7 Minutes Could Save Your Life

By Jennifer LoConte

We women eagerly spend countless hours at the hair salon having our hair straightened, permed, colored and styled. We go through the painful procedure of hair removal without even flinching. But how many women age 40 and over make time each year to get a mammogram? It takes approximately 7 minutes to screen for breast cancer and it could save your life.

The Importance of a Mammogram

Both Dr. Gregory Harper, MD, PhD, Medical Director for Breast Health Services and Dr. Lori Alfonse, Assoc. Medical Director for Breast Health Services and Surgical Oncologist stress the importance of mammograms as an essential tool to identify the possibility of early stages of breast cancer. Alfonse says, “Breast cancer mortality has decreased over the last 10 years because we can detect early stage disease through annual mammogram screenings. It is literally a life saver.” She adds, “It may be a bit uncomfortable, women may feel some pressure due to breast compression, but it’s not painful.” Just as important as the mammogram itself is where you go to have the screening done.  Harper recommends that women select a center with digital mammography, today’s standard. He says, “Digital mammography produces a clearer picture and is more sensitive for women with denser breasts,” and adds, “Seeing a radiologist who is a mammography specialist, meaning he or she reads over 1000 mammograms/year is also important.” Breast care centers need to be certified by the American College of Radiology and/or the College of Surgeons Commissioned on Cancer. Even women who have had breast augmentation through plastic surgery should continue having annual mammograms. Alfonse explains, “Because the standard for implant placement is below the pectoralis muscle, breast tissue will be in front of the implant. If, however, the patient has older implants that are above the chest wall muscle, an experienced radiologist will still be able to use different angles and views.”

The Monthly Self Exam

Another important tool in detecting early stages of breast cancer is a monthly self-exam. Women should mark their calendar as a reminder and examine their breasts the week following menstruation. Alfonse stresses the importance of learning the boundaries of breast tissue. She says, “It’s not just the area that protrudes but includes the area up to your clavicle/collar bone, down past the elastic of your bra, over to the chest bone, over to the middle of the armpit and up into the armpit.” The exam should also be done in two positions: standing in front of a mirror and lying flat on the back. By doing this each month, women should be able to notice if something feels different. Alfonse says that many times a difference can be due to hormonal or dietary changes and a woman should take note of an area that feels more tender or full. It should be watched closely from one menstrual cycle to the next. However, discharge, discoloration or an inverted nipple should immediately be reported. Pregnant women should continue to do breast exams as well. A blocked milk duct or a benign breast lump caused by hormonal pregnancy surges are fairly common, although Alfonse stresses that pregnant or lactating women should immediately report any abnormality.

Risk Factors

Many women believe that since breast cancer does not run in their families, they do not need to get an annual mammogram. They couldn’t be more wrong.  Harper states, “Only 1/3 of those women who have an identifiable risk factor test positive for breast cancer. In fact, 2/3 of those diagnosed have NO identifiable risk factor and no previous abnormal biopsies.” What are the risk factors? Age, gender and family history can increase risks but both doctors agree that having breasts and living long enough to get it are the two biggest risks. In fact, 12.5% or 1 in 8 women who live to age 90 will be diagnosed, while those who have a first-degree relative with breast cancer, doubles the risk to 1 in 4.

It Takes a Village

The higher standard of care today is for women to be evaluated by a multi-disciplinary team. Harper says that no single physician or practice can coordinate the care that is needed to manage a newly diagnosed patient. He says, “The surgeon, oncologist, radiation doctor, plastic surgeon, and even financial support should meet with the patient and family at one time in order to give her the full treatment and care plan.” The patient will leave with a timeline and recipe of what will come next and in what order, thus relieving unnecessary stress and anxiety. A mastectomy or removal of the breast is more than likely not necessary. Only 1/3 of women need one and for specific reasons. Harper says that the combined treatment for breast cancer is what matters most. If removal is necessary, Alfonse says that immediately after the mastectomy is performed, the plastic surgeon will begin the process of breast reconstruction.

