Breast Health & Imaging -- May 6, 2013 -- Dr. Lisa Bellina nd Dr - | Nashville News, Weather & Sports

Breast Health & Imaging -- May 6, 2013 -- Dr. Lisa Bellina nd Dr. Melinda Sava

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TOPIC: Breast Health & Imaging
Monday, May 6, 2013
Lisa Bellin, MD | breast surgeon
Melinda Sava, MD | breast imaging

News notes &

Improving mammograms

Although a mammogram is an excellent way to find most breast cancers when they are small and most curable, it does not detect all breast cancers. Newer techniques are being looked at to try to make mammograms more accurate.

Computer-aided detection and diagnosis

Computer-aided detection and diagnosis (CAD) was developed to help radiologists find suspicious changes on mammograms. This technology can be used with standard film mammograms or with digital mammograms.

Computers can help doctors find abnormal areas on a mammogram by acting as a second set of eyes. For standard mammograms, the film is fed into a machine which converts the image into a digital signal that is then analyzed by the computer. The technology can also be applied to an image captured with a digital mammogram. The computer then displays the picture on a video screen, with markers pointing to areas the radiologist should check more closely.

Early research on CAD showed a clear improvement in finding small cancers, with only a small increase in the number of women who had to come back for more tests. But studies of CAD in community practice have shown mixed results. Some showed a clear benefit from the use of CAD, and others showed that it did not find more cancers or find cancers earlier, but did increase the number of women who needed to come back for more tests and/or to have breast biopsies. Current research suggests that CAD is not a substitute for experience and expertise in reading mammograms. In other words, CAD is only helpful when the radiologists are experienced and have expertise in reading mammograms.

Tomosynthesis (3D mammography)

This technology is basically an extension of a digital mammogram. For this test, the breast is compressed once and a machine takes many low-dose x-rays as it moves over the breast. The images can then be combined into a 3-dimensional picture. Although this uses more radiation than most standard 2-view mammograms, the dose still is below the maximum dose allowed by the Mammography Quality Standards Act. This technology may allow doctors to see problem areas more clearly, which can mean fewer patients will need to be called back for more tests.

A breast tomosynthesis machine was approved by the Food and Drug Administration (FDA) in 2011 for use in the United States, but the role of this technology in screening and diagnosis is still not clear. Not all health insurance covers tomosynthesis, so you may want to check with your insurance company if this is recommended for you.

Other breast imaging tests

While mammograms are the most useful tests for screening and finding breast cancer early, other imaging tests may be helpful in some cases.

Breast MRI (magnetic resonance imaging)

MRI scans use magnets and radio waves instead of x-rays to produce very detailed, cross-sectional pictures of the body. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image of parts of the body. For breast MRI to look for cancer, a contrast liquid (called gadolinium) is injected into a vein before or during the scan to show details better.

Breast MRI is mainly used for 2 purposes:

  • women who have been diagnosed with breast cancer, to help measure the size of the cancer and look for any other tumors in the breast. It's also used to look at the opposite breast, to be sure that it doesn't contain any tumors.
  • certain women at high risk for breast cancer, screening MRI is recommended along with a yearly mammogram. MRI is not recommended as a screening tool by itself, as it can miss some cancers that a mammogram would detect.

Additional reasons for an MRI of the Breast:

  • Check women who are at high risk for breast cancer. MRI may be recommended as a screening tool for very high-risk women, such as those who test positive for the BRCA1 or BRCA2 gene, or who have two or more close family members who have had breast or ovarian cancer before age 50.
  • Check women who have dense breast tissue.
  • Check the opposite breast. MRI is sometimes used to evaluate the opposite breast in women diagnosed with certain types of breast cancer.
  • See what stage of breast cancer is present so the best treatment can be chosen.
  • Look at breast tissue changes during treatment for breast cancer.
  • Check breasts with inverted nipples for any sign of breast cancer.
  • Find a breast implant rupture. MRI of the breast is the best test for this purpose.
  • Look at a suspicious area of the breast for women with breast implants.

Just as mammograms are done with x-ray machines that are specially designed to image the breasts, breast MRI also requires special equipment. Breast MRI machines produce higher quality images than MRI machines designed for head, chest, or abdominal scanning. But there are hospitals and imaging centers that do not have dedicated breast MRI equipment available.

It's important that screening MRIs be done at facilities that also can do an MRI-guided breast biopsy. Otherwise, the entire scan will need to be repeated at another facility if a biopsy is needed.

