New Technology for Breast Cancer Detection

Intro: This is Weekly Dose of Wellness brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello, hello, hello! And welcome to our show. I am Deborah Howell, and today's guest is Dr. Gary Levine, Medical Director of MemorialCare Breast Centers. Welcome, Dr. Levine.

Gary Levine, MD: Thank you. Good morning.

Deborah Howell (Host): Good morning. Most of us know that a mammogram is an essential annual screening tool to detect early warning signs of breast cancer. But you're here to tell us about the benefits of digital tomosynthesis, or 3D mammography technology, and its role in improving cancer detection and increasing survival rates. So let's start at the beginning. When should women begin getting annual screening for mammograms?

Gary Levine, MD: So the American Cancer Society, the American College of Radiology, and essentially all of the other major organizations which deal with breast cancer recommend that women have their baseline mammogram at age 40 and annual mammograms afterwards until at least age 75.

Deborah Howell (Host): You know, I'd heard that changed, but I'm glad to hear you say that we really do need to get there every year.

Gary Levine, MD: Yes.

Deborah Howell (Host): Okay, so what are the screening methods available at the MemorialCare Breast Center at Saddleback Memorial?

Gary Levine, MD: So the gold standard for screening remains mammography, and we recommend again that women have annual mammography. Traditionally, mammography entailed the use of a 2D mammogram system, and for women with fatty breasts or breasts that are not dense radiographically, the 2D mammogram is more than sufficient. And studies throughout the world have shown that the mortality rate from breast cancer drops anywhere from 30 to 40 percent in women that have screening mammograms. But there's this subset of women that have dense breast tissue in whom a 2D mammogram may miss a breast cancer. And that's because the dense breast tissue can hide the cancer within it. And in those women, we use a new type of mammography called 3D mammography or digital tomosynthesis.

Deborah Howell (Host): I see. And I think you touched on this, how do you determine which screening method to use on any given patient?

Gary Levine, MD: Right, so we preferentially want to use 3D mammography on the women that benefit from it most, and those are the women with dense breast tissue. And that has nothing to do with the look or feel of the breast, it has to do with how dense the breast tissue is in terms of radiation being able to penetrate the breast tissue.

Deborah Howell (Host): Okay. So what are the benefits of the 3D digital tomosynthesis?

Gary Levine, MD: So again, 3D tomosynthesis allows us to look through that dense breast tissue 1 millimeter at a time. So we can find that breast cancer that otherwise may be hidden within that dense breast tissue. And studies have shown that we find 40% more breast cancers than traditional 2D mammography in these women that have very dense breast tissue.

Deborah Howell (Host): And I'm assuming you're finding it earlier than you used to.

Gary Levine, MD: That's right. And early detection is the key to surviving breast cancer. It's a very common disease, but if we find it early through early detection screening, it's a very, very curable disease. So again, idea is screen the patient, find it early. If we find it early, it's very easily curable. We don't want to let it progress to an advanced stage when it's a very life-threatening disease.

Deborah Howell (Host): Right. Tomosynthesis sounds a little bit scary the first time you hear it on the ear. Tell us why we should not be afraid of this technology.

Gary Levine, MD: Really it's very similar to a traditional mammogram that women are familiar with. The nice points are that we don't have to compress the breast quite as much when we take the mammogram because...

Deborah Howell (Host): Hurrah!

Gary Levine, MD: Yeah, because again, we're able to look through that dense breast tissue and don't have to worry about spreading it out so much as we did on a traditional mammogram. But otherwise, many patients really won't notice a significant difference. What happens is the gantry actually rotates over the breast, so we're getting these multiple angles of images of the breast, and that's reconstructed into a 3-dimensional picture that the radiologist can look at.

Deborah Howell (Host): I have to ask the question on behalf of women. What about the difference in radiation factors?

Gary Levine, MD: Right. So when 3D tomosynthesis first came out, there was a significant increase in radiation dose. With some software changes that have been made over the last few years, the doses are almost identical to a traditional 2D mammogram, so really there's no drawback to this technology at all and a huge benefit.