Delving Deeper

Dr. Sharon Schubach, Director of Breast Imaging at Easton Hospital is a certified radiologist specializing in breast imaging. Schubach says, “A mammogram is an x-ray of the breast that is placed between two compression plates. An x-ray goes through the breast in order to acquire a digital image.” Schubach looks specifically for a mass and ascertains whether or not it may be cancerous. Sometimes additional imaging or an ultrasound may be required. The second thing Schubach looks for is a calcification, which is a calcium deposit in the breast tissue showing up as a white spot. She explains that there are two types of calcifications: a macro, which is larger and usually not cancerous and a micro which are tiny specs that can be found in rapidly dividing cells. Calcifications can also be associated with fiberistic disease which is not cancerous. Sometimes the mass is worrisome enough to recommend a biopsy, which is not painful. A needle biopsy is the most common and involves localizing the area, making a small incision and inserting a needle. The second type of biopsy uses a stereotactic breast biopsy machine. Schubach says that both can be performed as outpatient procedures, usually taking 20 minutes and the patient can resume all activities immediately afterwards.

Knowledge is Power

Schubach states, “Women need to empower themselves to be pro-active with the health of their breasts, starting with the breast self-exam.” Patients are given a self-exam shower guide with easy-to-follow directions in addition to calendar stickers and can be hung in the shower as a monthly reminder. Schubach says that only 5 to 10% of breast cancers are actually hereditary and 75 to 90% of those who are diagnosed have no risk factors. She says, “Even though the incidence of breast cancer has been increasing, the death rate has decreased by 30% since 1988 due to the advancements made towards early diagnosis and early screening.”

Covering all the Bases

Here in the Lehigh Valley, we are fortunate to have access to medical facilities and imaging centers that offer comprehensive services such as those offered at Advanced Imgaging for Breast and Body. These services include digital mammography, PET mammography, PET/CT as well as HDR Brachytherapy. Since opening its doors in October 2006, Advanced Imaging has remained dedicated to the wellness of women using the latest breast care technology, timely results and a newly opened in-house boutique all in a warm and inviting medical facility. Located on the first floor of the Integrated Health Campus in Allentown, the center’s founder and director, Dr. Mark Gittleman, MD envisioned a comprehensive “one-stop-shopping” approach towards women’s breast health. They were also the first in the Lehigh Valley to offer mammogram results that same day, alleviating women’s fears and anxiousness.

The PET mammography (Positron Emission Mammography) is a nuclear study and only offered at three locations in the country. Dr. Tricia Kelly, board certified General Surgeon with specialization in breast surgery says, “The PEM can be utilized if there is a breast cancer diagnosis and can evaluate extensive disease.” HDR Brachytherapy is one of the latest advances in radiation therapy. Kelly explains, “Patients who only need partial breast radiation as opposed to whole breast radiation qualify for this accelerated course. It consists of a 5-day course vs. 7.5 weeks. She adds, “Women who are diagnosed early as opposed to advanced disease are ideal candidates.” Yet another reason why it’s so important to do monthly breast exams as well as annual mammograms.

The boutique, called Blossoms of Hope, is the newest addition to the center and carries prosthetics, fashionable wigs and scarves. Christine Downing, Executive Director says, “The women love shopping in the boutique and the center is peaceful and tranquil.” Additionally, Downing holds an annual Momagram Monday, the day after Mother’s Day which is followed by a free, educational seminar where guest speakers offer advice and answer questions. Downing says, “Some women have very basic questions and others are more in-depth. Once the dialogue begins, it’s amazing to see the support system these women build together.” Newly diagnosed patients often do not know where to turn or what their next steps should be. Kelly and Downing both agree that more women need to be educated and enlightened. They say, “Getting through the fear of the unknown and realizing that breast cancer, especially if caught early, is extremely treatable is the key.

SOURCES:
Lehigh Valley Health Network 610-402-CARE

Easton Hospital 610-250-4000

Advanced Imaging for Breast and Body 610-841-6062