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Chris Flowers, MD
ChrisFlowersMD (Physician - Radiology (Verified) )| Communities: Breast Cancer | Answers: 8 |
| Member Since: May. 2012 |
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Dr. Chris Flowers, Director of Breast Imaging and Research, is a radiologist at Moffitt Cancer Center affiliated with the Center for Women's Oncology and the Diagnostic Imaging Program.
Originally from the U.K., Dr. Flowers received his medical degree (MBBS) at the University College of London. Additional education and training includes: Internship at Harrogate Hospitals (Surgery) and Hull University Hospitals (General Medicine); Medical residency at Hull University Hospitals, Radiology residency and fellowship in mammography at Nottingham University Hospitals.
Dr. Flowers has been a breast imager since 1987 from the start of national breast screening programs in Europe. He led the South West Wales breast screening service for 19 years, His research interests included digital mammography, where he worked with FUJI Medical Systems in Europe in the mid 1990's to develop CR imaging in mammography, the precursor of current full field digital mammography. He led the education of UK radiologists in breast biopsy in the early 1990's, and was the editor of a book on breast biopsy.
In 2001, he won a European Union small business award for a feasibility study using optical imaging to visualize tumor cells in the axilla, to determine whether tagged cancer cells can be detected by fluorescent techniques. He was also the lead European partner for a prototype optical breast imaging device, developed in the USA.
In 2007, he was recruited to the University of California, San Francisco,where he became the Statewide lead as Radiology P.I. in the University of California ATHENA Breast Health Network which has brought together the 5 University of California Medical Centers, and formed an academic-industrial partnership to develop multidisciplinary studies and comparative effectiveness research in breast cancer.
Originally from the U.K., Dr. Flowers received his medical degree (MBBS) at the University College of London. Additional education and training includes: Internship at Harrogate Hospitals (Surgery) and Hull University Hospitals (General Medicine); Medical residency at Hull University Hospitals, Radiology residency and fellowship in mammography at Nottingham University Hospitals.
Dr. Flowers has been a breast imager since 1987 from the start of national breast screening programs in Europe. He led the South West Wales breast screening service for 19 years, His research interests included digital mammography, where he worked with FUJI Medical Systems in Europe in the mid 1990's to develop CR imaging in mammography, the precursor of current full field digital mammography. He led the education of UK radiologists in breast biopsy in the early 1990's, and was the editor of a book on breast biopsy.
In 2001, he won a European Union small business award for a feasibility study using optical imaging to visualize tumor cells in the axilla, to determine whether tagged cancer cells can be detected by fluorescent techniques. He was also the lead European partner for a prototype optical breast imaging device, developed in the USA.
In 2007, he was recruited to the University of California, San Francisco,where he became the Statewide lead as Radiology P.I. in the University of California ATHENA Breast Health Network which has brought together the 5 University of California Medical Centers, and formed an academic-industrial partnership to develop multidisciplinary studies and comparative effectiveness research in breast cancer.
Professional Info
Credential: MD
Primary specialty: Radiology
Medical school: University College of London
Residency: Hull University Hospital, Nottingham University Hospitals
Internship: Harrogate Hospitals and Hull University Hospitals
Fellowship: Nottingham University Hospitals
Research interests:
- Molecular Mammographic Imaging for Cancer Detection: The goal of which is to determine whether splitting an image of the breast into its water, fat and protein components, potentially improves the sensitivity and specificity of mammography
- Reducing radiation dosage in medical imaging
- Dual energy tomosynthesis
Imaging of tumor heterogeneity
- Collaborative research between Florida and California to show research initiatives translate into clinical practice, as a model for the nation
- I-SPY 2 trial
Hospital affiliation: Moffitt Cancer Center
Practice address:
12902 Magnolia Drive
Tampa, FL
33612
Practice phone number: 813-745-3980
Webpage:
http://chrisflowersmd.com
ChrisFlowersMD Activities
Part of a complete MRI report for the breasts will include background enhancement, as this is an indicator of hormonal influence on breast tissue, and reduces the sensitivity of MRI in the same way as having dense breasts reduces the sensitivity of mammography to a lower level. The latest version of our radiology reporting lexicon (BIRADS) is being published this year, which will include descriptions of background enhancement and how to word the findings. However, this background enhancement does not yet appear to be linked to an increased breast cancer risk, unlike having dense breasts (which increases your risk by 4-6 times).
