[ad_1]
Imagine finding a lump in your chest – it's big and you can feel it with your fingers. So you go to a clinic for a breast exam and the doctor sends you to an imaging center for a mammogram.
You expect a quick diagnosis – after all, it's a big mass – but the radiologist does not find anything on the scan.
The radiologist orders an ultrasound, the next step in breast cancer imaging, but still can not see it.
The tumor is apparently invisible, hidden in a tissue of connective tissue and glands.
That's what happened to Lisa Van Liefde in 2003, when she was diagnosed with breast cancer at age 46.
"It was almost as scary as the diagnosis: to know that he was there but he did not show up," she said. Then the question was: "Who knows if this had been the case during my previous mammogram? "She must have been smaller and missed."
Van Liefde had what is known as "dense breast tissue", a normal physiological condition that increases the risk of breast cancer in women. According to the National Institute of Health, about half of women over the age of 40 have dense breast tissue. Younger women tend to have higher breast density, which decreases with age.
Extremely dense breast tissue can make breast cancer screening almost impossible.
"The person with dense breasts has an increased number of glandular elements, which means that his breasts are able to produce more milk – and that's a good thing – but when it's noticeable. Breast cancer is a bad thing, "said Dr. Jonathan Sims, a radiologist at Oregon's imaging centers in Springfield, said.
It's as important a risk factor as having a direct family history with cancer, he said.
Hidden cancers in dense breasts may not be discovered until they become big enough to be found during a breast exam. But with the implementation of new screening technologies, risk assessment, increased awareness of the risk of breast density and automatic and individual breast clinical examinations, it is possible to quickly detect breast cancer that is difficult to detect. detect, said Sims.
A Russian genetic roulette game
Van Liefde followed the guidelines of the American College of Radiology and the Society of Breast Imaging: annual mammograms for all women aged 40 or older.
The main benefit of regular mammogram screenings is that a higher frequency increases the chances of getting breast cancer at the very beginning of its development, when it is smaller and easier to treat, Sims said.
But, as in the case of Van Liefde, nothing is simple with regard to breasts or the detection of their cancers, he said.
"It's not just an illness. There are about 15 different types of breast cancer and they all look different, "said Sims.
Breasts fluctuate and vary more than other parts of the body that contract cancer – each woman's breasts are physiologically unique and evolve throughout the woman's monthly menstrual cycle and throughout her life, said Sims.
"So you try to find something that seems variable in a completely variable process from one individual to another, and varies within each woman according to her life cycle. It's extremely, extremely complicated, "he said.
In dense breasts, tissues of fibrous and glandular tissue block the X-rays of a mammogram, sometimes hiding hidden cancers.
According to Dr. Benjamin Cho, an oncologist at the Willamette Valley Cancer Institute in Eugene, every time a cell divides, she has to copy more than one billion DNA instructions to another cell.
"When you do that, mistakes can be made. And when these mistakes are made, an error from time to time can cause cancer, "said Cho. Mutations in cells occur all the time, but most are eliminated by the immune system.
When a woman's breasts are dense, there are "more and more elements participating in Russian genetic roulette," said Sims – which means she's more likely to develop breast cancer.
At Cedar Clinic, another imaging center in Eugene, Dr. Michael Milstein, director and radiologist, uses a computerized risk assessment program to estimate the risk of developing breast cancer in a woman. It's a system they put in place three or four years ago and most imaging centers use, he said, a series of questions and answers. Milstein is looking for patients in the "high risk" category – 20% or more.
For high-risk patients with dense breast tissue, they may recommend ultrasound or magnetic resonance imaging. MRIs are not a good screening tool for women at low to moderate risk because they can give too much detail and harmless breast changes may seem suspicious. But MRIs are helpful for high-risk patients and to assess the extent of cancer already diagnosed, Sims said.
The breast cancer survivor, Linda DeHart, was a nurse navigator at the Willamette Valley Cancer Institute and retired in 2012. She remembers many women who had found masses in the chest that had not been mammographed during his stay there.
There was a gap between radiologists and primary care physicians – many family physicians reported the results of the mammogram to the patients and were not aware of the problems related to breast tissue density, said DeHart.
"It took me a while to understand it," she said. "They are not yet dealing with dense breast tissue."
Since Van Liefde's initial diagnosis 15 years ago, 35 states have passed laws in the past seven years that require radiologists to inform patients of breast density or high density risk, particularly in the area of cancer. Oregon in 2014.
It's a new focal point for breast cancer risk and detection, while radiologists are looking for ways to tackle it effectively.
New technology and three-pronged approach
In an effort to improve diagnoses, many imaging centers are moving from 2D mammography to 3D mammography, called digital tomosynthesis.
Some radiologists hope that this new type of mammogram will help detect cancers in dense breast tissue, and a 2014 study by the Journal of the American Medical Association shows that it increases cancer detection rates .
"It allowed us to find more cancers at a smaller size," Sims said.
The study also showed a decrease in patient recall rate, which means that fewer patients were recalled for additional screenings, which occurs when something suspicious but lacking in clarity is noticed on a screen. mammography. 3D mammograms give radiologists a more complete and detailed picture of breast tissue, helping them to distinguish suspicious abnormalities from benign changes.
Oregon imaging centers began using 3D in 2015. Their cancer detection rate increased from 4 cancers per 1,000 screenings to 5 out of every 1,000 cancers. And their recall rate decreased by 2.5 %, from 7.5% to 5%, said Jennifer Cantu, Director of Imaging and Women's Awareness at Oregon Training Centers.
The 3-D payment is more expensive than a 2-D mammogram, and depending on where the patient goes, it can cost between $ 85 and $ 100 more, Cantu said.
However, most insurance companies are covering it now, Sims said.
The Oregon Imaging Center and the Cedar Clinic both provide 3D mammograms to all of their patients. But it is not infallible.
"Even in 3-D, cancer that develops in very dense tissue may be lacking," said Milstein.
According to Sims, some types of breast cancer occur only in the form of mass or thickening and are not manifested in mammograms or ultrasound.
"That's why clinical breast exams and clinical breast exams are vitally important," he said.
Sims recommends a three-pronged approach to breast cancer screening: annual mammograms starting at age 40, monthly self-breast cancer exams, and annual clinical exams.
"This three-pronged approach has allowed the diagnosis of breast cancer to go from 40% to 4% mortality, a 10-fold reduction," said Sims.
When Van Liefde regained her size, she recently had a mammogram.
"When they finally had the MRI and the images, it was like a hot dog – it was already so big and it was almost touching my chest wall," Van Liefde said. "But the bottom line is that it was a good sized tumor and they could not even see it."
Source link
