Dr. Law talks about the Advantages of 3D mammography and its benefits in early detection. Dr. Law explains what is considered early detection, why is it important, and the signs or symptoms that women should look out for in between mammograms
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Advantage of 3D Mammography, and it’s Benefit in Early Detection
Featuring:
Suzanne Law, DO
Suzanne Law, DO SPECIALTIES include Surgery - Breast, Surgery - General. Transcription:
Cheryl Martin: It's been proven that screening mammograms can help reduce the death rate from breast cancer among women. One option is 3D mammography. We'll learn more about it and it's benefits in early detection coming up next.
This is McLaren's In Good Health, the podcast from McLaren. I'm Cheryl Martin. Our guest this episode is general and breast surgeon, Dr. Suzanne Law. It's great to have you on.
Suzanne Law, DO: Thank you. It's nice to be here.
Cheryl Martin: Traditionally, doctor, regular mammogram screening should begin at 40. But are there circumstances that women should begin them sooner?
Suzanne Law, DO: Yes, generally, for average risk women with average breast density, we do recommend yearly mammograms starting at 40. But the types of risk that would require an earlier diagnosis would be things such as carrying a genetic mutation, having a strong family history where the breast cancer risk is higher. There are also some personal characteristics such as breast density that can make it more beneficial to start earlier. In general, when we do start earlier, we start around age 30. There are even some cases in which we start younger than that, such as in family history of genetic breast cancer, if a woman tests positive for the gene mutation. And we can start as early as age 25, but often we use a different imaging modality like an MRI.
Cheryl Martin: So let's talk about 3D. How vast of a difference is 3D mammography when compared to 2D?
Suzanne Law, DO: Well, 3D mammography is a little bit of a misnomer. What the real name is tomosynthesis, which means taking a normal low dose mammogram at various angles. When we do the old 2D mammograms, you're taking the x-ray through a breast from top to bottom or side to side, and all those layers of breasts are layered on top of each other. When you do the 3D, you're taking the images at different angles, so you can kind of spread it out in a way. And so those images are then digitized and we can scroll through them and it helps to decrease the false positive rate. Sometimes we see a shadow and it's just breast tissue on breast tissue on breast tissue. So when we do the 3D mammogram, and we are looking through the breast tissue at different angles, we can tease out a finding to be able to see it better. So some of the benefits of this are a lower callback rate. We're less likely to see a shadow, that's not really anything. It has the best advantage in dense breasts where the breast tissue is already white on the mammogram and a breast cancer is white, so now we're looking for a polar bear in a snowstorm. So if we can sort of spread out that tissue and try to narrow down on a small lesion, it's much easier to see. So the overall efficacy is better. We can find things more clearly and also have fewer shadows that would cause us to do more and more and more testing.
Cheryl Martin: Now, because there are more images being taken, is there a greater risk?
Suzanne Law, DO: Not really. In the very beginning when 3D first came out, they were actually doing 2D and 3D images on the same patient at the same time. Now, we don't need to do that because, when we do the 3D, we can computer analyze them and turn them into a 2D view as well as a 3D view. When we look at a 3D view, we're actually scrolling through the images, kind of like when you are focusing a microscope on a slide where you can look up and down through the tissue. So now, the radiation is almost exactly the same as a regular 2D mammogram.
Cheryl Martin: That's great. Are there any other benefits that 3D provides the doctor?
Suzanne Law, DO: There's definitely more accuracy in diagnosing imaging abnormalities and determining who needs a biopsy. The problem with some of the older scans was we would see these shadows that look like something, and our only option was to send them for a biopsy. So by being able to more clearly see the tissue, we can really determine who needs a biopsy and decrease the number of biopsies we do, which decreases the anxiety for the patients as well. Less stress if you aren't getting called back all the time for more testing.
Cheryl Martin: Now, what's considered early detection and why is it so important?
Suzanne Law, DO: Well, early detection means finding a breast cancer at an early stage before it can even be felt or cause any symptoms. So when we find breast cancer early, it's usually limited to the breast. That's the stage we want to find it in because then the treatment is easier and cure rates are much higher. For localized breast cancer, which means a cancer that's limited to the breast, cure rates are 99%. What we look at when we look at cure rates is basically what percentage of patients are still alive five years after that diagnosis, and that's 99% for stage I or localized breast cancer. Once the breast cancer gets regional, meaning in the breast and lymph nodes, that number drops a little bit, but it's still pretty high at 86%. And then, once we get into breast cancer that has been there so long it's already spread to other parts of the body, that drops that survival down to 28%. So of course, the benefit is find it small and take it out before it can become a bigger problem. The other benefit is that the smaller we find it, the more likely a woman will be a candidate for breast-conserving surgery.
Cheryl Martin: So since breast cancer has the potential to be aggressive, as you mentioned, what signs or symptoms should women look out for in between mammograms?