What the MRI report is saying is that you have a lot of background benign changes that are causing your breasts to light up like the holiday season! This is a normal finding, and is nothing to be concerned about. It may be also down to the timing of your MRI, and next time you have an MRI, you should check with your provider to see which days of your cycle are best to avoid this happening again, and allowing the MRI to be more accurate. If not a staging cancer scan or research scan, we limit our MRIs in young women to between days 10 and 14 after the start date of your period.
What the MRI report is saying is that you have a lot of background benign changes that are causing your breasts to light up like the holiday season! This is a normal finding, and is nothing to be concerned about. It may be also down to the timing of your MRI, and next time you have an MRI, you should check with your provider to see which days of your cycle are best to avoid this happening again, and allowing the MRI to be more accurate. If not a staging cancer scan or research scan, we limit our MRIs in young women to between days 10 and 14 after the start date of your period.
New answer by ChrisFlowersMD (Physician - Radiology (Verified)) in topic(s) Test Results, Breast Cancer Screening Reports, Breast Cancer Screening, Breast Cancer Imaging, Breast Magnetic Resonance Imaging (MRI), Screening Results, Breast Cancer, Results, Breast Magnetic Resonance Imaging (MRI) Results, Breast Imaging, Breast Imaging Results, Breast Cancer Screening Results
1
Answer |
11 months ago
This is a rather open question, but both ultrasound and MRI screening for women at high risk have revealed the potential for increasing false positive exams; that is, having a recall or biopsy when the eventual outcome is not one of cancer. The rate of false positive MRI findings is dependent on a number of things, from whether you are already a high risk person, in which case the radiologist is playing it safe with a lower threshold than normal, your hormonal status (young or peri-menopausal), or the timing of the MRI with regards to the menstrual cycle. Radiologists who do not read breast MRI as part of their job are also much more likely to call a normal area of breast tissue as suspicious and require a biopsy. Best advice is to seek out the best center in your area that is accredited by the American College of Radiology (ACR), and find out about the experience of their radiologists. If they are not accredited, check out another provider to have this done.
New answer by ChrisFlowersMD (Physician - Radiology (Verified)) in topic(s) Breast Cancer Screening, Breast Magnetic Resonance Imaging (MRI), Breast Cancer Imaging, Screening Guidelines, Breast Magnetic Resonance Imaging (MRI) Results, Breast Imaging, Breast Cancer False Positives, Breast Cancer Screening Risks, Mammogram Results, Breast Cancer, Screening Results, Screening Mammograms, Screening, Breast Cancer Biopsy
1
Answer |
11 months ago
Current mammography is the gold standard tool for breast imaging with a high sensitivity and specificity. However, mammography is imperfect, and the sensitivity can vary depending on both age of the patient and the density of the breast tissue. Our diagnosis up to now has relied on specific features on the X-ray to help us decide what is benign and what is malignant. Mammography has had a reasonable report so far, but could do better, may sum it up best.
We have described molecular mammography applied to the description of a simple technique we developed at the University of California, San Francisco, and is now the subject of a major grant between University of California - San Francisco, Chicago University and Moffitt Cancer Center. We believe that we can get much more information out of standard mammography than just anatomical information. By using a tiny dual energy exposure, without having to use contrast injections, we have been able to devise a way of looking at water, lipid and protein maps of the breast. What we have found from our phantom and pilot studies was that when these maps are combined, we get a unique signature from a benign lump (such as a fibroadenoma) compared with that from a cancer. If we are able to validate our work by further studies, then a mammography result will not just give information about appearances, but will also guide radiologists to whether it is likely to be benign or a malignant condition. One day this improved specificity may even allow us to avoid biopsy in women with definitively benign lesions.
