Breast cancer is the second leading cause of cancer death in women, exceeded only by lung cancer, according to the American Cancer Society. And those numbers are on the rise.
Researchers at the U.S. National Cancer Institute predict that in 2030, roughly 441,000 U.S. women will be diagnosed with breast cancer, up from 283,000 in 2011 — the most recent year for which numbers are available.
Physicians at the Virginia Women’s Center and Radiologic Associates of Fredericksburg have teamed up to do their best to make sure this predicted increase in the incidence of breast cancer doesn’t hold true locally.
Through a new breast health program, radiologists from Radiologic Associates of Fredericksburg are now on-site at Virginia Women’s Center offices. This partnership allows patients to undergo routine screening and follow-up diagnostic testing in surroundings familiar to them. By making the screening process as easy as possible for patients, they hope to see more women getting annual screenings.
Additionally, Virginia Women’s Center patients now have access to 3-D mammography — the biggest advancement in breast imaging in the last 10 years, according to radiologist Roni Talukdar, MD, with Radiologic Associates of Fredericksburg.
Nationally, less than 50 percent of women get a yearly mammogram, according to the Susan G. Komen breast cancer organization.
“That’s not acceptable,” says Kristin Schraa, MD, a gynecologist with Virginia Women’s Center. “We know that annual screening mammography saves lives.”
Early detection, physicians agree, is the key to survival. Women who find the cancer early — either through breast self-exams or annual screenings — are much more likely to survive.
“Getting a yearly mammogram beginning at 40 years old is the best way to combat breast cancer,” says Dr. Talukdar.
Breast cancer signs and symptoms
According to the American Cancer Society, the most common symptom of breast cancer is a new lump or mass on the breast: “A mass that’s painless, hard and has irregular edges is more likely to be cancer, but breast cancers can be tender, soft or rounded. They can even be painful.” There’s not a one-size-fits-all symptomatology.
For this reason, it’s important to have any new breast mass, lump or change checked by a healthcare provider experienced in diagnosing breast diseases.
Other possible symptoms of breast cancer include
• Swelling of all or part of a breast.
• Skin irritation or dimpling.
• Breast or nipple pain.
• Nipple retraction (turning inward).
• Redness, scaliness or thickening of the nipple or breast skin.
• A nipple discharge other than breast milk.
Decreasing the risk
Women can help reduce their risk of developing breast cancer by
• Maintaining a healthy weight.
• Exercising regularly (at least four hours a week).
• Getting plenty of sleep.
• Avoiding alcohol.
• Avoiding exposure to carcinogens (chemicals that are known to cause cancer, like nicotine).
• Breastfeeding their babies when possible.
Women with a family history of breast cancer or inherited changes in their genetic makeup could have a higher risk of developing breast cancer. They should talk with their physician about medications that block or decrease estrogen as well as possible preventative surgeries to remove breast tissue and/or the ovaries and fallopian tubes.
The goal of screening tests for breast cancer is to find the cancer before it causes symptoms. Drs. Schraa and Talukdar both recommend that women begin having yearly mammograms at age 40, or earlier if they're at high risk.
While breast cancer screenings cannot prevent breast cancer, cancer found during screening exams is more likely to be smaller and confined to the breast. The size of a breast cancer and how far it has spread are some of the most important factors in predicting a woman's survival.
“Finding breast cancer early reduces a woman’s risk of dying from the disease by 25 to 30 percent or more,” according to www.breastcancer.org.
During a mammogram, each breast is briefly compressed between two plates attached to the mammogram machine. The top plate is plastic and adjustable, while the bottom plate is a fixed metal X-ray plate. The bottom plate holds the X-ray film that records the image. Compressing the breasts between the plates reduces breast movement and makes the layer of breast tissue as thin as possible. While each image takes just seconds to record, this part of the procedure is critical to producing high-quality images that are viewed by a radiologist.