Suzanne Law, DO: Breast cancer that develops between mammograms is sometimes called interval breast cancer. Some of these can be aggressive. Sometimes it's just that it's a very small cancer and it just became visible. But sometimes we do find cancers that grow fairly fast and can pop up in between those imaging studies. The types of symptoms we watch for, of course, are palpable lumps, something you can feel, but also things such as a change in shape of the breast, like a little indentation or retraction of the nipple as if someone's pulling on it from behind, it's kind of sinking into the breast, things like redness of the skin, flaking or ulceration in the nipple or sudden changes in the skin of the whole breast, such as a thickening or redness that looks like an orange peel.
Other things are nipple discharge, especially if there's blood in it. And new-onset pain can sometimes be a sign of a new lesion in the breast, but pain is such a common problem that it's not usually related to cancer, but it can be. So, of course, it bears mentioning to your physician if a new pain starts happening.
Cheryl Martin: But can a woman really detect if her breast cancer has metastasized?
Suzanne Law, DO: Typically, that's something her doctor would have to determine. There are symptoms we can ask about such as new-onset bone pain or changes in cognition or things like that. Often, it's other points we pick up in yearly physical, such as checking labs and looking for changes in the labs. Most of the time, it's not something a woman would notice. But of course, all new symptoms should be mentioned to her physician. And then, we may decide to do other testing to try to find out if that's a problem.
Cheryl Martin: Any other comments, Dr. Law, on this important topic for women's health you wanted to add?
Suzanne Law, DO: Just that the idea of screening and early detection is so important that we like to encourage women to have their yearly mammograms and follow the recommendations of their physician and the governing bodies that we look at such as American Cancer Society, American Society of Breast Surgeons. They put out recommendations as to when we should start mammograms, who's considered high risk and who should start earlier, and if other imaging should be done.
Some studies suggest that women should have a formal risk assessment by the time they're 25 and that's something their doctor can do. And it's merely going through family history, personal history and using risk calculators of which we have several to try to determine a woman's overall lifetime risk for developing breast cancer. Typically, if that number is greater than 20%, we consider that high risk. And we're going to add things to keep a sharp eye out for development of breast cancer, so we can catch it early and treat it
Cheryl Martin: Dr. Suzanne Law, some great information about 3D mammography and its benefits in early detection. Thanks so much for being with us.
Suzanne Law, DO: My absolute pleasure. Thank you for having me.
Cheryl Martin: To learn more, visit mclaren.org/law. That's M-C-L-A-R-E-N.org/law. Thanks for checking out this episode of McLaren's In Good Health. If you found this podcast helpful, please tell others and share it on your social channels and be sure to check out the entire podcast library for other topics of interest to you.
Cheryl Martin: It's been proven that screening mammograms can help reduce the death rate from breast cancer among women. One option is 3D mammography. We'll learn more about it and it's benefits in early detection coming up next.
This is McLaren's In Good Health, the podcast from McLaren. I'm Cheryl Martin. Our guest this episode is general and breast surgeon, Dr. Suzanne Law. It's great to have you on.
Suzanne Law, DO: Thank you. It's nice to be here.
Cheryl Martin: Traditionally, doctor, regular mammogram screening should begin at 40. But are there circumstances that women should begin them sooner?
Suzanne Law, DO: Yes, generally, for average risk women with average breast density, we do recommend yearly mammograms starting at 40. But the types of risk that would require an earlier diagnosis would be things such as carrying a genetic mutation, having a strong family history where the breast cancer risk is higher. There are also some personal characteristics such as breast density that can make it more beneficial to start earlier. In general, when we do start earlier, we start around age 30. There are even some cases in which we start younger than that, such as in family history of genetic breast cancer, if a woman tests positive for the gene mutation. And we can start as early as age 25, but often we use a different imaging modality like an MRI.
Cheryl Martin: So let's talk about 3D. How vast of a difference is 3D mammography when compared to 2D?
Suzanne Law, DO: Well, 3D mammography is a little bit of a misnomer. What the real name is tomosynthesis, which means taking a normal low dose mammogram at various angles. When we do the old 2D mammograms, you're taking the x-ray through a breast from top to bottom or side to side, and all those layers of breasts are layered on top of each other. When you do the 3D, you're taking the images at different angles, so you can kind of spread it out in a way. And so those images are then digitized and we can scroll through them and it helps to decrease the false positive rate. Sometimes we see a shadow and it's just breast tissue on breast tissue on breast tissue. So when we do the 3D mammogram, and we are looking through the breast tissue at different angles, we can tease out a finding to be able to see it better. So some of the benefits of this are a lower callback rate. We're less likely to see a shadow, that's not really anything. It has the best advantage in dense breasts where the breast tissue is already white on the mammogram and a breast cancer is white, so now we're looking for a polar bear in a snowstorm. So if we can sort of spread out that tissue and try to narrow down on a small lesion, it's much easier to see. So the overall efficacy is better. We can find things more clearly and also have fewer shadows that would cause us to do more and more and more testing.
