Testing It Up

A small town in Pennsylvania has recently been given a medical equipment upgrade.

In their press release, Easton Hospital Health and Wellness Center reported that it is now home to the latest technology in breast cancer detection: 3D mammography. This breakthrough technology allows for a three-dimensional examination of the breast tissue for a closer scrutiny. The procedure improves the assessment of the breast structure by distinct separation of overlapping tissues.

Also called breast tomosynthesis, this novel technique reduces the physical pain during scanning. Unlike conventional mammography wherein the breast tissue is subjected to pressure, this technique uses no pressure. This development alone has sparked interest in women who are hesitant to undergo mammography because of the pain. The 3D mammography system used in Easton is called Selenia Dimensions breast tomosynthesis, which is ergonomically designed for better patient comfort.

But more than the benefits of a pain-free procedure, the greatest advantage of 3D imaging is the clarity of the images. Easton’s 3D Mammography system generates crisp imaging details, thereby giving radiologists a higher confidence level in diagnosis. Results from a 3D mammography system are expected to be far better than the conventional method.

The procedure involves scanning the breast in several angles. The machine then takes 1-mm scans of the tissue, and then reconstructs the images to form a three-dimensional image of the breast. From the digital image, radiologists can then examine the breast for abnormalities or signs of breast cancer.

Easton Hospital Health and Wellness Center is located in Forks Township, Northampton County, PA.

Two reports published in the Annals of Internal Medicine indicate that the benefits of having mammograms may outweigh the risks for women in their 40s who have a higher than average risk of developing breast cancer.

One of the studies, which was conducted by researchers led by Dr. Heidi Nelson of Oregon Health & Science University in Portland, consisted of a review of 66 studies that looked at women’s risk for developing breast cancer based on their family history, weight, drinking and smoking habits, as well as if they had given birth or breastfed.

Based on the study, women who have a mom or sister who have breast cancer or very dense breasts may be twice as likely to develop the disease as well. Dr. Nelson and her team of researchers concluded that knowledge of risk factors associated with breast cancer may assist doctors and patients in coming up with a more personalized screening strategy.

The second study, on the other hand, was led by Nicolien van Ravesteyn from Erasmus Medical Center in Rotterdam, the Netherlands. Some of the researchers actually worked on both studies, including Nelson and van Ravesteyn, and its results mirrored those determined by the first study.

In a commentary accompanying the new reports, Dr. Otis Brawley, Chief Medical Officer at the American Cancer Society, wrote that making screening decisions based on the individual cancer risk of a woman “has the potential to save more lives than our current practice… Risk-based screening can refocus efforts onto the women who are most likely to benefit from screening.”

A study published in the Journal of the National Cancer Institute indicated that there may be a downside to breast-conserving surgery for women who have ductal carcinoma in situ (DCIS).

DCIS, defined as abnormal cells in the milk ducts and considered as the earliest stage of breast cancer, is usually treated through breast-conserving surgery that involves the removal of the abnormal tissue.

In the editorial that accompanied the study, editorial co-author Joshua Fenton, assistant professor at the University of California, shared: “Women making treatment decisions about DCIS need to understand that many women will need additional surgery or invasive intervention after breast-conserving surgery.”

The most common invasive procedure that will follow such a surgery is a biopsy to remove abnormal tissue in the same breast.

Lead researcher Larissa Nekhlyudov of Harvard Medical School and Harvard Vanguard Medical Associates in Boston clarified, however, that women should be made aware that breast-conserving surgery will be followed by a long follow-up period: “We’re not suggesting that women have a mastectomy instead… The good news is that the majority of these women will not have a (cancer) recurrence. But the work-ups for a possible recurrence are likely to continue for years.”

The study findings may prove to be useful in weighing the advantages and disadvantages of mammograms. The increase in number of mammograms has been accompanied by an increase in DCIS diagnoses. However, these may or may not progress to tumors that invade the breast tissue. There is also no way to predict which cases will progress to tumors, so women with DCIS almost always receive treatment, which may not be necessary in some cases.

A survey conducted by the University of Massachusetts Medical School in Worcester determined that more than 80 percent of women felt that the recommendation against having women under the age of 50 undergo breast cancer screening is unsafe.

Reuters featured the results of the study, and shared the following quote from the article published in the American Journal of Obstetrics and Gynecology: “Indeed, they have been exposed to consistent and high profile media campaigns, endorsed by medicine and a variety of interest groups, that have indoctrinated them into the concepts that mammograms lead to early detection and early detection saves lives.”

Most women, however, overestimate their risk for developing breast cancer.

In late 2009, a group of independent experts funded by the government changed the recommendation regarding screening mammography. The U.S. Preventive Services Task Force (USPSTF) recommended that women should only start undergoing routine screening upon reaching the age of 50. Furthermore, women between the ages of 50 and 74 are advised to undergo mammograms every two years.

