Posts Tagged ‘breast cancer’

What you need to know about digital vs. film mammograms

Tuesday, February 22nd, 2011

In a recent report published in the journal Radiology, the findings of a research group from Barcelona, Spain, provided women and the medical community with some key information about the use and efficacy of digital mammography. As reported in DoctorsLounge, the researchers, headed by Maria Sala, M.D., Ph.D, concluded that digital mammography had a lower false-positive rate than screen-film mammograms; however, there was “no significant difference in the cancer detection rate between the two, according to [the] study.”

If you are unfamiliar with this new technology, here’s a video presented by WellSpan HealthSource. See what they believe some of the benefits are for digital mammography.

httpv://www.youtube.com/watch?v=_TLhjsFeQDg

Here’s the statistical information regarding false-positive and detection rates between these two modalities of mammograms.

The researchers found no significant difference in the cancer detection rate between the two modalities, with the screen-film detection rate at 0.45 percent and digital at 0.43 percent. The false-positive rate for screen-film mammography was 7.6 percent but for digital mammography the rate was 5.7 percent. Digital mammography also had lower recall rates and was less likely to result in a false-positive result leading to an invasive procedure. The lower false-positive risk remained even after results were adjusted for women’s characteristics, screening program characteristics, and time trends.

Who should undergo digital mammography?

Dr. Michael Wu, of the Palo Alto Medical Foundation, has an informative post on the issue of who the best candidates are for digital versus film mammography. He gives a synopsis of the groups, as reported by The New England Journal of Medicine, who are the best candidates to undergo digital mammograms.

Those who benefited:

  • Women < 50
  • Women with dense breast tissue
  • Women who were premenopausal or perimenopausal.
  • Those who did not appear to benefit:

  • Women > 50
  • Women post-menopausal
  • Those without dense breast tissue
  • Dr. Wu’s post also addresses issues such as cost effectiveness and radiation exposure differences between the two methods of digital and film mammograms. What may be of interest to many women is that the actual technique (which I understand can be painful for many women) is the same. Perhaps further development of devices and systems will lower this problem – hopefully – in the future. Needless to say, the discomfort for 20 – 30 seconds is far outweighed by the benefits of early detection of breast cancer.

    3-D Mammogram recently approved by FDA

    It was also recently reported by PRNewswire that the FDA recently approved the first 3-D digital mammogram (tomosynthesis scans) system. Hologic, Inc., a leader in the development, manufacturing and distribution of medical devices, including medical imaging systems and the company whose system won this approval, ran a series of clinical trials using this new 3-D mammography system.

    Undoubtedly beaming with joy over having his company’s product be the first to be approved, Rob Cascella, President and CEO of Hologic, has this to say about this new medical weapon in the fight against breast cancer:

    Our Dimensions 3-D takes advantage of all of the benefits of digital mammography and quite simply makes it better with the combination of fast, high quality 3-D breast imaging. We believe tomosynthesis has the potential to change how screening and diagnostic mammography is performed, and over time will prove invaluable to the earliest possible detection of breast cancer and in the reduction of unnecessary diagnostic interventions.

    it will be very interesting to see if the recent study in Spain by Dr. Sala and his colleagues is taken further by his group or other researches to examine whether this newer 3-D technology will further change the landscape in lowering false-positive rates or – even more important – increasing the early detection rate for breast cancer.

    Some basic, highly disturbing facts about breast cancer:

    The PRNewswire release also provides the following information about breast cancer:

    One in eight American women will develop breast cancer sometime in her lifetime. In 2009, an estimated 192,370 new cases of invasive breast cancer were diagnosed among American women, as well as an estimated 62,280 additional cases of in situ breast cancer. Over 40,000 American women died from breast cancer in 2009. Only lung cancer accounts for more cancer deaths in American women. The stage at which breast cancer is detected influences a woman’s chance of survival. If detected early, the five-year survival rate is 98 percent. At this time, there is no sure way to prevent breast cancer, which is why regular mammograms starting for most women at age 40 are so important.

