Trends in Breast Health and 3-D Mammography
Since one in eight American women will develop breast cancer, early detection is key. Dr. Janet Baum, Director of Breast Imaging, discusses the screening process.
Featuring:
Janet Baum, MD
Dr. Baum is the Director of Breast Imaging at Harrington HealthCare System. She is an Associate Professor and Radiologist at Harvard Medical School/BIDMC. She received her medical degree from the University of Michigan Medical School. She completed an internship at St. Joseph Mercy Ann Arbor and a residency at University of Michigan Hospitals and Health Centers. Transcription:
Prakash Chandran (Host): About one in eight women in the United States will develop breast cancer in her lifetime. So, it’s really important to have regular screenings because early detection can help save lives. But what exactly do you need to know about these screenings and what should you do to stay healthy? Let’s talk about it with Dr. Janet Baum, the Director of Breast Imaging at Harrington Hospital.
This is Healthy Takeout, the podcast from Harrington Hospital. I’m Prakash Chandran. So, first of all Dr. Baum, it seems very obvious, but let’s cover why it’s so important that women have regular breast screenings.
Janet Baum, MD (Guest): Because if we find something on mammography before it’s felt even; it’s often smaller and at an earlier stage and more treatable. And with appropriate treatment, 95% of women with early breast cancer never have a recurrence.
Host: Okay. Well that’s good to know. And at what age should women begin having these breast examinations or mammograms?
Dr. Baum: There’s a lot of controversy but those of us who specialize in breast disease including surgeons, radiologists, radiation oncologists and medical oncologists believe that women should start having annual mammography at 40 every year until approximately 75. And after 75, if they are healthy, they should continue to have them.
If a family member has had an early breast cancer, a mother or a sister in particular say at 45, then we recommend that the women start ten years before that age.
Host: Okay so let’s say for example, my wife’s mother had breast cancer at 45; you would then recommend that my wife start getting checked at 35.
Dr. Baum: Correct.
Host: Okay and just in regards to the examination itself, what exactly is a mammogram?
Dr. Baum: It’s an x-ray and as many women who have had them will tell you, it’s a little uncomfortable because they put the breast on a plate in two different projections at least and compress it and take an x-ray. There are several different kinds of mammography available today. There’s what’s called 2-D digital mammography which is a projection through the breast that then goes to a detector that is then displayed on a computer for us to review. And there’s also 3-D mammography which is what’s called a tomosynthesis exam and that’s where the machine when your breast is in compression, the machine moves across and it take multiple slices through the breast and then there’s a program that reconstitutes it for us to be able to review as slices through the breast which helps remove overlying dense tissue so that you can actually see a mass or distortions and better see masses to define them better.
Host: Yeah, that’s pretty incredible. And I know that Harrington now offers the 3-D mammograms. So maybe talk to us a little bit about the advantages of having a 3-D mammogram.
Dr. Baum: Well, there are a number of studies out there that show that 3-D mammography reduces the recall rate which means the rate when you have a screening, you get called back for us to look at an area again. Because it gives us better information about some areas and removes the overlying densities so that you can see areas better. And say this is obviously a benign finding. Or we can say there is a finding and we’re not sure and we need to bring the patient back and do spot films which means local compression. Instead of compressing the whole breast, you just compress a small area, or you may need to do an ultrasound to look at something within the breast.
The 3-D imaging also better demonstrates certain types of findings which we used to have great difficulty even on 2-D digital mammograms seeing and that is small focal asymmetries and are areas of distortion, what’s called architectural distortion which show up beautifully on 3-D and sometimes when you look at the accompanying 2-D image that’s obtained at the same time; you don’t see it.
Host: And how long does a mammogram like a 3-D one take for example?
Dr. Baum: Well, what most places including we are currently doing is the patient is placed in compression first from top bottom and then from a side angle but with an angle on, not straight from the side and with the top bottom projection we take an instantaneous 2-D image and then immediately take the 3-D image and with our machine; the patient is in compression for each view of each breast and there’s typically two views for a standard mammogram for 11 seconds for each view.
Host: I see. Okay so, I’m curious as to – I want to talk about breast health in general. And I’m curious as to what women can do to monitor on their own for abnormal lumps.