We have described molecular mammography applied to the description of a simple technique we developed at the University of California, San Francisco, and is now the subject of a major grant between University of California - San Francisco, Chicago University and Moffitt Cancer Center. We believe that we can get much more information out of standard mammography than just anatomical information. By using a tiny dual energy exposure, without having to use contrast injections, we have been able to devise a way of looking at water, lipid and protein maps of the breast. What we have found from our phantom and pilot studies was that when these maps are combined, we get a unique signature from a benign lump (such as a fibroadenoma) compared with that from a cancer. If we are able to validate our work by further studies, then a mammography result will not just give information about appearances, but will also guide radiologists to whether it is likely to be benign or a malignant condition. One day this improved specificity may even allow us to avoid biopsy in women with definitively benign lesions.
New answer by ChrisFlowersMD (Physician - Radiology (Verified)) in topic(s) Breast Cancer Screening, Breast Tumor Detection, Breast Cancer Imaging, Breast Cancer Screening Tests, New Developments Breast Imaging, New Developments Breast Cancer Screening, Breast Tumor Detection New Developments, Breast Imaging, Molecular Breast Imaging (MBI), Molecular Mammographic Imaging (MMI), Breast Cancer, New Developments Breast Cancer Detection, Breast Cancer Detection
1
Answer |
11 months ago
Conventional imaging looks at the anatomy of the breast, whereas molecular breast imaging looks at physiology. Scintimammography is a type of Molecular Breast Imaging (MBI), which looks at the altered physiology of the breast, using the distribution of a radioactive isotope within the breast tissue. Scintimammography uses a similar agent to that used in bone scans. Once it has distributed around the body, the images are taken. This is made up of a number of dots, with clumps of these dots showing a positive finding. A newer more accurate type of scintimammography (called breast specific gamma imaging - BSGI) uses two small plates next to the breast to get better quality images. Another variant is Positron emission mammography (PEM) which is strictly a different type of procedure which uses powerful radioactive particles to use for imaging.
The benefits of using this technology are found in patients with very dense breasts, and in patients who are not physically able to have an MRI scan. These exams can often identify other tumors apart from the initial one that was found. Some groups claim that these tests are as accurate and less expensive than MRI scans
The downsides of this test are down to the use of a radioactive isotope, in that a significant radiation dose has to be used. BSGI and PEM use radioactive isotopes which do not give a significant dose to the breast, but because they are excreted via the bladder, there is an increased risk of damage to the colon and genitourinary organs. Until radiation doses used with these scan can be significantly reduced, I rarely recommend that it is used and then only where it is most appropriate.
The benefits of using this technology are found in patients with very dense breasts, and in patients who are not physically able to have an MRI scan. These exams can often identify other tumors apart from the initial one that was found. Some groups claim that these tests are as accurate and less expensive than MRI scans
The downsides of this test are down to the use of a radioactive isotope, in that a significant radiation dose has to be used. BSGI and PEM use radioactive isotopes which do not give a significant dose to the breast, but because they are excreted via the bladder, there is an increased risk of damage to the colon and genitourinary organs. Until radiation doses used with these scan can be significantly reduced, I rarely recommend that it is used and then only where it is most appropriate.
New answer by ChrisFlowersMD (Physician - Radiology (Verified)) in topic(s) Uses Of Scintimammography, Uses Of Molecular Breast Imaging (MBI), Breast Cancer Screening, Scintimammography, Breast Tumor Detection, Breast Cancer, Breast Cancer Screening Tests, Breast Cancer Imaging, Breast Tumor Detection New Developments, Breast Cancer Screening Recommendations, Breast Imaging, Molecular Breast Imaging (MBI)
1
Answer |
11 months ago
The short answer is no, as mammography uses tiny radiation doses which, when put into the context of natural background radiation we experience every day, is negligible.