    This video by one of the country’s premier institutions for cancer treatment, MD Anderson Cancer Center, provides some very useful information and some excellent suggestions for undergoing a mammogram.

    httpv://www.youtube.com/watch?v=Y-GmNmPeqHQ

    Readers’ Information

    There is no doubt that many physicians, researchers and women have exceedingly superior knowledge of these techniques, systems, risks and benefits, and the like. Have any of you been involved in this research? Have you  had or do you know someone who has undergone digital mammography? What information can you share with our readers about this new technology? We invite you to share this information and spread the word by sharing this post with you friends. As we always say, being an informed patient is essential to improving your health and survival.

    CT Scans – Are You Being Properly Protected Against Radiation?

    Thursday, December 2nd, 2010

    According to new research presented at the annual meeting of the Radiological Society of North America, breast shields should be used for men and women undergoing CT scans of the chest/lungs. According to Terry Healey, M.D., Director of thoracic radiation at Alpert Medical School of Brown University, the breast shield is capable of reducing the level of radiation by about 30%.  This is significant considering that radiation can cause or contribute to the development of various malignancies (e.g. breast cancer, lung cancer, esophageal cancer).

    Although some physicians argue that the use of breast shields may impact the quality of the CT scan (i.e., by producing artifacts such as streaks or lines making the interpretation of the study more difficult), this new research suggests that the use of breast shields does not impact the diagnostic quality of the CT scan. A breast shield is nothing more than a thin piece of heavy metal placed in front of the chest during the CT scan procedure.

    Researchers studied 50 patients, who needed CT scans of the chest. Most of the patients were undergoing the study to rule-out lung cancer.  For some patient the shield was placed directly on the chest. For other patients, the shield was slightly elevated from the chest surface. Overall, some artifact was present in about 2/3 of the cases. However, in the opinion of the researchers, there were no instances where the artifact interfered with the diagnostic quality of the radiographic study.

    According to Judy Yee, M.D., vice chair of radiology at the University of California: ”[T]here’s no good reason not to use breast shields. The cost is relatively low and the benefit large.”

    Perhaps a larger patient population is needed for the results of this research to be more widely accepted by the radiology community. We’d appreciate anyone who has experience in this field to share their thoughts on this topic. Do such shields cause artifact that makes the study less accurate and potentially dangerous to a patient? Does the accuracy of the scan, when a shield is used, depend on which type of scanner is used or which generation of scanner is being used? Are there other techniques that can be used to protect a patient yet not run the risk of artifact “mis-read”? We’re not physicians or radiology technicians, so we welcome any insights those who are might have on this topic.

    If you are concerned about excessive radiation and need to undergo a chest CT, ask your radiologist if a protective shield can be used during your CT scan. Discuss the issue and – as we always stress – take charge of your own medical care. Be an informed patient and be responsible for your own health and safety. Know what the issues, risks and benefits are and discuss it with your doctor. Then – and only then – make an informed decision.

    Image from emedicine.medscape.com

    Mammography the “Australian Way” – Why aren’t we doing this in the US?

    Wednesday, November 17th, 2010

    I came across an online article today by Marianne Betts of heraldsun.com.au that there was a problem regarding mammogram reports that had gone out to over 5,000 women who recently had this test performed. There was apparently a breakdown in their review process, which required massive notifications to the women involved.

    While this is no doubt very serious business for all concerned, I decided to post this blog for an entirely different reason. I simply was not aware that in Australia, two radiologists read mammograms independent of each other as a normal practice.

    A senior radiologist, Professor Jenny Crawson, is quoted as saying that this standard practice of two separate, independent radiology reads (i.e. interpretations) is standard practice in Australia was a “proven success.”

    The article goes on to report that with this practice, if both radiologists agree the images are “clear” (no evidence of detectable suspicious lesions/cancer), then the patient is given the “all clear” notification. However, if they disagree, the opinion of a third radiologist is sought.

    Dr. Cawson is then quoted to say:

    There’s a lot of  scientific evidence that if you have two radiologists reading mammograms you have a higher detection rate of breast cancer than if you have one radiologist.

