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Breast cancer screening driving early detection

Northeast Mississippi Daily Journal - 10/4/2017

Oct. 04--Northeast Mississippi radiologists don't want the debate over mammograms to keep women from getting screened annually for breast cancer.

"All of the professional groups are in agreement," said Tupelo radiologist Dr. Joanna Sadowska, who completed a fellowship in breast imaging.

The American College of Radiology, Society of Breast Imaging and American College of Obstetrics and Gynecology all recommend women of average risk for breast cancer start annual screening for breast cancer at age 40 and continue as long as they are in good health.

Mammography can uncover tumors that would otherwise remain hidden. Typically, a tumor has to be about the size of a nickel to be felt, said New Albany radiologist Dr. Justin Lohmeier. Mammography can find tumors the size of a pea and smaller.

"We can really detect cancer when it's very small," Lohmeier said.

Diagnosing breast cancer at its earliest stages gives women the most options for treatment and the best chance for eliminating the cancer completely. Mammography has helped reduce the death rate from breast cancer by 30 percent, according to the American College of Radiology.

Radiologists are trained to pick up subtle changes in breast imaging studies that can point to abnormal growths. It's very helpful to have multiple years of studies for comparison, Sadowska said, allowing radiologists to rule out otherwise suspicious spots and saving women unnecessary biopsies.

"Cancer is usually not stable for years," Sadowska said.

Screening is focused on women who don't have any symptoms, like a mass they can feel, or unusual discharge from the nipple. Those women may need a mammogram to investigate what's causing the changes and they should talk to their doctor.

"You don't have to wait to be 40 if you have symptoms," Lohmeier said.

Women need to understand their risk. Family history, personal history of cancer, age at the onset of menstruation, age at first pregnancy, breastfeeding and certain genetic syndromes all impact a woman's lifetime risk for developing breast cancer, Sadowska said.

Women with more than a 20 percent lifetime chance of developing breast cancer are considered high risk. Average risk is about 12 percent or 1 in 8.

Women at high risk are typically encouraged to start screening 10 years younger than the age a first degree relative was diagnosed with breast cancer, Sadowska said. If a woman's mother was diagnosed at age 35, she should start at age 25. Screening is not typically recommended before 25. Annual screening with breast MRI is also a recommended option for the small group of women at high risk for breast cancer.

Debate

Concern about over-diagnosis, anxiety over call backs and unnecessary biopsies has pushed the debate about when women should start breast cancer screening and how often they should be screened.

The U.S. Preventive Services Task Force recommends breast cancer screening every other year between 50 and 74 for women of average risk. It recommends women in their 40s talk to their doctors about the benefits and risks of screening to make an informed decision about when to start.

The American Cancer Society recommends starting mammograms between 40 and 45, annual mammograms between 45 and 55 and mammograms every two years after 55.

While most breast cancers are diagnosed in women ages 50 to 70, radiologists are concerned that waiting could miss too many cancers.

"We see so many young women 40 to 49," Lohmeier said, noting that breast cancer diagnosed in younger women can be more aggressive.

All of the professional and advocacy organizations now stress the importance of women fully understanding mammographies benefits and limits and their own personal risk profile.

Getting called back for additional views can be nerve-wracking for patients, but it's really just part of a careful review. About 8 percent of women are called back for additional views on their mammograms, Lohmeier said. Only 40 percent of the women called back are diagnosed with cancer.

"If you get called back, usually you don't have cancer," Lohmeier said.

Next steps

Emerging technology in breast cancer screening is showing promise at reducing the number of women who have to return for additional views. Breast tomosynthesis is beginning to make its way to Northeast Mississippi.

Sometimes called 3-D mammography, breast tomosynthesis uses the same technology as larger CT scanners. It collects multiple images very quickly as the scanner moves in an arc. The images are then assembled via computer to give radiologists a 3-D image of the breast.

It takes a little longer to complete than standard mammography and it is more expensive, but it is less expensive and time-consuming for women who would otherwise have to return for additional images.

Baptist Memorial-North Mississippi Diagnostic Center in Oxford is now offering breast tomosynthesis. NMMC Breast Care Center anticipates it will begin the installation process this fall. Baptist Memorial-Union County is slated to get the technology in the next year.

"We find that tomosynthesis helps us in two ways," said Oxford radiologist Dr. Thomas Sneed. "It increases the detection rate of breast cancers, and it reduces unnecessary call backs for additional imaging. Some published literature indicates a 30 percent increase in detection rate and 40 percent reduction in call backs."

It takes a little longer than traditional mammography. Like mammography, the exposure to radiation is very small, less than levels on an airplane flight, Sadowska said.

Tomosynthesis is most helpful for women with dense breasts. The density of breast tissue, typical in younger women, can make it difficult to see calcifications that can pinpoint abnormal areas of growth.

"It allows us to see the architecture in dense breasts and look for subtle cancers," Lohmeier said.

At the Oxford diagnostic center, breast tomosynthesis is being recommended to all women undergoing screening mammography, Sneed said. It is currently covered by Medicare. Some private insurance carriers cover it, but some others do not.

Lohmeier anticipates breast tomosynthesis will become the standard in breast screening in the next five years.

michaela.morris@journalinc.com

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(c)2017 the Northeast Mississippi Daily Journal (Tupelo, Miss.)

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