However, there have been many scares and concerns about radiation from mammography even though not warranted, from the Dr Oz thyroid shields scare of 2011 to tsunamis causing meltdown of nuclear power plants in Japan. The thyroid association confirmed that there was no concern and recently produced a statement that thyroid shields do not need to be worn for radiation protection when having mammograms. If you are anxious about radiation, then making steps to minimize your exposure by getting high quality mammograms, and seeking out lower dose mammography where possible may be important to you. An example is 3D breast mammography, known as tomosynthesis currently is between 1.6 and 3 times the radiation dose of a regular mammogram, so you may wish to avoid one of those. Avoid having CT scans that are not medically indicated, as it is the skin dose from these scanners that causes radiologists concern. A test like that should be medically indicated, as the results outweigh the risks. A good professional site to read more about this is the 'image wisely' site which encourages radiologists to pledge that they will minimize unnecessary tests and reduce radiation exposure to their patients -http://www.imagewisely.org/Patients
However, there have been many scares and concerns about radiation from mammography even though not warranted, from the Dr Oz thyroid shields scare of 2011 to tsunamis causing meltdown of nuclear power plants in Japan. The thyroid association confirmed that there was no concern and recently produced a statement that thyroid shields do not need to be worn for radiation protection when having mammograms. If you are anxious about radiation, then making steps to minimize your exposure by getting high quality mammograms, and seeking out lower dose mammography where possible may be important to you. An example is 3D breast mammography, known as tomosynthesis currently is between 1.6 and 3 times the radiation dose of a regular mammogram, so you may wish to avoid one of those. Avoid having CT scans that are not medically indicated, as it is the skin dose from these scanners that causes radiologists concern. A test like that should be medically indicated, as the results outweigh the risks. A good professional site to read more about this is the 'image wisely' site which encourages radiologists to pledge that they will minimize unnecessary tests and reduce radiation exposure to their patients -http://www.imagewisely.org/Patients
New answer by ChrisFlowersMD (Physician - Radiology (Verified)) in topic(s) Breast Cancer Screening, Screening Mammogram Risks, Breast Cancer Mammography, Screening Mammogram, Breast Cancer Screening Tests, Breast Imaging Tests, Mammogram Risks, Breast Imaging, Breast Cancer Diagnosis, Tests, Mammography, Breast Cancer Screening Risks
1
Answer |
11 months ago
20 years ago a tumor was either an invasive ductal cancer or a lobular cancer. We knew that there was a good prognosis group who had positive ER status, as well as a poorer prognosis group who were HER2 +ve. Gradually we identified that breast cancer was not just one disease but a collection of different types and subgroups, with more being discovered every year. We now have a large number of tumor tissue biomarkers that we can use to sub-type a rainbow of different cancers.
Tumor heterogeneity is one stage beyond personalized medicine, as we observe that everyone has cancers that are composed of both good and bad 'actors', such as a mix or ER+ and ER- cells. The ER+ cells react quickly and easily to most therapies, but as this cell population begins to decrease, it allows ER- cells to continue to grow. We believe a fundamental understanding of how different populations of cancer cells grow and change with negative stimuli is important. As a result, this is a research topic of ours at Moffitt Cancer Center.
We are analyzing the different enhancement patterns on MRI and doing advanced imaging analysis to identify whether we can tell from imaging whether there is a group of women who are likely to do well with chemotherapy, and comparing that with biological analysis of core biopsy samples. We hope that our work will assist us in developing better targeted treatments in the future.
Tumor heterogeneity is one stage beyond personalized medicine, as we observe that everyone has cancers that are composed of both good and bad 'actors', such as a mix or ER+ and ER- cells. The ER+ cells react quickly and easily to most therapies, but as this cell population begins to decrease, it allows ER- cells to continue to grow. We believe a fundamental understanding of how different populations of cancer cells grow and change with negative stimuli is important. As a result, this is a research topic of ours at Moffitt Cancer Center.
We are analyzing the different enhancement patterns on MRI and doing advanced imaging analysis to identify whether we can tell from imaging whether there is a group of women who are likely to do well with chemotherapy, and comparing that with biological analysis of core biopsy samples. We hope that our work will assist us in developing better targeted treatments in the future.