    So it’s a quality assurance mechanism to maximise cancer detection.

    Have any of you heard of this practice being followed anywhere else? Anywhere in the United States? Is anyone aware if this program or practice has been studied in the United States or elsewhere in terms of effective higher detection of breast cancers? If we are not doing this (which I’ve never heard of) here in the US, why not? Cost?

    I would really like to hear what you know about such a practice.

    Image from norwalkradiology.com

    Wrapping-up Breast Cancer Awareness Month – It’s a Year-Long Battle – Don’t Forget!

    Friday, October 29th, 2010

    This year we saw the NFL and White House go pink in honor of Breast Cancer Awareness month.  As the 25th year of Breast Cancer Awareness month comes to close, it’s incredible to look back and see how far we have come over the past 25 years in promoting awareness and early detection as well as in the advances in treatment of this disease.

    Cases of breast cancer are documented throughout history with the earliest reports dating back to Ancient Egypt in 1600 BC.  However, it wasn’t until the 17th Century in Europe that an understanding of the disease began to take place.  It was during this time that the first surgeries to remove the breast tumor, breast muscle and lymph nodes were performed to eradicate the disease from the body.  In 1882, William Stewart Halsted performed the first mastectomy, the Halstead Radical Mastectomy, which remained a popular treatment up until the 1970’s.  While this form of surgical treatment is rarely used today, there are three variations of Halstead’s procedure performed to remove breast tumors: partial mastectomy (also called lumpectomy), modified radical mastectomy, and the rarely used total simple mastectomy.

    The movement to increase breast cancer research and awareness did not take off until the 20th century.  It was in 1952 that the American Cancer Society created the Reach to Recovery program, a group of women who would travel to hospitals to support patients who had mastectomies performed. This program remains in effect today.

    By the 1970’s, breast cancer advocacy began to increase rapidly as more non-profit organizations and governmental organizations formed to increase knowledge and awareness as well as to sponsor research to aid in eradication of the disease. Over the last two decades, major breakthroughs in detection and treatment modalities have been made.

    The first step to early detection was the development of modern mammography in 1969, when the first x-ray units dedicated to breast imaging were available. By 1976, mammography as a screening device became standard practice.  Mammograms are the best radiographic method available today as they can detect tumors that are too small to be felt. To increase early detection the Mammography Quality Standards Act was passed by Congress in 1992 to ensure that all women have equal access to quality mammography for detection of breast cancer in its earliest and most treatable stages as well as to improve the quality of mammography facilities. When breast cancer is detected, modern treatment typically involves a combination of surgery and medical treatment with chemotherapy, radiation therapy and/or hormone therapy.  Advances in such treatments have resulted in increased five year survival rates.  Patients who get treatment in the early stages of breast cancer have a five year survival rate of 80% or better. Despite treatment advances, the most important thing for breast cancer survival is early detection through monthly self-checks and yearly mammogram examinations in women over the age of 40.  Lastly, advances in reconstructive surgery have helped women to feel more comfortable with their body image as well as restore confidence in their sexuality.

    Despite these advances, every 69 seconds someone’s mother, sister, daughter or friend loses their life to breast cancer somewhere in the world.  While major advances in breast cancer detection and treatment have reduced the mortality rate from the disease, we still have a long way to go.

    As Breast Cancer Awareness month comes to a close, we should take a moment to honor and remember those that have battled the disease by reminding ourselves and encouraging our loved ones to perform monthly self-checks and to obtain a yearly mammogram.

    Breast cancer is not a one month a year disease. We need to encourage all women to fight breast cancer twelve months a year.

    Warning to Women of Menopausal Age: HRT Linked to Increase in Death from Breast Cancer

    Friday, October 22nd, 2010

    One day after Pfizer wins the latest lawsuit regarding HRT in Arkansas, a new study published in the October 20, 2010 issue of the Journal of the American Medical Association found a link between prolonged use of HRT and the risk of not only developing breast cancer but of dying from the disease.

