It has long been accepted that mammograms can save lives by detecting breast cancer earlier than by just feeling for abnormal masses. Most people are also aware that there seems to be controversy about who really benefits and whether mammograms are even safe to get year after year.
In general, the answers to these questions are reassuring. The amount of radiation exposure from mammograms is a tiny fraction of what it was 20 years ago. This is not true of some other types of x-ray tests; more about that in a later article. Yearly mammograms have clearly been shown to improve survival from breast cancer in women of ages 50 to 70. In women ages 40 to 50, the incidence of breast cancer is lower, so more tests need to be done to find a cancer, thus, controversy about whether this is good public health policy. There still is a benefit however and yearly mammograms are a good idea for most women, especially those with a higher risk for this type of cancer.
The technology continues to change and requires women to be self-advocates. The best mammograms are now second generation digital ones. The quality of the images produced are astoundingly clear. So far they have been demonstrated to find more cancers and create fewer false alarms in younger women and those with dense breasts. They are more demanding of the radiologist, thus, the other factor has become the specialized skill level of the radiologist. The best outcomes have been shown to be by fellowship trained breast specialists who spend much or all of their time only on breast imaging.
The term breast imaging is now used because there are multiple types of tests the radiologist uses. Ultrasound is also a very sophisticated test if done optimally and almost useless if done poorly. It is generally best used to carefully look at a specific area felt on exam or found on a mammogram. An ultrasound of a whole breast is of limited value, although, on occasion is useful for certain purposes. The latest technology includes measuring tissue elasticity, distinguishing benign from malignant more accurately.
Magnetic Resonance Imaging has gotten a lot of attention, and if done well can be a very useful test in women with inherited BRCA mutations, very dense breasts, or to be sure there are no additional lesions needing treatment in women about to undergo surgery for newly diagnosed breast cancer. Breast MRI requires very specialized equipment and doctor skills and can be a terrible test when not done well because it finds so many false positives.
Finally, the radiologist is an extremely important member of the treatment team because he or she must place “bracketing J-wires” to guide the breast surgeon when he removes a mass. Errors here in skill or teamwork jeopardize the chance of cure and good cosmetic outcome.
Fortunately, the community benefits from the Sheila Veloz Center, which has the resources to have the best equipment and is serviced by the Tower Radiology Group, who also serve St. John’s Hospital-John Wayne Cancer Center in Santa Monica. Dr’s. Dan Kirsch, Jane Descalos, Ted Hittle and Ian Levine are all top radiologists and are experts at J-wire placement.
UCLA Cancer Center – Santa Clarita is located at 23929 McBean Parkway, Suite 215 in Valencia. For more information, please call 661-255-5350 and visit www.cancer.med.ucla.edu.