Mammograms are read, or interpreted, by radiologists — doctors who specialize in diagnosing and treating diseases and injuries using medical imaging techniques such as X-rays. When reviewing a mammogram, radiologists are looking for calcifications — tiny mineral deposits within the breast tissue that can be the earliest sign of cancer — as well as solid and cystic masses.
The main challenge with mammograms is that they aren’t perfect. Normal breast tissue can hide a breast cancer so that it doesn't show up on the mammogram. This is called a "false negative." When a screening mammogram shows an abnormal area that looks like a cancer but turns out to be normal, it’s called a "false positive." Ultimately the news is good: no breast cancer. But the suspicious area usually requires follow-up with more than one doctor, along with extra tests and procedures, including a possible biopsy.
Besides worrying about being diagnosed with breast cancer, the additional tests and follow-up visits required by a false-positive mammogram result can cause even more stress.
The new collaboration between Virginia Women’s Center and Radiologic Associates of Fredericksburg means that when women get called back for those additional tests, it will be back to their doctor's office — a place they are already familiar with and a doctor they already know.
Virginia Women’s Center is now able to offer mammography for patients with breast implants, diagnostic mammography, breast biopsies and breast ultrasounds in its offices.
Nationally, about 8 to 10 percent of women who have 2-D mammograms are called back to undergo additional testing. While this can happen for many reasons, one of the most common reasons is because traditional 2-D images are not clear enough for the radiologist to interpret accurately.
On the other hand, 3-D mammography — also called "digital tomosynthesis" — creates a three-dimensional picture of the breast using X-rays. The procedure complements the standard 2-D mammogram and is performed at the same time with the same system. There is no additional compression required, and it takes only a few additional seconds.
During the 3-D part of the exam, the X-ray arm takes several low-dose images from different angles around the breast that are used to create the 3-D picture. The images are then converted into a stack of very thin layers.
The radiologist is able to review the reconstruction, one thin slice at a time, making it easier to see if there's anything to be concerned about. Because of the quality of the images, radiologists are also able to more easily identify cancer that could be hiding behind overlapping tissue.
“One of the best things about 3-D mammography is that the study is much more conclusive. Fewer people have the frightening experience of needing to come back for more images,” says Dr. Schraa.
A 2013 study, “Increased Risk of Developing Breast Cancer After a False-Positive Screening Mammogram” (Henderson et al. 2015), found that 3-D mammography identified more breast cancers and led to fewer callbacks compared to conventional 2-D mammography.
Women who are concerned about radiation exposure don’t need to worry about any increased risk with the 3-D technology, says Dr. Talukdar. The exposure is well below the limit set by the Federal Drug Administration, and the risk of breast cancer far outweighs the risk of radiation exposure from the procedure.
“If the clearer images prevent a patient from having to come back for more images, they are actually being exposed to less radiation,” explains Dr. Schraa.
Studies on 3-D mammography show a 40 percent improvement in early detection and a 40 percent decrease in unnecessary callbacks and biopsies.
“All of the data we’ve seen and my own personal experience have shown that this has incredible promise in helping us save lives,” says Dr. Talukdar. “I’ve already detected cancers that I don’t think I would have seen on 2-D mammography.”
With Medicare and Medicaid now covering the 3-D portion of the procedure, Dr. Schraa is hopeful that other insurance companies will quickly follow suit. In the meantime, the Virginia Women’s Center only charges a small fee to cover the cost of the improved technology to those patients whose insurance won’t cover 3-D screenings.
“We feel so strongly that it’s such a better option. We are encouraging all of our patients to choose 3-D screening,” says Dr. Schraa. “It’s what we are doing for ourselves and what we recommend for our patients.”
Henderson, L. M., R. A. Hubbard, B. L. Sprague, W. Zhu, and K. Kerlikowske. 2015.
"Increased Risk of Developing Breast Cancer After a False-Positive Screening Mammogram." Cancer Epidemiology, Biomarkers & Prevention 24:1882-89.
Roni Talukdar, MD, with Radiologic Associates of Fredericksburg.
Kristin Schraa, MD, is a gynecologist with Virginia Women’s Center.