Mammography

Yeah. I hate this question. And I get it whenever the patient's cancer was missed on mammo. I think that so much emphasis has been put on screening mammos yet it is often not well known that mammos miss up to 20% of breast cancers on screening studies. [Reference: www.cancer.gov/cancertopics/factsheet/detection/mammograms] Crummy, I know, but when you look at the stats, it's still the best we have right now for mass screening. And it is responsible for the decrease in mortality and increase in early stage diagnosis over the last decade or so. [Reference: Regular mammograms may decrease the risk for deadly breast cancer by 49%, a new case-control study suggests.

According to the Dutch investigators, the greatest reduction occurred in women aged 70 to 75 years and represented a drop of 84%.

"Our study adds further evidence that mammography screening unambiguously reduces breast cancer mortality," said senior researcher Suzie Otto, PhD, from the Department of Public Health at Rotterdam's Erasmus Medical Centre, the Netherlands, in a news release.

The study was published online December 6, 2011 in Cancer Epidemiology, Biomarkers, and Prevention]


So even though it did not pick up the first cancer, odds are that it will pick up the next one if it occurs. That's why we still order it in these cases. Ultrasound is too time consuming and misses the non invasive cancers. MRI is very expensive and not specific enough for mass screening although we do use it in high risk patients even though we don't have a whole lot of data. MRI also does not pick up DCIS well unless high grade. Some argue that a previous diagnosis of cancer automatically puts you into a high risk category and therefore you should have screening MRI annually, but that is not yet standard of care and therefore not always covered by insurance. Yeah. I hate this question. And I get it whenever the patient's cancer was missed on mammo. I think that so much emphasis has been put on screening mammos yet it is often not well known that mammos miss up to 20% of breast cancers on screening studies. [Reference: www.cancer.gov/cancertopics/factsheet/detection/mammograms] Crummy, I know, but when you look at the stats, it's still the best we have right now for mass screening. And it is responsible for the decrease in mortality and increase in early stage diagnosis over the last decade or so. [Reference: Regular mammograms may decrease the risk for deadly breast cancer by 49%, a new case-control study suggests.

According to the Dutch investigators, the greatest reduction occurred in women aged 70 to 75 years and represented a drop of 84%.

"Our study adds further evidence that mammography screening unambiguously reduces breast cancer mortality," said senior researcher Suzie Otto, PhD, from the Department of Public Health at Rotterdam's Erasmus Medical Centre, the Netherlands, in a news release.

The study was published online December 6, 2011 in Cancer Epidemiology, Biomarkers, and Prevention]


So even though it did not pick up the first cancer, odds are that it will pick up the next one if it occurs. That's why we still order it in these cases. Ultrasound is too time consuming and misses the non invasive cancers. MRI is very expensive and not specific enough for mass screening although we do use it in high risk patients even though we don't have a whole lot of data. MRI also does not pick up DCIS well unless high grade. Some argue that a previous diagnosis of cancer automatically puts you into a high risk category and therefore you should have screening MRI annually, but that is not yet standard of care and therefore not always covered by insurance.

Mammograms have a failure rate of 10%, for women with dense breast tissue it is over 40%. this is not really the best imaging tool. there are others with potential, but the Mammogram Machine makers are large contributors to facilities and Cancer Societies, therefore the lock step validations.
Two issues were against my making an informed decision, first I was not aware of dense breast tissue, was never told by any treating professional, and only two states have made it a law to advise women, Connecticut and Texas.
My own Governor Brown of California had the bill to do so on his desk and on the last day to sign it into law he refused saying incredibly, "he did not want to cause women to have anxiety, and also possibly saving your life is too expensive to suggest better screening. "Liberal" democrat Governor Brown, "Conservative" Republican governor Perry did care about women's lives. Shame on you Mr. Brown.
I agreed to a six months wait and watch delay. Never would have, had I understood dense breast and mammography failure. the ultrasound failed as well. When six months later I heard "biopsy," I went for a second opinion of my choice.
I drove 100+ miles to Venice Beach, Ca. to Dr. Kevin Kelly, 30+ year radiologist focusing on breasts. Dr. Kelly invented SonoCine, a different way of screening using an ultrasound. A full 11 days, two core biopsies and an MRI after, my "esteemed" Imaging unit gave me the exact diagnosis. Dr. Kelly told me that there was no cancer where they were looking, but beyond and deeper is where his SonoCine detected my cancer, pathology reports support this as well.