MRIs cost more than mammograms. Most major insurance companies pay for these screening tests if a woman can be shown to be at high risk, but it's a good idea to check with your insurance company before having the test. There are still some concerns about costs and limited access to high-quality MRI breast screening services for women at high risk of breast cancer.

When getting ready for a breast MRI, you can eat and drink as usual. You will need to take off clothes with metal parts such as zippers, snaps, or buttons, and put on a gown or top. Jewelry, hairpins, safety pins, and anything else made of metal must be removed before you go into the MRI room. The technologist will ask if you have any metal in your body, such as surgical clips, staples, implanted catheters, pacemakers, artificial joints, metal fragments, tattoos, permanent eyeliner, and so on. Some metal objects will not cause problems, but others might. Tell the staff before the scan if you have any allergies, if you have breast implants, or if you are pregnant or breast-feeding.

You may need to have an IV put in so you can get contrast dye to help outline the structures of the breast. For the actual MRI, you will lie on your stomach on a padded platform with spaces for your breasts. You will need to be very still during the test, which can take up to an hour.

Breast ultrasound

Ultrasound, also known as sonography, uses sound waves to look inside a part of the body. A gel is put on the skin of the breast and a handheld instrument called a transducer is rubbed with gel and pressed against the skin. It emits sound waves and picks up the echoes as they bounce off body tissues. The echoes are converted by a computer into a black and white image on a computer screen. This test is painless and does not expose you to radiation.

Breast ultrasound is sometimes used to evaluate breast problems that are found during a screening or diagnostic mammogram or on physical exam. Breast ultrasound is not routinely used for screening. Some studies have suggested that it may be helpful to use ultrasound along with a mammogram when screening high risk women with dense breast tissue (which is hard to evaluate with a mammogram). But at this time, ultrasounds cannot replace mammograms. More studies are needed to figure out if ultrasound should be added to routine screening mammograms for some groups of women.

Ultrasound is useful for taking a closer look at some breast masses, and it's the only way to tell if a suspicious area is a cyst without putting a needle into it to take out (aspirate) fluid. Breast ultrasound may also be used to help doctors guide a biopsy needle into an area of concern in the breast.

There is a newer system, called a 3-dimensional automated ultrasound, which can be used on the breast. The FDA has approved it to be used along with mammography. The 3-D ultrasound can be done with a handheld transducer, but more often the breast is covered with gel before a larger unit is placed over the entire breast area and left in place as the machine gets images from different angles.

Ultrasound has become a valuable tool to use along with mammograms because it's widely available, non-invasive, and costs less than other options. But the value of an ultrasound test depends on the operator's level of skill and experience—though this is less important with the new automated ultrasound systems. Ultrasound is less sensitive than MRI (that is, it detects fewer tumors), but it has the advantages of costing less and being more widely available.

Ductogram (galactogram)

A ductogram, also called a galactogram, is sometimes used to help find the cause of nipple discharge. In this test, a very thin plastic tube is put into the opening of a duct in the nipple that the discharge coming from. A small amount of contrast material is put in. It outlines the shape of the duct on x-ray and can show whether there is a mass inside the duct.


Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.

Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost, colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter substances in lymph and help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.

The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen.

Age and health history can affect the risk of developing breast cancer.

Anything that increases your chance of getting a disease is called a risk factor. Risk factors for breast cancer include the following:

  • Older age.
  • Menstruating at an early age.
  • Older age at first birth or never having given birth.
  • A personal history of breast cancer or benign (noncancer) breast disease.
  • A mother or sister with breast cancer.
  • Treatment with radiation therapy to the breast/chest.
  • Breast tissue that is dense on a mammogram.
  • Taking hormones such as estrogen and progesterone.
  • Drinking alcoholic beverages.
  • Being white.

Breast cancer is sometimes caused by inherited gene mutations (changes).

The genes in cells carry the hereditary information that is received from a person's parents. Hereditary breast cancer makes up approximately 5% to 10% of all breast cancer. Some altered genes related to breast cancer are more common in certain ethnic groups.

Women who have an altered gene related to breast cancer and who have had breast cancer in one breast have an increased risk of developing breast cancer in the other breast. These women also have an increased risk of developing ovarian cancer, and may have an increased risk of developing other cancers. Men who have an altered gene related to breast cancer also have an increased risk of developing this disease. (For more information, refer to the PDQ summary on Male Breast Cancer Treatment.)

