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'breast cancer' posts

What test is best for breast screening?

I often get asked why can’t a woman just get a breast MRI rather than a mammogram. The imaging tests that we do for breast cancer screening and evaluation of abnormalities have different strengths and weaknesses.

Mammograms are very useful as a screening tool. They can be done quickly and read efficiently by the breast radiologist. They have minimal radiation exposure. They can be done by a mobile coach in locations that are more convenient to patients. They are excellent for identifying abnormal calcium deposits within the breast tissue and for seeing disrupted tissue and masses. They may be less effective in women who have dense breast tissue but the digital techniques have helped some with that. 

Ultrasound is a great tool for evaluating a mass or tissue asymmetry found on mammograms. It can distinguish between a benign appearing solid mass, a fluid filled cyst, a mass that is suspicious for cancer, or normal appearing breast tissue. There is no radiation exposure. It is less reliable as a screening tool because it can be dependent on the skill of the physician or technologist doing the procedure. It is possible to miss abnormalities or to mis-interpret normal findings as abnormal. There are studies underway evaluating using an automated version of ultrasound as a screening test but the results are not conclusive and this is not considered ready for standard practice.

Breast MRI is a highly sensitive test that is very dependent on...

Getting a mammogram

Frequently women will ask me: Where should I get my mammograms? There are several things to think about.

First, you want to go to a Center that is accredited by the American College of Radiology. This means that they have high quality images and well-trained radiologists. It is preferable to have a digital mammogram but if that technology is not available, then film mammograms are better than not having one done. While it is not clear that digital mammograms improve survival, they do allow the radiologist to examine the images more clearly and to use computer assisted diagnostic tools.

The radiologists’ experience is also important. Dedicated breast centers usually have radiologists who are specialized in breast imaging. These sub-specialized radiologists are very experienced in using mammograms, ultrasound, and breast MRI to diagnose breast disorders and are less likely to miss abnormalities.

Convenience is also a consideration. You want to make it easy to get your mammograms. Some Breast Centers will have mobile mammography programs that will bring mammogram screening to your place of work, local community or senior center, or even your church or synagogue. If possible, it is a good idea to get your mammograms at the same Center or within the same hospital system every year. That way the radiologists have easy access to your prior studies and can compare them to the current ones.

Here are some other things to know about getting mammograms:

What you need to know about breast screening

In 2009, the United States Preventive Services Task Force (USPSTF) created significant controversy and confusion for both providers and patients when they revised their breast screening guidelines. (The USPSTF is promoted as an unbiased group that reviews relevant studies and makes guideline recommendations. Specialists may be asked to review the guidelines but no breast specialists (surgeons or radiologists) were on the actual review panel.)

The guideline development process aims to weigh the potential benefit of services against the potential harm, and make recommendations accordingly. For breast screening, the harms considered were “psychological harms,” imaging tests and biopsies in women who were ultimately found not to have cancer, inconvenience, and the possibility of treating a cancer that might not have been life threatening. Radiation exposure was considered to be a minor concern. Regarding benefits – the only benefit considered was reduction in death rates from breast cancer.

These USPSTF guidelines recommend...

Mammography-Detected Breast Cancer in 40-49 Year-olds Has Better Prognosis

SEATTLE, Feb. 23, 2012 – Based on a study of nearly 2,000 breast-cancer patients, researchers at the Swedish Cancer Institute say that, in women between the ages of 40 and 49, breast cancers detected by mammography have a better prognosis. The study appears in the March issue of Radiology.

“In our study, women aged 40 to 49 whose breast cancer was detected by mammography were easier to treat and had less recurring disease and mortality, because their cancer was found at an earlier stage,” Henry Kaplan, M.D., medical oncologist with Swedish Cancer Institute (SCI).  

Women Invited to Unique, Complimentary Breast Health Event Oct. 25 at the New Swedish Hospital Campus in Issaquah

KUOW Radio Airs Pieces on CyberKnife for Breast Cancer at Swedish, New Directions in Cancer Care

Personalized medicine is the future of healthcare

If you were diagnosed with cancer or another disease, wouldn’t you want your treatment and medicines to be as unique as you are?

This is a growing trend in medicine where the type of treatment a patient gets depends on their DNA.

A few weeks ago, Dr. Hank Kaplan of the Swedish Cancer Institute spoke with KING5 about the I-SPY clinical trial (click here to watch the KING5 story).

The usual treatment for breast cancer may be surgery, followed by chemotherapy, possibly radiation and as a last resort, a clinical trial.

The I-SPY clinical trial turns that thinking upside down by actually extracting DNA from a tumor to figure out which new drug will likely work best, then giving it to the patient first, even before surgery.

"The goal of the I-SPY trial is really to develop a faster and cheaper way to develop new drugs for breast cancer . We're hoping that this is a new paradigm that will work for other kinds of cancer too," said Dr. Kaplan.

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