    This new study began with data from the Women’s Health Initiative, a randomized-controlled study of post-menopausal women that abruptly ended in 2002, when a definitive increase in the incidence of breast cancer was discovered in women taking the combined HRT of estrogen-plus-progestin.  Since the end of that study, researchers continued to follow the participants and found that women taking the combined HRT were more likely to have an invasive breast cancer, more likely to have breast cancer that spread to the lymph nodes, and more likely to die from breast cancer than participants in the placebo group.

    Estrogen-plus-progestin pills like Prempro increase breast density making tumors difficult to identify on mammograms which delays the diagnosis and inevitably the treatment for the disease. The researchers conclude that women taking HRT should use the lowest dose for the shortest amount of time to reduce their risk of developing breast cancer.

    The Today Show’s Dr. Nancy Snyderman discusses the study’s conclusions on the Today website with a warning to women of menopausal age to consider the risks of HRT and to discuss with their physicians the possibility of taking the lowest dose for the shortest amount of time.

    It is important to note that the study findings only apply to hormone replacement therapy with estrogen-plus-progestin pills or combined hormone therapy, not to estrogen-only therapy.

    Contributing Author: Rachel A. Leyko

    Woman undergoes mastectomy only to learn a week later, she never had cancer. Now another patient of same doctor claims the same fate.

    Friday, June 4th, 2010

    The Vancouver Sun reported that in 2001, Dr. Barbara Heartwell of the Hotel Deiu Grace Hospital in Windsor, ON performed an unneccessary mastectomy. Janice Laporte was the victim of Dr. Heartwell’s disfiguring mistake.

    Ms. Laporte underwent a mastectomy in September of 2001 , and was told just one week post-operative that she never had breast cancer. Ms. Laporte’s case details are protected by a confidentiality clause; her case was settled soon after filing suit in 2002. Ms. Laporte told the Canadian Press, after a second patient came forward:

    “It’s bad enough to have to be told you have cancer or to have a mastectomy,” she said.

    “That is devastating enough, but then to hear that it was done for no good reason just compounds everything.”

    “At least things are being looked in to now,” she said. “It’s unfortunate that this has to happen for them to look into this kind of stuff.”

    The second woman who allegedly fell victim to Dr. Heartwell’s “mistaken diagnosis” is Laurie Johnston, a middle-aged single mother of a teen daughter. Ms. Johnston claims she underwent an unneccessary mastectomy in November of 2009.

    Ms. Johnston has filed suit with similar accusations to those of Ms. Laporte. “Heartwell performed ‘dramatic, disfiguring and invasive surgery’…” Since filing suit, Ms. Johnston has also taken her case public.

    Hotel Deiu Grace Hospital claims it became aware of the lawsuit when a reporter inquired about details of the case. The hospital has since launched an investigation into Dr. Heartwell’s cases. Dr. Kevin Tracey stated during a news conference with the Canadian Press that:

    “During the course of our investigation she indicated that in our review of her past cases we would find additional cases of concern”

    Apparently, these “additional cases of concern” caused the hospital to widen it’s investigation to include over 10,000 pathology reports  which were completed by Dr. Olive Williams.

    Dr. Williams’ privileges were suspended in January; Dr. Heartwell voluntarily stopped operating in the early weeks of March. Both physicians have been reported to the College of Physicians and Surgeons of Ontario.

    To prevent further such tragic events as happened to Ms. Laporte and ostensibly Ms. Johnston as well, a pre-surgery safety checklist was implemented into hospital practice in April. Deb Mathews, Ontario’s Health Minister, claims that of the items on the checklist, review of biopsy results are required prior to administering anesthesia.

    A Windsor lawyer, Harvey Strosberg, predicts that Ms. Johnston’s case will never see the inside of a courtroom. Her case is strong and he predicts that she will likely reach a settlement agreement.

    Simply put – it SHOULD never see ‘the inside of a courtroom. How tragic!

    Univ of Michigan's Cancer Center Study Tests Freezing Technique for Breast Cancer Tumor | Testing It Up – Test Country Blog

    Saturday, March 6th, 2010

    Is there a new treatment for breast cancer on the horizon? Read this blog report –  Study Tests Freezing Technique for Breast Cancer Tumor | Testing It Up.