New answer by ChrisFlowersMD (Physician - Radiology (Verified)) in topic(s) Test Results, Breast Cancer Screening, Breast Tumor Detection, Tumor Biology, Breast Cancer Biology, New Developments Breast Cancer Treatment, Breast Tumor Detection New Developments, Cancer Pathology, Breast Cancer Diagnosis, Tumor Pathology, Breast Cancer Tumor, Mammogram Results, Breast Cancer, Breast Cancer Pathology, New Developments Breast Cancer Detection, Pathology Results, Breast Cancer Detection
1
Answer |
11 months ago
In general, regular screening is offered to first degree relatives of women who developed breast cancer at a young age starting approximately 10 years before the age that cancer was originally diagnosed in the mother. Mammography is the most important and cheapest investigation for the majority of these women, and can be done at a relatively early age, provided the breast tissue is not dense. All young women are said to have dense breasts, but this is a myth, and only applies to a proportion of this age group. We need to limit radiation exposure over the lifetime of a high risk patient, and so the use of MRI for screening is especially important in women under the age of 30 years. If your mother developed cancer under the age of 50 years, it would be work searching out a high-risk clinic, run by many breast care centers, where you can be appropriately counseled and directed towards screening and risk reduction interventions that are appropriate for you and with which you are comfortable. At Moffitt Cancer Center, we have so many women in our high risk clinics that we have a dedicated specialist who oversees these clinics. Keeping radiation dose to a minimum has driven us towards using MicroDose mammography, which is approximately 50% or less dose than a regular mammogram, and 3-6 times less than a tomosynthesis exam. Always check out a facility that is ACR accredited and uses digital mammography, and the experience of the radiologist is important, as the majority of mammography in the USA is reported by general radiologists, and read over 400 exams per year. In comparison, radiologists specializing in breast imaging generally read over 2,000 mammograms per year.
New answer by ChrisFlowersMD (Physician - Radiology (Verified))
2
Answers |
11 months ago
This is a good question as it affects many women these days who may have had bilateral mastectomies plus or minus reconstructions of various types for either cancer, or because their family history is so strong, that they chose risk reduction surgery. There are no specific guidelines for these women, as there is no outcome data or any trials that have been performed on these women.
If you have had bilateral mastectomies without reconstruction, then physical examination is the best way to look out for any evidence of recurrence. Women are normally good at doing this, especially if they report any new 'lump' appearing on their chest wall following mastectomy. Any imaging done is usually ultrasound as the first test. This equally applies to male breast cancer sufferers, who usually undergo mastectomy routinely for their treatment. Patients with reconstructed breasts have other challenges, depending on the type of reconstruction which has been performed. In general, patients need to be aware of any change in their reconstructed breasts, although new lumps are frequently related to benign scar change, called fat necrosis, especially when plastic surgery has been involved.
Women who have had 'pedicle flaps', (TRAM or DIEP flaps) or who have implant reconstructions can sometimes have difficulty with routine physical examination, with the potential for missing a cancer developing in the marginal tissue near the breast bone and around the side towards the armpit (axilla). A breast MRI is the main tool that I would recommend in this situation, as many centers have demonstrated that you can pick up recurrent cancer before it can be felt. However, in the current economic situation, many insurance companies are not covering women for MRI unless that have a recent diagnosis of cancer. It is therefore important to discuss the options with your healthcare professional.
In summary, there are no guidelines apart from getting regular physical exams. The best screening tool for women with reconstructed breasts is MRI.
If you have had bilateral mastectomies without reconstruction, then physical examination is the best way to look out for any evidence of recurrence. Women are normally good at doing this, especially if they report any new 'lump' appearing on their chest wall following mastectomy. Any imaging done is usually ultrasound as the first test. This equally applies to male breast cancer sufferers, who usually undergo mastectomy routinely for their treatment. Patients with reconstructed breasts have other challenges, depending on the type of reconstruction which has been performed. In general, patients need to be aware of any change in their reconstructed breasts, although new lumps are frequently related to benign scar change, called fat necrosis, especially when plastic surgery has been involved.
Women who have had 'pedicle flaps', (TRAM or DIEP flaps) or who have implant reconstructions can sometimes have difficulty with routine physical examination, with the potential for missing a cancer developing in the marginal tissue near the breast bone and around the side towards the armpit (axilla). A breast MRI is the main tool that I would recommend in this situation, as many centers have demonstrated that you can pick up recurrent cancer before it can be felt. However, in the current economic situation, many insurance companies are not covering women for MRI unless that have a recent diagnosis of cancer. It is therefore important to discuss the options with your healthcare professional.
In summary, there are no guidelines apart from getting regular physical exams. The best screening tool for women with reconstructed breasts is MRI.
New answer by ChrisFlowersMD (Physician - Radiology (Verified))
1
Answer |
11 months ago
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