Dr. Baum: Well, women should check their own breasts and we recommend once a month and if the woman is still menstruating, she should do it at the end of the menstrual cycle, so about the end of week one. And I recommend that they check their breasts and I tell patients if you have to, draw a little diagram with a paper, pencil and ruler and do it with a pencil because the first two to three months you examine your breasts; you are going to feel things that are slightly different. And make some notes because every breast, even the breast that’s totally fatty will have some lumps, bumps, bands of tissue and it’s important to know what’s normal.
And then after that, when you check it just briefly, it will take just a couple of minutes and you can say oh, this is a new lump. I need to let my doctor know.
Host: Okay and I want to talk about diet and lifestyle choices. Is there anything that women can do to help prevent the onset of breast cancer when it comes to their diet?
Dr. Baum: Well, we do know that obesity is an increased risk factor. So, being at an appropriate weight is important. So, obviously decreasing calories if you are eating too much. And there’s no other definite proof about other diet changes at this point.
Host: Okay and Dr. Baum I’m sure you see so many women that come in and get screenings with you. I’m curious as to any patterns that you see or any advice that you’ve formulated over the years that you wish more women would know before they come in to see you?
Dr. Baum: Well, if they do feel a lump or if their doctor or nurse practitioner feels a lump when they are examining them; they should make sure they know where it is so that they can tell the technologist because if they have a lump, we try to put a marker on the skin so we can take extra views of that area if we need to right away for those patients that come in for what we call a diagnostic mammogram because they have a lump.
Host: All right so, if you are checking yourself every month, which it sounds like you should be after your menstrual cycle; then makes sure to really identify and pinpoint where you are feeling that so like you said, your team can go in and really analyze that area to make sure everything is okay. Is that correct?
Dr. Baum: Correct. And we may do it with mammography alone, mammography and ultrasound if needed and in some patients, we may go on to doing breast MRI to evaluate lumps and before we decide if the patient needs to have a biopsy. And sometimes, we may need to tell the patient – many times that everything looks good or once in a while we tell them they need a biopsy and most biopsies today are done image-guided which means it’s a needle biopsy as an outpatient procedure and it can be done under mammography, ultrasound or MRI depending on which is appropriate approach for the lesion and for the given patient.
Host: All right Dr. Baum, really fascinating to hear about all of this technology to help monitor this and detect things early. So, I really appreciate your time today. That’s Dr. Janet Baum, the Director of Breast Imaging at Harrington Hospital. Thanks for checking out this episode of Healthy Takeout. Head to www.harringtonhospital.org to get connected with Dr. Baum or another provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.
Prakash Chandran (Host): About one in eight women in the United States will develop breast cancer in her lifetime. So, it’s really important to have regular screenings because early detection can help save lives. But what exactly do you need to know about these screenings and what should you do to stay healthy? Let’s talk about it with Dr. Janet Baum, the Director of Breast Imaging at Harrington Hospital.
This is Healthy Takeout, the podcast from Harrington Hospital. I’m Prakash Chandran. So, first of all Dr. Baum, it seems very obvious, but let’s cover why it’s so important that women have regular breast screenings.
Janet Baum, MD (Guest): Because if we find something on mammography before it’s felt even; it’s often smaller and at an earlier stage and more treatable. And with appropriate treatment, 95% of women with early breast cancer never have a recurrence.
Host: Okay. Well that’s good to know. And at what age should women begin having these breast examinations or mammograms?
Dr. Baum: There’s a lot of controversy but those of us who specialize in breast disease including surgeons, radiologists, radiation oncologists and medical oncologists believe that women should start having annual mammography at 40 every year until approximately 75. And after 75, if they are healthy, they should continue to have them.
If a family member has had an early breast cancer, a mother or a sister in particular say at 45, then we recommend that the women start ten years before that age.
Host: Okay so let’s say for example, my wife’s mother had breast cancer at 45; you would then recommend that my wife start getting checked at 35.
Dr. Baum: Correct.
Host: Okay and just in regards to the examination itself, what exactly is a mammogram?
Dr. Baum: It’s an x-ray and as many women who have had them will tell you, it’s a little uncomfortable because they put the breast on a plate in two different projections at least and compress it and take an x-ray. There are several different kinds of mammography available today. There’s what’s called 2-D digital mammography which is a projection through the breast that then goes to a detector that is then displayed on a computer for us to review. And there’s also 3-D mammography which is what’s called a tomosynthesis exam and that’s where the machine when your breast is in compression, the machine moves across and it take multiple slices through the breast and then there’s a program that reconstitutes it for us to be able to review as slices through the breast which helps remove overlying dense tissue so that you can actually see a mass or distortions and better see masses to define them better.