The decision to undergo screening mammography among women under the age of 50 is left to the discretion of the individual woman concerned, and her attending physician.

The survey involved the distribution of questionnaires to 247 women in their 40s who underwent annual well-woman exams. Of these respondents, Dr. Autumn Davidson and her colleagues determined that more than eight out of ten women preferred to undergo annual mammograms. They also incorrectly assessed the lifetime risk of developing breast cancer among women in the US at 37 percent; scientists indicate that 12 percent, or one in eight women, will develop breast cancer in their lifetime.

There is a lot of debate going on regarding when a woman should submit oneself to routine mammograms, along with doubts as to whether the procedure brings as much good as it should.

At this time, the American Cancer Society (ACS) has the following recommendation: “Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health.” There have been other groups, however, who are pushing for changing the recommended age to 50.

Dr. Otis Brawley, chief medical officer of the American Cancer Society, was quoted in a feature on Bloomberg Business Week: “I have tremendous difficulty in not recommending an intervention [mammography] that a number of clinical trials suggest is beneficial… That’s where we stand.”

The results of a recently-released Swedish study support the recommendation of the ACS. The study revealed that women in their 40s who regularly undergo mammograms can reduce the risk of dying from breast cancer by 29 percent. The research, touted as one of the largest such studies to date, analyzed data from more than a million women; researchers, however, did not     take into account other potential harms related to screening, such as unnecessary biopsies.

Dr. Daniel Kopans, senior radiologist in the breast imaging division of the Massachusetts General Hospital and a member of the American College of Radiology Breast Imaging Commission, offered the opinion that mammography for women in their 40s saves lives. He said: “The Swedish study, to me, should be the nail in the coffin [of the debate]… This whole business of we don’t know if works for women in their 40s that should end. Randomized controlled trials show a benefit beginning at age 40.” Kopans is also a professor of radiology at Harvard Medical School.

Despite the recent recommendations from the U.S. Preventive Services Task Force (USPSTF), a majority of American women reportedly still believe in getting mammograms using the existing guidelines that are currently being followed.

This conclusion was drawn based on the results of a survey conducted by USA Today and Gallup, the results of which were revealed through a feature on USAToday.com. The survey consists of 1,136 women respondents, and revealed that a total of 76% of this representative population Disagree or Strongly Disagree to the recommendations of the USPSTF.

One of our readers, Cindy, also made her sentiments very clear and expressed displeasure over the recommendations.

Among the concerns that women had regarding the new recommendations is that delaying mammograms may place their lives in danger. Most women who responded to the survey reportedly intend to get mammograms before they turn 50, adhering to the recommendations set forth by the American Cancer Society.

The poll also showed, however, that women still make decisions based on preconceived notions that may need to be corrected. For instance, a majority of the respondents reportedly were under the impression that the USPSTF based their recommendations solely on cost, which is untrue. The fact that this recommendation was released at a time when health insurance coverage is a hot topic may have fuelled this belief.

Also, almost half of the respondents believed that the risk of women in their 40s for developing breast cancer is extremely higher that in actually is.

While we do understand the strong reactions of some women over these recommendations, it may be to everyone’s best interest to exercise due diligence in educating one’s self about the disease. Whether it’s the American Cancer Society or USPSTF that is making the recommendation, ultimately, a woman’s body is her own and she should have the right to take care of it as she sees fit. What is important for a woman is to work closely with her physician, revealing pertinent family medical histories and lifestyles and other information that may serve as guidelines towards assessing one’s medical needs.

Yesterday, we did a feature on the questions that you might want to consider asking when you go for a mammogram. For some women, the results of the mammogram and the diagnostic x-ray that might follow the mammogram may be less than favorable, but as we mentioned yesterday, that need not be a pronouncement that is to be equated to fatality.

One of the first courses of treatment that may be suggested to women who are diagnosed with breast cancer is surgery. This may mean either a full mastectomy or breast removal, or lumpectomy or the removal only of the tumor or growth and the tissue that surrounds it. There are cases where the combination of breast-conserving surgery and the testing of the lymph nodes followed by radiation may have the same life-saving effects as that of having a full mastectomy. If it does come to this point, it is a good idea to work with your physician and ask him or her to fully discuss with you the implications of both a mastectomy and a lumpectomy.

Another good thing to do will be to do your own research and ask as many questions as you can. Sometimes, the fact that we ask questions will help our doctors tell us everything we need to know. And while we do not have anything against general practitioners, in cases like this, it will be surgeons who specialize in the treatment of breast cancer as well as hospitals and medical centers that specialize in breast cancer treatment that will be the best to work with. Not only will they be able to present you with options that will best fit your specific situation, they are also in a better position to explain all the procedures you might need to undergo and what their implications are. Also, do not hesitate about finding someone else who can give you a second opinion on your case. It is important for you to be well-informed, as you are, after all, making a decision that will have a huge impact on both your life and that of your family’s.