Cheryl Martin: Now, because there are more images being taken, is there a greater risk?
Suzanne Law, DO: Not really. In the very beginning when 3D first came out, they were actually doing 2D and 3D images on the same patient at the same time. Now, we don't need to do that because, when we do the 3D, we can computer analyze them and turn them into a 2D view as well as a 3D view. When we look at a 3D view, we're actually scrolling through the images, kind of like when you are focusing a microscope on a slide where you can look up and down through the tissue. So now, the radiation is almost exactly the same as a regular 2D mammogram.
Cheryl Martin: That's great. Are there any other benefits that 3D provides the doctor?
Suzanne Law, DO: There's definitely more accuracy in diagnosing imaging abnormalities and determining who needs a biopsy. The problem with some of the older scans was we would see these shadows that look like something, and our only option was to send them for a biopsy. So by being able to more clearly see the tissue, we can really determine who needs a biopsy and decrease the number of biopsies we do, which decreases the anxiety for the patients as well. Less stress if you aren't getting called back all the time for more testing.
Cheryl Martin: Now, what's considered early detection and why is it so important?
Suzanne Law, DO: Well, early detection means finding a breast cancer at an early stage before it can even be felt or cause any symptoms. So when we find breast cancer early, it's usually limited to the breast. That's the stage we want to find it in because then the treatment is easier and cure rates are much higher. For localized breast cancer, which means a cancer that's limited to the breast, cure rates are 99%. What we look at when we look at cure rates is basically what percentage of patients are still alive five years after that diagnosis, and that's 99% for stage I or localized breast cancer. Once the breast cancer gets regional, meaning in the breast and lymph nodes, that number drops a little bit, but it's still pretty high at 86%. And then, once we get into breast cancer that has been there so long it's already spread to other parts of the body, that drops that survival down to 28%. So of course, the benefit is find it small and take it out before it can become a bigger problem. The other benefit is that the smaller we find it, the more likely a woman will be a candidate for breast-conserving surgery.
Cheryl Martin: So since breast cancer has the potential to be aggressive, as you mentioned, what signs or symptoms should women look out for in between mammograms?
Suzanne Law, DO: Breast cancer that develops between mammograms is sometimes called interval breast cancer. Some of these can be aggressive. Sometimes it's just that it's a very small cancer and it just became visible. But sometimes we do find cancers that grow fairly fast and can pop up in between those imaging studies. The types of symptoms we watch for, of course, are palpable lumps, something you can feel, but also things such as a change in shape of the breast, like a little indentation or retraction of the nipple as if someone's pulling on it from behind, it's kind of sinking into the breast, things like redness of the skin, flaking or ulceration in the nipple or sudden changes in the skin of the whole breast, such as a thickening or redness that looks like an orange peel.
Other things are nipple discharge, especially if there's blood in it. And new-onset pain can sometimes be a sign of a new lesion in the breast, but pain is such a common problem that it's not usually related to cancer, but it can be. So, of course, it bears mentioning to your physician if a new pain starts happening.
Cheryl Martin: But can a woman really detect if her breast cancer has metastasized?
Suzanne Law, DO: Typically, that's something her doctor would have to determine. There are symptoms we can ask about such as new-onset bone pain or changes in cognition or things like that. Often, it's other points we pick up in yearly physical, such as checking labs and looking for changes in the labs. Most of the time, it's not something a woman would notice. But of course, all new symptoms should be mentioned to her physician. And then, we may decide to do other testing to try to find out if that's a problem.
Cheryl Martin: Any other comments, Dr. Law, on this important topic for women's health you wanted to add?
Suzanne Law, DO: Just that the idea of screening and early detection is so important that we like to encourage women to have their yearly mammograms and follow the recommendations of their physician and the governing bodies that we look at such as American Cancer Society, American Society of Breast Surgeons. They put out recommendations as to when we should start mammograms, who's considered high risk and who should start earlier, and if other imaging should be done.
Some studies suggest that women should have a formal risk assessment by the time they're 25 and that's something their doctor can do. And it's merely going through family history, personal history and using risk calculators of which we have several to try to determine a woman's overall lifetime risk for developing breast cancer. Typically, if that number is greater than 20%, we consider that high risk. And we're going to add things to keep a sharp eye out for development of breast cancer, so we can catch it early and treat it
Cheryl Martin: Dr. Suzanne Law, some great information about 3D mammography and its benefits in early detection. Thanks so much for being with us.
Suzanne Law, DO: My absolute pleasure. Thank you for having me.
Cheryl Martin: To learn more, visit mclaren.org/law. That's M-C-L-A-R-E-N.org/law. Thanks for checking out this episode of McLaren's In Good Health. If you found this podcast helpful, please tell others and share it on your social channels and be sure to check out the entire podcast library for other topics of interest to you.