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Jenna Johnson expects to reach a major milestone next month: a free diagnosis of breast cancer.
The now 56-year-old executive assistant and office manager was diagnosed in November 2013, after reporting a few months late for her annual mammogram. That's when she first learned about a new type of mammogram, one that provides more detailed images than standard two-dimensional mammography.
Known a breast tomosynthesis or 3-D mammography, it sometimes costs more than 2-D screening, but Johnson's insurance would cover the cost and give 3-D a try. Good thing she did. Her cancer was so small and early stage that it could not have been shown on standard two-dimensional images.
"It was a bit of a shock when they found something," said Johnson, a mother of two who lives in Citrus Park. "But because they caught it early, I was able to keep a positive attitude.
The radiologist who reads Johnson's movies that day, Dr. Mia Jackson, medical director of imaging at the Shimberg Breast Center at St. Joseph's Women's Hospital, confirms that a 2-D mammogram may have picked up cancer.
"I refer to that now as my 'A-ha!' Case," Jackson said. "The cancer was much more obvious with 3-D it was less than a centimeter in size.
3-D mammography has been approved by FDA approval in 2011, and it is not all of them. Because it takes more pictures of the breasts, 3-D takes a few minutes longer than traditional screening. If available, patients can usually pay an additional $ 40 to $ 80 for the newer technology.
3-D mammography takes pictures in thin slices, giving doctors a look at breast tissue at a time, often making abnormalities with 2-D mammography.
"I'm a big fan of it," said Jackson, whose full-time job is looking at images for breast cancer. "It should be the standard of care for all women."
Looking at 3-D images is like flipping through the pages of a book or looking for something in the book by just looking at the cover, or looking for a bird in the forest. With 3-D, Jackson said, "You can walk through the forest to find the bird, versus standing on the edge of the forest and looking."
Because they are less likely to be positive, they are less false positive results, and they are less likely to be more effective than other biopsy, as well as to reduce the risk of re-screening or additional screening. tests. And 3-D imaging picks up slightly more cancers than 2-D.
"We should use 3-D mammography on every woman," Jackson said. "We certainly offer to all our mammography patients."
But about 20 percent of patients at the Shimberg Breast Center do not opt for it, usually because of cost.
"I think that it will be all about it," Jackson said. In the meantime, she recommends that women who can afford it for 3-D imaging when it's time for their annual mammogram.
Another, more advanced technology for screening is magnetic resonance imaging, or MRI. It is used in addition to mammography because MRI can miss some cancers that mammography picks up. Because MRI is highly sensitive (and prone to picking up abnormalities that may not be cancer) and is significantly more expensive than 2-D or 3-D mammography ($ 1,000 or more versus around $ 50 for a 2-D mammogram), it is usually for a small group of women who have greater than average risk for breast cancer.
In March, the American College of Radiology and the Society of Breast Imaging released new guidelines for breast cancer screening in women at greater than average risk. BRCA1 or BRCA2; BRCA1; BRCA1 or BRCA2; those who have not had genetic testing but have a parent, sibling or child with a known BRCA mutation; those with a 20 percent or greater lifetime risk of developing breast cancer (determined by a credible breast cancer risk assessment or genetic testing); those with a history of chest radiation therapy before 30; those who have dense breasts and a personal history of breast cancer; In these cases, women in these high-risk groups should be screened for breast cancer no later than 30, with a combination of mammography and MRI.
Most women begin getting mammograms at 40 or 50, depending on which criteria they choose. Women at high risk for breast cancer, as sometimes as early as 25, and may need to be more than once a year.
"Everyone agrees that mammography saves lives," said Dr. Bethany Niell, chief of breast imaging at Moffitt Cancer Center. "What we want to do is identify those women at high risk (for breast cancer) so they can benefit from screening and supplemental screening with MRI."
Some women believe having dense breasts alone should be eligible for MRI screening. Most doctors disagree.
"Having dense breasts – along with other risk factors – may make MRI necessary," said Niell. But if that's your only risk factor, it's not an indication for supplemental MRI screening.
Who would be a good candidate for supplemental MRI screening? One example, according to Niell, is a 28-year-old woman whose mother had ovarian cancer and a BRCA mutation; she should begin screening with MRI. Or, a 55-year-old woman with a 20 percent or more estimated lifetime risk of breast cancer. She may also benefit from breast MRI along with mammography.
The American College of Radiology's new guidelines for breast cancer risk assessment by 30, especially if they are African-American or Ashkenazi Jewish descent, because of their unusually high risk for the disease.
There are a number of different tests for the purpose of assessment, but the Gail model and the Tyrer-Cuzick model are among the most commonly used. They ask a range of questions, such as age, race, ethnic background, age of menstruation onset, number of pregnancies, history of breast cancer and first-degree female relative to breast or ovarian cancer. The Gail questionnaire can take just a few minutes; The Tyrer-Cuzick is more comprehensive and requires a lot of detail about your own health and medical history.
The idea is to determine your lifetime risk of developing breast cancer. For the average woman, it's about 12.5 percent; for high-risk women, it's 20 percent or higher. These are the women who need to talk with their doctors to see if they would benefit from breast MRI in addition to screening mammography.
"We should be evaluating every woman for breast cancer risk," said Dr. Robert Gabordi, a breast surgical oncologist and genetic specialist at St. Joseph's Women's Hospital. "A lot of women who are high risk do not even know it."
Contact Irene Maher at [email protected]
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