Breast cancer is one of the leading health concerns for women. The fact that it is a cause of concern also means that a lot of effort and time is being poured towards research about the disease and the development of diagnostic and treatment techniques. Being diagnosed with breast cancer does not necessarily mean a death sentence nowadays.

The availability of knowledge and options, however, has also given rise to a new occurrence: over-diagnosis. In some cases, women are being subjected to treatment options that may not be the best fit for their specific cases. In this day and age, it is now as important to put trust in yourself and make your own efforts towards dealing with the disease as it is to put your trust and have faith in your doctor.

Asking questions should begin even before diagnosis, at a time when you are going to your first mammogram. Brush aside your anxiety as to what the test might end up finding, but be concerned about another thing: who will be interpreting the results of your test. In cases like this, it is totally within your rights to look for someone who is a breast-imaging specialist as opposed to a general practitioner; more often than not, it is this person who can accurately interpret your results for you. If your medical center does not have one on the staff, you may want to have your procedure done at a place that has one.

So you have already gone for a screening. A lump was found, what now? The next step will be to undergo a diagnostic x-ray, and before having one done, you are totally being reasonable if you would like someone specializing in mammograms to read your diagnostic x-ray. If you do not have one in your immediate area, having to drive an hour or two to the next town that has one would well be worth the effort.

We are by no means done – we have done mammograms, but what about after? There are questions you might want to think of asking when you have reached that point, which we will bring to you in succeeding posts.

A recently released study from a group of Danish researchers indicates an irony when the use of the mammogram is taken into consideration. On the one hand, the study concedes to the fact that since its development and subsequent use in medicine, the mammogram has inevitably lead to the survival of quite a number of women diagnosed with breast cancer. The down side is that its use – sometimes provided for free by certain organizations – has lead to an increase in the discovery of what are known as “harmless cancers” — cancers that may have disappeared of their own accord over time and will not have caused any harm to the patient in her lifetime.

The study was published online in BMJ according to an article on Forbes.com, and revealed that there as a 35% incidence of so-called over-diagnosis of breast cancer due to breast cancer screening programs. The researchers analyzed data from prevailing breast cancer screening programs in five countries: the United Kingdom; Manitoba, Canada; New South Wales, Australia; Sweden, and certain parts of Norway. These results come in the wake of another study which indicated that certain forms of breast cancer can actually disappear naturally, without the benefit of treatment.

The figures lead to speculation among the researchers that due to an increased number of patients undergoing mammograms and the rigorous guidelines followed by mammography, doctors may be finding – and treating – even those breast cancers that are not meant to be found and treated. In the same breath, however, the study stresses the importance of the mammogram as a tool for diagnosis and subsequent treatment, which can eventually lead to a patient’s survival. There is, after all, no hard-set line that separates the lethal from the harmless form of breast cancer.

Over-diagnosis is the term used to indicate the detection of certain cancers that do not cause problems in the course of a person’s lifetime. It is something that is not unique to breast cancer; there are statistics for other forms of cancer as well.

After the recent controversy surrounding prostate cancer screening, a study now placed another type of cancer screening under scrutiny — mammograms for the screening breast cancer. It is already common knowledge that while breast cancer screening through mammograms can save lives through early detection, the procedure also has its risks and disadvantages.

There is a tendency, however, to dwell on the adage that “early detection saves lives”, which is a saying that over 90% of women strongly believe in. The result, as found by experts, is that there may be women who are undergoing mammograms to screen for breast cancer at a frequency that may no longer be as beneficial as they hope or expect it to be.

The study, done by John D. Keen of the John H. Stroger Jr Hospital of Cook County and James E. Keen of the University of Nebraska, will be able to provide women and their attending physicians with a way to make informed decisions on whether or not to subject themselves to mammograms, and if they would, how often they should do it.

The study calculated the age-dependent absolute benefit of breast cancer screening in three ways. These are the absolute risk reduction from repeated screening, the number of women who should undergo repeated screening in order to save one life, and the percentage of survival among those who did versus those who did not undergo mammograms.

Observations during the study include a gradual increase in the life-saving benefits of mammography as patients get older along with screen-free absolute death risk, estimated at about 1% over 15 years beginning at age 55. For every 1,000 women aged 50 and above who undergo breast cancer screening, 1.8 lives are saved over a period of 15 years while it was noted that there is only 0.1% increased chance of survival with breast cancer screening over not undergoing the procedure for women aged 40.

The authors made the assumption that “a life saved” means that early detection through timely screening is able to lead to absolute cure for a woman diagnosed with breast cancer, who otherwise would have died if the disease was not caught in time.

The study, though, is rather controversial, and has resulted in conflicting opinions from some experts.