Regular Testing is Key to Early Diagnosis
By Kerry E. Chandler, MD,
Director, Breast Imaging Services,
Wake Radiology Diagnostic Imaging

According to the American Cancer Society, a woman has a one in ten chance of developing breast cancer at some point in her life. While the statistics are frightening, women can often take action to detect breast cancer at an earlier stage and increase their chance of being completely cured of this often devastating disease.

Most women are aware that the current medical recommendations are to have yearly screening mammograms after age 40, but unfortunately, many do not do so. Annual screening mammography has been proven to significantly decrease the risk of death from breast cancer in the population of women over age 40. Yearly screening mammography after age 40 enables detection of breast cancer as early as possible.

The most important risk factors for breast cancer are gender, increasing age, personal history of breast cancer, strong family history of breast cancer, genetic risk factors, history of having had a breast biopsy with results that indicate elevated risk, and rarely, a history of radiation therapy treatment to the chest at younger age.

Gender: While men can also develop breast cancer, it is overwhelmingly a disease that affects women.

Age: Nearly eight of ten breast cancers are diagnosed in women who are over age 50. Although women between ages 40 and 50 are not diagnosed as frequently with breast cancer as those that are older, there is still a significant incidence of breast cancer in this age group. These younger women tend to have breast cancer that is more aggressive (grows and spreads more rapidly) thus making annual screening mammography in this age group all the more important in helping to diagnose breast cancer before it is advanced.

Personal history of breast cancer: If a woman has had breast cancer, she has a greater chance of developing a new cancer in the other breast or same breast.

Family history: If a woman has a first-degree relative (mother, sister or daughter) who has had breast cancer, particularly before menopause, that woman’s risk for developing breast cancer is increased.

Genetic risks: Women who test positive for genes named BRCA1 and BRCA2 have up to an 80 percent risk of getting breast cancer during their lives. These genes are typically found in women who have a very strong history of breast cancer, typically with more than one first degree relative having had breast cancer at early ages. If a woman has a very strong family history of breast cancer she should consult with her physician or a genetic counselor to see if she is a candidate for genetic testing.

Abnormal breast biopsy: If a woman has had certain types of abnormal breast biopsy results, this may indicate higher risk for cancer. If a breast biopsy is performed, the patient should ask if the results of her biopsy place her in a high risk group even if that biopsy is negative for cancer.

Previous chest radiation therapy: If a woman has had radiation therapy to the chest especially if that treatment was when she was young (usually in treatment for another cancer), she has increased risk to develop breast cancer.

While some studies have linked postmenopausal hormone therapy (HRT) to breast cancer, data has not been absolutely definitive to date with respect to estrogen replacement therapy and breast cancer risk. Long term studies are ongoing, and these will help to clarify the breast cancer risk associated with estrogen hormone replacement therapy. Women should discuss the risks and benefits of hormone replacement therapy with their physician before beginning long-term treatment.

Screening Mammography and Self Breast Exams Are
Critical Components to Breast Cancer Detection

Along with the yearly screening mammogram, women should perform a monthly self-breast exam. When this habit is established, women are often able to detect very subtle abnormalities in their own breasts that can lead to diagnosing breast cancer at an early stage. A yearly clinical breast exam performed by a physician or other health care practitioner is also recommended.



BREAST IMAGING

SCREENING MAMMOGRAPHY
Screening mammography is an x-ray study of the breasts performed to identify breast cancer. Large numbers of these studies are performed by radiologists and read by specially trained physicians who have expertise in and an interest in interpreting mammography. These screening studies are read on a daily basis under ideal viewing conditions in order to identify subtle abnormalities that may require further imaging to characterize.

In most of our sites, Wake Radiology is now using digital mammography exclusively. Digital mammography differs from film mammography in that a computer is used to process the information obtained from the mammography study. Many patients are confused about digital mammography and believe that it does not use any x-ray radiation and that it does not require that the breast be compressed. Digital mammography does use x-rays to obtain the image but the radiation dose needed is even less than the already low dose of an analog (film) mammogram. The breast must still be compressed in order to obtain excellent images. The most important advantage of digital mammography is its superiority in evaluating dense breast tissue that is more common in younger women.

What if an Abnormality is found on a Screening Mammogram?
Less than 10 percent of women who have had screening mammography will require additional studies in order to evaluate questionable findings. This does not mean that breast cancer is present. In fact, most of these women are found to be “negative” on further testing. Women recalled for additional studies are naturally concerned. At Wake Radiology we make a phone call to all women who we determine have an abnormal screening mammogram and need diagnostic mammography so we can speak with them personally, reassure them and schedule the necessary testing - often on the same day or next day.

DIAGNOSTIC MAMMOGRAPHY/BREAST ULTRASOUND
The diagnostic mammogram consists of routine and specialized views performed to help characterize a clinical breast problem such as a new breast lump or to help characterize an abnormality seen on a screening mammogram. Breast ultrasound is also often used to help characterize a new breast lump or to help evaluate an abnormality seen on a mammogram. Often these two studies are all that is needed to make a definite diagnosis, and it is Wake Radiology’s policy to let the patient know the results of these studies at the time they are performed.

BREAST SPECIFIC GAMMA IMAGING (BSGI) – A New Diagnostic Tool
Wake Radiology is home to the area’s only BSGI program. This recently introduced nuclear medicine study is approved by the Food and Drug Administration (FDA) as an effective means of demonstrating breast cancer. It is especially useful in women who are at increased risk for breast cancer and have mammograms that are particularly difficult to interpret. The procedure involves an injection of a small amount of radioisotope, which is preferentially taken up by metabolically active cells in the breast (including cancer cells) allowing them to be visualized using a small gamma camera that is designed specifically for the breast. BSGI is very sensitive in detecting cancer and is especially helpful when it is negative, meaning a very low likelihood of cancer.

BREAST MRI – New Opportunity in Cancer Detection
Breast MRI is another imaging study that can be helpful in evaluating for breast cancer. Breast MRI can be used to screen the breast for cancer in women at high risk. Breast MRI can also be used to evaluate the extent of cancer in the breasts in a woman who has been recently diagnosed with breast cancer so her treating physicians can plan the most appropriate surgery and therapy. Breast MR can also be very helpful in evaluating the post surgical breast in women who have had breast cancer to evaluate for recurrent cancer. Breast MR is also used to evaluate the breast in women who have a concerning physical exam and/or a difficult to interpret mammogram or ultrasound exam. Breast MRI is becoming progressively more important in helping to find and evaluate breast cancer

There is an ever increasing array of imaging studies to diagnose breast cancer along with constantly improving therapies for breast cancer. The improvements in imaging and treatment have led to a marked decline in breast cancer mortality over the past ten years. Yet, it all begins with screening and each woman’s decision to have a yearly screening mammography and yearly breast exams after the age of 40 or even earlier if they are at increased risk for cancer.

For more information, visit the Wake Radiology Web site at www.wakeradiology.com

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