Host: Yeah, that’s pretty incredible. And I know that Harrington now offers the 3-D mammograms. So maybe talk to us a little bit about the advantages of having a 3-D mammogram.
Dr. Baum: Well, there are a number of studies out there that show that 3-D mammography reduces the recall rate which means the rate when you have a screening, you get called back for us to look at an area again. Because it gives us better information about some areas and removes the overlying densities so that you can see areas better. And say this is obviously a benign finding. Or we can say there is a finding and we’re not sure and we need to bring the patient back and do spot films which means local compression. Instead of compressing the whole breast, you just compress a small area, or you may need to do an ultrasound to look at something within the breast.
The 3-D imaging also better demonstrates certain types of findings which we used to have great difficulty even on 2-D digital mammograms seeing and that is small focal asymmetries and are areas of distortion, what’s called architectural distortion which show up beautifully on 3-D and sometimes when you look at the accompanying 2-D image that’s obtained at the same time; you don’t see it.
Host: And how long does a mammogram like a 3-D one take for example?
Dr. Baum: Well, what most places including we are currently doing is the patient is placed in compression first from top bottom and then from a side angle but with an angle on, not straight from the side and with the top bottom projection we take an instantaneous 2-D image and then immediately take the 3-D image and with our machine; the patient is in compression for each view of each breast and there’s typically two views for a standard mammogram for 11 seconds for each view.
Host: I see. Okay so, I’m curious as to – I want to talk about breast health in general. And I’m curious as to what women can do to monitor on their own for abnormal lumps.
Dr. Baum: Well, women should check their own breasts and we recommend once a month and if the woman is still menstruating, she should do it at the end of the menstrual cycle, so about the end of week one. And I recommend that they check their breasts and I tell patients if you have to, draw a little diagram with a paper, pencil and ruler and do it with a pencil because the first two to three months you examine your breasts; you are going to feel things that are slightly different. And make some notes because every breast, even the breast that’s totally fatty will have some lumps, bumps, bands of tissue and it’s important to know what’s normal.
And then after that, when you check it just briefly, it will take just a couple of minutes and you can say oh, this is a new lump. I need to let my doctor know.
Host: Okay and I want to talk about diet and lifestyle choices. Is there anything that women can do to help prevent the onset of breast cancer when it comes to their diet?
Dr. Baum: Well, we do know that obesity is an increased risk factor. So, being at an appropriate weight is important. So, obviously decreasing calories if you are eating too much. And there’s no other definite proof about other diet changes at this point.
Host: Okay and Dr. Baum I’m sure you see so many women that come in and get screenings with you. I’m curious as to any patterns that you see or any advice that you’ve formulated over the years that you wish more women would know before they come in to see you?
Dr. Baum: Well, if they do feel a lump or if their doctor or nurse practitioner feels a lump when they are examining them; they should make sure they know where it is so that they can tell the technologist because if they have a lump, we try to put a marker on the skin so we can take extra views of that area if we need to right away for those patients that come in for what we call a diagnostic mammogram because they have a lump.
Host: All right so, if you are checking yourself every month, which it sounds like you should be after your menstrual cycle; then makes sure to really identify and pinpoint where you are feeling that so like you said, your team can go in and really analyze that area to make sure everything is okay. Is that correct?
Dr. Baum: Correct. And we may do it with mammography alone, mammography and ultrasound if needed and in some patients, we may go on to doing breast MRI to evaluate lumps and before we decide if the patient needs to have a biopsy. And sometimes, we may need to tell the patient – many times that everything looks good or once in a while we tell them they need a biopsy and most biopsies today are done image-guided which means it’s a needle biopsy as an outpatient procedure and it can be done under mammography, ultrasound or MRI depending on which is appropriate approach for the lesion and for the given patient.
Host: All right Dr. Baum, really fascinating to hear about all of this technology to help monitor this and detect things early. So, I really appreciate your time today. That’s Dr. Janet Baum, the Director of Breast Imaging at Harrington Hospital. Thanks for checking out this episode of Healthy Takeout. Head to www.harringtonhospital.org to get connected with Dr. Baum or another provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.