Tests have been developed that can detect altered genes. These genetic tests are sometimes done for members of families with a high risk of cancer. (Refer to the PDQ summaries on Screening for Breast Cancer, Prevention of Breast Cancer, and Genetics of Breast and Ovarian Cancer for more information.)

Tests that examine the breasts are used to detect (find) and diagnose breast cancer.

A doctor should be seen if changes in the breast are noticed. The following tests and procedures may be used:

  • Mammogram: An x-ray of the breast.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, the doctor may need to cut out a small piece of the lump. Four types of biopsies are as follows:
  • Excisional biopsy: The removal of an entire lump or suspicious tissue.
  • Incisional biopsy: The removal of part of a lump or suspicious tissue.
  • Core biopsy: The removal of part of a lump or suspicious tissue using a wide needle.
  • Needle biopsy or fine-needle aspiration biopsy: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle.
  • Estrogen and progesterone receptor test: A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If cancer is found in the breast, tissue from the tumor is examined in the laboratory to find out whether estrogen and progesterone could affect the way cancer grows. The test results show whether hormone therapy may stop the cancer from growing.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

  • The stage of the cancer (whether it is in the breast only or has spread to lymph nodes or other places in the body).
  • The type of breast cancer.
  • Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
  • A woman's age, general health, and menopausal status (whether a woman is still having menstrual periods).
  • Whether the cancer has just been diagnosed or has recurred (come back).

Acknowledgement given to the National Cancer Institute as originator of the information provided herein, with the NCI web site as the source.

(7) ways to prevent breast cancer by reducing the risk factors beyond genetic s

1. Exercise

In one experiment, the researchers asked 1550 women aged 40-85 years about their exercise habits. The women who actively exercise have half the risk of breast cancer is lower than those who exercise less. Walking 30 minutes, five times a week can lower the risk of breast cancer by 18 percent according to another study involving 74 thousand women aged 50 to 79 years.

2. Keeping the weight

American Cancer Society had conducted a study involving 62 thousand women. The researchers found that the more weight gain since she was 18 years old, the greater the risk of breast cancer at the time of menopause. Those who gained weight to 30 kilograms increased the risk twofold. Excess weight seems to increase estrogen, which supports the formation of cancer.

3. Avoiding fat

There is a link between high consumption of unsaturated fats plural chain (corn oil, sunflower, etc.) with breast cancer. Choose unsaturated fatty acids single chain, such as olive oil.

In Sweden have carried out the research for the past 6 years to more than 61 thousand women aged 40 to 76 years. Those who consumed 10 grams of unsaturated fat each day single chain decreased risk of breast cancer by 45 percent. Conversely, any consumption of 5 grams of unsaturated fat plural chain increases the risk of breast cancer by 69 percent. These data explain why breast cancer is rare in Spain, Greece and Italy, even though 42 percent fat calories they get in the form of oil. That's because they consume unsaturated fats single chain.

4. Lots of eating vegetables and fruits

Carotenoid pigments found in fruits and vegetables protect believed breast cancer. New York University researchers compared blood samples of 270 women with breast cancer and 270 healthy women blood samples. Women who have the lowest carotenoid has two times higher risk of developing breast cancer compared to the highest berkarotenoid. Always include vegetables and fruits in your daily diet, especially the carrots, tomatoes, watermelon and spinach.

5. Many consume soy

The incidence of breast cancer in Asian women is only one-fifth of Western women. Scientists believe that the cause is a diet rich in soy. An experiment showed that the Japanese fermented soy can reduce the risk of breast cancer. Those who consume three or more servings per day had a lower risk than those who ate only one serving or less.

Soy contains phytoestrogens which prevent breast cancer by limiting the carcinogenic effects of estrogen. Drinking a glass of soy milk or three pieces of tofu / tempeh every day can protect you from breast cancer.

6. Breastfeeding

Breastfeeding is not only beneficial for babies, but also for her mother to suppress estrogen levels. The researchers compared the number of births and patterns of breastfeeding women living in developed and developing countries. They found that women in developed countries may reduce breast cancer risk by half if you have more children and breastfeed them like the women in the developing world (an average of 30 months per birth).

7. Do not smoke

The younger the woman smoked, the greater the chances of developing breast cancer before menopause. California Environmental Protection Agency reported that passive smoking, especially among young women, is one of the causes of breast cancer. For the husband or father, quit smoking for the wife or daughter do not get breast cancer.

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