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'Cancer Prevention & Screening' posts

Do self breast exams matter?

Self breast exams: to do or not to do?

Remember when there were monthly emails you could sign up for to remind you and your friends to do your self breast exams at home? Remember seeing the news anchors talking about their monthly self breast exams in an attempt to remind you to do your breast “due diligence?” What happened to self breast exams and are they still important?

Initially, self breast exams were recommended as a screening tool to help early detection of breast cancer. Unfortunately long-term studies have not confirmed that they actually live up to their hype. Two large studies looking at over 200,000 women in both Russia and China didn’t show any difference in breast cancer mortality after 15 years between the women who were performing routine self exams and those who were not. In fact, the women that were practicing self exams found more lumps and underwent more biopsies for benign reasons. Reviews of several other studies failed to show a benefit of regular breast self-examinations including no benefit of early diagnosis, or reductions in deaths or stage at diagnosis. Hence in 2009, the US Preventative Services Task Force advised that clinicians no longer recommend routine self breast examination as a screening tool for breast cancer detection.

Even though you don’t need to be doing a monthly self exam, you should...

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:

The True Family Women’s Cancer Center Opening

We at the Swedish Cancer Institute are excited about the new True Family Women’s Cancer Center, located in downtown Seattle, which opens on June 5. Recognizing that women may have unique needs when faced with a cancer diagnosis, the True Center brings together multiple specialists who treat women with all types of cancer and provide care that is compassionate, caring, and highly coordinated. It is funded entirely by philanthropy.

The True Center is located on floors 5 and 6 of the Arnold Pavilion at 1221 Madison. Floor 5 will house medical oncology teams, our psychiatrist, social workers, genetic counselors, naturopathic physicians, nutritionists, The Rivkin Ovarian Cancer Center Clinic offices, a patient education satellite, our American Cancer Society Patient Navigator, and a financial counselor. The 6th floor will be the home to our multidisciplinary clinic, which will house our breast surgery teams, cancer rehabilitation physician, physical therapists, and social worker. Also on Floor 6 will be gynecological oncology consultations and specialized breast imaging. Other specialists may also be available to see patients in the multidisciplinary clinic.

The co-location of these services allows for improved patient convenience and enhanced communication among the members of care provision teams. Instead of ...

Swedish Set to Open Comprehensive True Family Women’s Cancer Center

SEATTLE – May 29, 2012 – Swedish Cancer Institute (SCI) is set to open its new True Family Women’s Cancer Center to patients on Tuesday, June 5. Carefully designed with the female cancer patient in mind, the new 23,600-square-foot women’s cancer center gives Swedish Cancer Institute the ability to consolidate most of its services for treating women’s cancers into one facility. The new center acts as a treatment hub where women are guided through personalized and coordinated multidisciplinary treatment of their cancer, including disease-specific education and holistic support activities.

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).  

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