Don't tell me there are not any other screening methods, stop stonewalling them.

Teresa Masters I'm not really familiar with thermography, but despite the appeal of avoiding exposure to ionizing radiation it's just not proven to be effective yet.

It needs rigorous testing, which is why it's not FDA approved yet. At least one study show poor sensitivity - http://www.ncbi.nlm.nih.gov/pubmed/21377664

And now MRI can do some thermal imaging, but this too needs careful testing: http://www.ncbi.nlm.nih.gov/pubmed/20432295

There is no perfect test, and adding more tests may make it more confusing and stressful. So how do I feel? Stick with the evidence, not the anecdote.

Molecular breast imaging is also known as breast specific gamma imaging or BSGI. Molecular breast imaging is promising as it can find cancers with a sensitivity of less than 3mm (this is better than MRI). The drawback is the high level of radiation currently associated with MBI. There are many centers working on the technology of MBI to get the radiation level of MBI to an acceptable dose. I look forward to this advancement as I feel it would be an excellent, more sensitive screening test once the radiation level is lowered. Here is my overview of BSGI.

BSGI stands for breast specific gamma imaging. BSGI is a fairly new technique that involves injecting a radioactive substance technetium (t-99) into a patient's veins and then scanning their breast with a gamma camera.
The gamma camera takes images of the breast and the areas where the radioactive substance has concentrated (this may indicate a breast cancer) will show up darker.
Pros of BSGI are increased sensitivity for detecting tumors at a smaller size than other available imaging techniques.
Cons of BSGI are the higher amount of radiation the person is exposed to during the test.
Some considerations: This test is reasonable for a person to have performed if they are first diagnosed with breast cancer to assess for occult cancers in either breast. Another scenario is a person who cannot have an MRI but requires a more sensitive test. Currently this is NOT a test for women to have yearly, too much radiation!

To read more in depth information on BSGI please visit http://www.mybreastcanceranswers.com/bsgi-breast-specific-gamma-imaging

Resources:

http://www.medscape.com/viewarticle/727881

http://www.gm-ideas.com/

www.dilon.com




Molecular breast imaging is also known as breast specific gamma imaging or BSGI. Molecular breast imaging is promising as it can find cancers with a sensitivity of less than 3mm (this is better than MRI). The drawback is the high level of radiation currently associated with MBI. There are many centers working on the technology of MBI to get the radiation level of MBI to an acceptable dose. I look forward to this advancement as I feel it would be an excellent, more sensitive screening test once the radiation level is lowered. Here is my overview of BSGI.

BSGI stands for breast specific gamma imaging. BSGI is a fairly new technique that involves injecting a radioactive substance technetium (t-99) into a patient's veins and then scanning their breast with a gamma camera.
The gamma camera takes images of the breast and the areas where the radioactive substance has concentrated (this may indicate a breast cancer) will show up darker.
Pros of BSGI are increased sensitivity for detecting tumors at a smaller size than other available imaging techniques.
Cons of BSGI are the higher amount of radiation the person is exposed to during the test.
Some considerations: This test is reasonable for a person to have performed if they are first diagnosed with breast cancer to assess for occult cancers in either breast. Another scenario is a person who cannot have an MRI but requires a more sensitive test. Currently this is NOT a test for women to have yearly, too much radiation!