Deborah Howell (Host): All right, I just heard a big cheer go up from a whole bunch of women with dense breast activity.

Gary Levine, MD: You asked me earlier about other screening technologies and I do want to touch on that. Although mammography still remains our gold standard, there are women in whom we need to do additional screening. And women with extremely dense breasts in whom even 3D mammography isn't sufficient to examine the breast, we add ultrasound examination. And that's a technology that isn't limited by breast density, so it's really excellent for these women with very, very dense breast tissue. So it doesn't replace the mammogram, we add to the mammogram by doing an ultrasound screening as well.

Deborah Howell (Host): And do you do that at the same time?

Gary Levine, MD: Yes, we do it at the same visit. And then finally, there's this subset of women who are at a very high risk. They either have genetic breast cancer in their families or they've had breast cancer before, and these women are screened a bit differently. And it's reserved for women that have a greater than 20% lifetime risk of developing breast cancer. And in these women, we actually use MRI, which is a totally different technology for screening the breast. And it uses magnetic resonance rather than radiation, and it is our most highly sensitive test for detecting breast cancer. But it's a very expensive test, and therefore this study is only reserved for women who are at the highest risk.

Deborah Howell (Host): So four different types of technologies to root out anything that we might not want lurking inside of us, right?

Gary Levine, MD: That's right. And again, cancer is a very scary disease, especially breast cancer, which has this psychological component associated with it. But what I want people to remember that it's also an extremely curable disease if we find it early and we can easily treat it.

Deborah Howell (Host): Excellent to know. Doctor, what is the dense breast law?

Gary Levine, MD: Right. So a few years ago, and this began in Connecticut, a woman who had dense breast tissue, and in whom her cancer detection was delayed because of the dense breasts, she actually started this crusade that women should know their breast density so that they can be proactive in terms of their care. And Connecticut was the first state to pass a breast density law, and what it says basically is that if a woman has dense breast tissue, that they should be informed of it. And that actually is now present in at least 15 states throughout the United States. There's actually federal legislation pending which may make it universal throughout the country.

Deborah Howell (Host): I have to tell you myself, when I went for my last mammogram, they informed me that I had dense breasts, and this was brand new information to me, and I was glad to have it.

Gary Levine, MD: And I agree. And I think it's a good idea, as long as we have a protocol in place for taking the next steps. And now with the new technology, including tomosynthesis, whole breast ultrasound screening, and some other technologies that are being developed, we have ways of further evaluating, further screening these women who not only have a tougher time diagnosing breast cancer, but also have a slightly higher risk of developing breast cancer. So just having that dense breast tissue alone is an independent risk factor, makes them a little more prone to developing cancer.

Deborah Howell (Host): Okay, good to know. So what is the percentage of women who have dense breasts?

Gary Levine, MD: About 40% of our women that we see have what we call BI-RADS 3 or BI-RADS 4 breast density, and that's those women with high-density breast tissue. So 40% of the population.

Deborah Howell (Host): And again, it has nothing to do with the look of the breast or the feel of the breast, it's just the tissue type, right?

Gary Levine, MD: It's the tissue type. It's appearance on an x-ray. Usually these are women who are young, because as we get older our breast tissue is generally replaced by fat. So the breast density tends to decrease over time. So a woman in her 40s is much more likely to have high-density breast tissue than somebody in their 60s or 70s. But that's not always the case. And in fact, 15% of women, their breast density always stays high even when they're in their 60s or 70s or beyond.

Deborah Howell (Host): Okay. So we can't underline it enough: please go every year, ladies, get examined, and know your breast density, and know your options.

Gary Levine, MD: Exactly.

Deborah Howell (Host): Thank you so much for taking time out of your day to be on the show today, Dr. Levine. It went too fast.

Gary Levine, MD: It's my pleasure. Thank you very much.

Deborah Howell (Host): For more information or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. That's all for this time. I'm Deborah Howell, we will see you soon for another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have yourself a wonderful day.