    Cryoablation – freezing – has been successfully used in mice to stop the spread of breast cancer.  The research was conducted by a team at the University of Michigan Comprehensive Cancer Center, which is affiliated with the university’s medical school.

    Dr. Michael Sabel, who led the team of researchers,  explained the following in a news release:

    “Cryoablation has strong potential as a treatment for breast cancer… Not only does it appear effective in treating the primary tumor with little cosmetic concerns, but it also may stimulate an immune response capable of eradicating any cells that have traveled throughout the body, reducing both local and distant recurrence, similar to giving a breast cancer vaccine.”

    The original report on this important research was done by BusinessWeek – for further information read the posting by that publication.

    If you go to the Center’s site,  you will also find fascinating and important stem cell research being conducted by that institution and an informative video done by the Center’s director, Dr. Max Wicha, regarding their stem cell research efforts.

    It was at this Center that breast cancer stem cells were first discovered in 2003.

    While there has been a steady decline in the death rate related to breast cancer since 1990, the bad news is that approximately 41,000 women are still dying each year in the United States alone from this horrible disease.

    Aspirin Found to Decrease Mortality in Breast Cancer Patients

    Wednesday, February 17th, 2010

    A recent study reported in Medical News Today and published in the Journal of Clinical Oncology suggests that women who take aspirin at the conclusion of chemotherapy are less likely to die from breast cancer.

    The study involved 4,164 female registered nurses who were diagnoses with breast cancer between 1976 and 2002. Because aspirin is contraindicated during chemotherapy, those patients who took aspirin generally began taking the drug a year after their breast cancer diagnosis.

    The result of the study suggests a positive correlation between taking aspiring and decreased mortality rates. Women who took aspirin at least two days a week reduced their mortality risk by 64% to 71%.

    Questioning The Change In Mammography Guidelines

    Sunday, January 31st, 2010

    Recently, I posted a blog on the new guidelines for mammograms  issued in November 2009 by the US Preventive Services Task Force.

    A new posting on Medical News Today provides ‘the other side of the argument.’  Specialist in diagnostic imaging have questioned these new guidelines.  A recent article - Questioning The Change In Mammography Guidelines – takes the position that -

    The methodology and evidence behind a widely publicized change in national mammography guidelines is questionable, according to a review in the Journal of Diagnostic Medical Sonography (JDMS), published by SAGE

    For those who have been following the history of these ‘guidelines,’ you know that they have changed a number of times.  One wonders if they shouldn’t be required reading on Twitter for physicians so that they can keep up with the ‘standard of care’ when treating their patients.  Where will it all end?  Who knows.  I stand by the advice given in our prior post:

    Perhaps the best advice – Women be knowledgeable about the recommendations and discuss them and their application to you and your risk factors for breast cancer with your gynecologist.  If you are a young woman or are unfamiliar with what a mammogram is all about, you may want to consider watching a video of what this test is all about and how it is performed.

    Medical News: Sorting Out the Mammography Mess – in Hematology/Oncology, Breast Cancer from MedPage Today

    Saturday, January 30th, 2010

    Confused about when you should start undergoing screening mammography?  A recent article in medpage today -Medical News: Sorting Out the Mammography Mess – in Hematology/Oncology, Breast Cancer from MedPage Today – attempts to educate women about this seemingly ever-changing set of guidelines.

    The article contains an audio interview with Dr. Len Lichtenfeld, Deputy Chief Medical Officer of the American Cancer Society, which is worth a ‘listen.’

    This whole new discussion as to when women should get screening mammograms arose when the US Preventive Services Task Force issues its recent recommendations.

    Perhaps the best advice – Women be knowledgeable about the recommendations and discuss them and their application to you and your risk factors for breast cancer with your gynecologist.  If you are a young woman or are unfamiliar with what a mammogram is all about, you may want to consider watching a video of what this test is all about and how it is performed.