To read more in depth information on BSGI please visit http://www.mybreastcanceranswers.com/bsgi-breast-specific-gamma-imaging

Resources:

http://www.medscape.com/viewarticle/727881

http://www.gm-ideas.com/

www.dilon.com

THank you!It did not miss the tumor. The mammography I had in September 2009 saw the tumor. Ironically September 2009 was the month that I was scheduled anyway for my annual mammo as the previous one was in September 2008. But because we discovered the lump at the very end of August 2009, it turned into a diagnostic mammo.I did go back and reqest the x-ray and the mammo report again from the mammo in 2008, and had my current radiologist take a look at it. Although I had dense breasts, nothing was there at that time. I had just had an annual GYN check up in early July 2009, which included a routine breast exam. Again, my breasts were cystic and dense, but no tumor was felt that day. I have many questions that can't be answered. Was it there and they missed it? Did I miss it? Did it grow that fast that soon? I hear with Triple Negative anything is possible. Those words "dense" and "cystic" never worried me before, but if my daughters have the same body type, I will for sure encourage them to be aware, be healthy, avoid carcinogens and most important, do frequent breast exams. We need to know our girls! THank you!It did not miss the tumor. The mammography I had in September 2009 saw the tumor. Ironically September 2009 was the month that I was scheduled anyway for my annual mammo as the previous one was in September 2008. But because we discovered the lump at the very end of August 2009, it turned into a diagnostic mammo.I did go back and reqest the x-ray and the mammo report again from the mammo in 2008, and had my current radiologist take a look at it. Although I had dense breasts, nothing was there at that time. I had just had an annual GYN check up in early July 2009, which included a routine breast exam. Again, my breasts were cystic and dense, but no tumor was felt that day. I have many questions that can't be answered. Was it there and they missed it? Did I miss it? Did it grow that fast that soon? I hear with Triple Negative anything is possible. Those words "dense" and "cystic" never worried me before, but if my daughters have the same body type, I will for sure encourage them to be aware, be healthy, avoid carcinogens and most important, do frequent breast exams. We need to know our girls!

Despite recent claims, there is no 3D imaging yet available. Tomosynthesis (aka “tomo”) is about "2.5D" looking at the breast in a 270 degree arc but not 360 degrees. Tomo requires about 8 films and does require compression. It does give a better look at the markedly dense breast. It should not become the "routine screening" for all women. At UMass Memorial, we have been awarded a federal grant along with four other centers in the United States to build and pilot CT scanning for the breast. Our initial work with a home built unit and mastectomy specimens was highly successful leading to the grant award. CT scanning is truly 3D with 360 degree views without compression, faster times and more views. Radiation exposure should be equivalent to Tomo. We have raised over $500,000 to build and install our breast CT unit within the year. Again as with tomo, breast CT is not at this time meant for routine screening. Despite recent claims, there is no 3D imaging yet available. Tomosynthesis (aka “tomo”) is about "2.5D" looking at the breast in a 270 degree arc but not 360 degrees. Tomo requires about 8 films and does require compression. It does give a better look at the markedly dense breast. It should not become the "routine screening" for all women. At UMass Memorial, we have been awarded a federal grant along with four other centers in the United States to build and pilot CT scanning for the breast. Our initial work with a home built unit and mastectomy specimens was highly successful leading to the grant award. CT scanning is truly 3D with 360 degree views without compression, faster times and more views. Radiation exposure should be equivalent to Tomo. We have raised over $500,000 to build and install our breast CT unit within the year. Again as with tomo, breast CT is not at this time meant for routine screening.

I’d worry less about the performance of the mammography than about the read of the actual image. The actual mechanics of performing the mammography, while important, are less important than having a well-qualified radiologist. A good radiologist will know both whether the mammography was set up correctly in the first place just by looking at the image (and will re-order another one if not), and whether it’s being read and interpreted correctly. I’d worry less about the performance of the mammography than about the read of the actual image. The actual mechanics of performing the mammography, while important, are less important than having a well-qualified radiologist. A good radiologist will know both whether the mammography was set up correctly in the first place just by looking at the image (and will re-order another one if not), and whether it’s being read and interpreted correctly.