merely order up her preferred diagnostic test from a medical menu. Most insurance will cover a screening mammogram but not other measures, Campbell said. “You need an indication to do further studies.”
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Derry Twp. police officer Laura A. Pavone had her first mammogram one month after her 40th birthday and discovered she had breast cancer. “Having a mammogram when I was 40 was the best decision of my life,” said Pavone, a mother of three. “I was healthy, had no family history and never felt anything abnormal.”
Yet, last year, she was diagnosed with DCIS, or ductal carcinoma in situ, where cancer cells invade the lining of the duct. These tiny tumors are not usually discovered by a self-exam.
Area technicians and radiologists rely on an expanding number of high-tech diagnostic tests to find a lump, pinpoint its size and location, determine malignancy and work with breast surgeons to map out treatments. Soon, they will even have a 3-D option for mammograms.
While mammograms are often viewed as the gateway test for detecting all breast cancers, that is not always the case, said Dr. Todd Campbell of Holy Spirit Hospital’s Oakwood Breast Care Center in Mechanicsburg.
In most cases, if a screening mammogram indicates something suspicious, a more detailed mammogram or ultrasound will be ordered. However, if a 30-year-old woman comes in with a lump already, an ultrasound might come first.
“It usually depends on the patient’s age,” said Tracy Reed, mammography supervisor at PinnacleHealth System, which has two diagnostic sites — at the Medical Science Pavilion of Community General Osteopathic Hospital and Fredericksen Outpatient Center — and three screening sites — at Harrisburg Hospital, Dillsburg Imaging and Millersburg Imaging.
Yet, “a screening mammogram is still the most important tool we have for the early detection of breast cancer,” Campbell said.
While not perfect, this “dedicated X-ray of the breast” is precise, picking up about 85 percent of all cancers, said Dr. Scott Wise, a radiologist and director of the Women’s Imaging Center at Tristan Associates, which has locations in Camp Hill, Hershey, and Susquehanna and Lower Paxton townships. That accuracy rate drops to about 50 percent in women with dense breasts, where fatty tissue is scarce and problems appear as white spots on a white background.
“But far and away, it is the best study to show early calcifications,” Wise said. Although most calcium deposits are benign, a cluster of tiny calcium specks — called “microcalcifications”— might be an early sign of breast cancer, he added.
The wide variety of tests available each have their own strengths and weaknesses:
Screening Mammograms — A mammogram delivers a controlled beam of low-dose radiation to create a shadow on film. Soft tissue appears darker, and dense tissue appears white. Calcifications also appear white.
Views of the compressed breast are usually taken from the top and the side, while the patient stands in front of a tall rectangular machine. The compression only last about 10 seconds each time. The entire test, from the moment a patients strips down to the waist and dons a gown to the time she leaves with results, typically only takes about 35 to 45 minutes, Wise said.
Area imaging centers often read the exams while women wait, so they can deliver results, and peace of mind, right away. In unclear cases, radiologists might ask for more views.
“The interpretation takes more time than the test,” Campbell said.
To allay any confusion about changing guidelines for mammograms, area radiologists agree that a baseline exam should be done between the age of 35 and 40, and a yearly mammogram should be done starting at age 40. In 2009, the U.S. Preventive Services Task Force ignited a national debate when they recommended that mammograms start at 50, not 40, and be conducted every two years, instead of every year. The American Cancer Society has remained firm in recommending that women get an annual mammogram starting at 40, as have other organizations.
Experts admit that while the mammogram is not 100 percent accurate, it is still the best view in town — especially when used in tandem with other tools.
Diagnostic mammograms — These more comprehensive mammograms are performed when a patient is having a problem or has had a problem in the past that doctors are following, Reed said.
Tomosynthesis — This 3-D mammogram uses a rotating exposure that lasts about 10 seconds during breast compression to produce a stack of images similar to a CT scan’s sliced images. The machine is expected to cut down on false positive readings. It was just approved by the U.S. Food and Drug Administration in February, and PinnacleHealth expects to offer it soon at their Lower Paxton Twp. location.
Breast ultrasounds — These exams are typically done when a patient is feeling a lump, or a nodule that cannot be felt is detected on the mammogram, Reed said. An ultrasound can determine whether the lump is a fluid-filled cyst or a solid nodule, employing sound waves to create a picture of breast tissues. It is done with the patient lying down in a darkened room, situated by a technician at a monitor.
Breast MRI — Breast MRIs “have really exploded,” Campbell said. Because MRIs are “an extremely powerful study,” they are excellent at determining the size of breast cancer and seeing multiple spots, Wise said.
If an abnormality is detected on a mammogram, an MRI is sometimes recommended, Reed said. If a patient has a strong family history and is deemed high-risk, it might also be done. Breast MRIs are also the go-to screen after a breast cancer diagnosis to look at other possible abnormalities before surgery. However, Campbell said, in women with no prior problems, the breast MRI “may not always be clinically relevant.”
“It is sensitive but not very specific,” so it can show suspicious areas that might not be abnormal, he said.
Thermography — Thermography takes a compression-free photograph of the heat produced by the body, with areas of more blood flow producing more infrared rays on a thermogram. This screening is not utilized locally, as it is judged to be “experimental at this point,” Campbell said. In June, the FDA issued a warning to consumers that it should not be used as a mammogram substitute.
Stereotactic, ultrasound, or MRI breast biopsy — As a higher-level screening tool, breast biopsies, or needle core biopsies, take samples of suspicious breast tissue for analysis by a pathologist. The biopsy can be performed with stereotactic (a mammogram), ultrasound or MRI pictures, Reed said, with the method determined by the radiologist.
Most women cannot merely order up her preferred diagnostic test from a medical menu. Most insurance will cover a screening mammogram but not other measures, Campbell said. “You need an indication to do further studies.”
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