Breast Cancer Detection Goes High Tech
The American Cancer Society caused a bit of a stir last week when it changed its recommendations for women on when to begin and how often they should get mammograms. But what has not changed is that mammography is still the first line of defense against breast cancer. Dr. Donald Farmer is President of Pensacola Radiology Consultants and the Medical Director at the Ann Baroco Center for Breast Health at Sacred Heart Hospital in Pensacola. He says mammography is still the gold standard for breast cancer detection because "it's hard to beat for convenience, it's hard to beat for price and it's been around for so many years that everybody's comfortable with it. It's a good baseline for us."
And while Dr. Farmer says mammography has been around for years, it certainly has changed in the past decade. "Like everything else in medicine technique wise, equipment wise (mammography) has progressively increased in sophistication. " Farmer says changes in targets and energies have improved the process and they also have "digital processing of the mammography image, which we didn't have 4 years ago."
Having digital images of the breast gives a clearer picture and allows doctors to detect spots that may have been too small to see when mammograms were shot on film. There is also a process called breast tomosynthesis. "That is a new modality that you add to the digital mammography where you basically produce thin slices of the breast (image) and you can see through the tissue much better than just with a regular mammogram" said Dr. Edwin Rivera, a physician at Baptist Hospital in Pensacola. he says this technology helps with women who have very dense breast tissue, cutting down of the number of women you have to recall for more images.
And finding new ways of detecting lesions in dense breast tissue is a priority in the breast cancer community. "That's really our Achilles heel when it comes to mammography, breast density." says Dr. Farmer. "I equate it to looking for a polar bear in a snowstorm. If you got a dense breast and you're trying to see a change in density or trying to see some subtle micro calcifications, it's very difficult to perceive. And that's why we've tried to develop other modalities, to better allow us to evaluate those women." Farmer says that's important because women who have dense breasts are usually younger,and those are the women who have more aggressive types of cancer.
There are currently 24 states, including Alabama and Louisiana that require doctors to inform women about their breast density after a mammogram. A similar bill had been introduced in Florida but did not pass. Dr. Farmer says once a woman is found to have dense breasts, they may need additional testing. This could include automated or targeted breast ultrasound. "We also now use fairly extensively breast MRI." Dr. Farmer says in a perfect world, breast MRI would be offered to everybody. But it’s more costly than mammography and insurance will not always cover the procedure. "While there are many patients who would benefit from (breast MRI), we have to be a little more sophisticated in which patients we earmark for having a breast MRI."
Finally, looking into the future, doctors hope that advances in genetics and nano-technology will provide them with more weapons in the fight against breast, and all other cancers. And back to where we started, the American Cancer Society now recommends that women begin receiving annual mammograms at age 45 instead of 40…and that at age 54, they go from annual screening to every other year. As always, the views of your personal doctor and/or insurance company may vary.