Approximately one in eight women will be diagnosed with breast cancer during her lifetime. While the disease can have a profound impact on the patient and her loved ones, it is also one that can be effectively treated with surgery, radiation therapy, hormone therapy and chemotherapy.
City of Hope's breast cancer program offers a uniquely patient-centered approach for women diagnosed with breast cancer. Our expert team of doctors and researchers are turning innovative laboratory breakthroughs into promising new therapies that can impact our patients today and in the future.
We also focus on treating the whole person, addressing physical, emotional, psychosocial and spiritual issues that a breast cancer diagnosis can bring for the patient and loved ones.An accurate and thorough diagnosis is important so that your breast cancer team can develop the best treatment plan for you.
At City of Hope, your care team will utilize the most advanced breast imaging technologies and laboratory techniques to guide your personalized treatment.
Imaging studies give your breast cancer team important information about changes that may be occurring in your breast tissue. Breast imaging is an important part of a woman's health care, so that problems can be detected when they are most treatable.
Listen in as Lusi Tumyan, MD discusses all the new options for women who have been diagnosed with breast cancer.
Selected Podcast
Have You Had Your Breast Cancer Screening?
Featured Speaker:
Lusi Tumyan, MD
Lusi Tumyan, M.D., is an outstanding specialist in breast imaging at City of Hope. Transcription:
Have You Had Your Breast Cancer Screening?
Melanie Cole (Host): Breast cancer screening is an important tool to help detect cancer in its early stages, when it is more easily treatable. As a dedicated team of breast cancer experts, City of Hope focuses on compassionate, patient-centered, leading-edge care to save the lives of women. My guest today is Dr. Lusi Tumyan. She’s an outstanding specialist in breast imaging at City of Hope. Welcome to the show, Dr. Tumyan. At what age should healthy women begin having regular mammograms, and how often should they have them?
Dr. Lusi Tumyan (Guest): That’s a very controversial topic at this point because various different organizations recommend different things. The American Radiology Society recommends starting at age of 40. United States Task Force, which came out in 2009, they recommend starting at age of 50. Obstetrics and gynecology groups are recommending to start at age of 40. I think it should be an individualized discussion between the patient and the referring provider that would determine their overall risk factors and determine their level of comfort of starting at age 40 versus at the age of 50, taking into account the risks and harms of screening mammogram as well as the benefits of mammogram.
Melanie: We’ve all heard about mammograms, and if women have had them, they’re not nearly as bad as you imagine that they are. But what’s the difference between a screening mammogram and a diagnostic mammogram?
Dr. Tumyan: Screening mammogram only does two views of the breast. What we’re actually doing is we’re taking a three-dimensional breast and we are taking two images and recreating in two dimensions. And we only get two views. With diagnostic mammogram, that’s usually for patients that have a specific problem, whether its patient is coming in for palpable lesion or patients coming in for surgical planning or other things. For those, we take additional images. It could be one image. It could be multiple images, but it is a problem-solving mammogram.
Melanie: Women go in for their annual mammograms depending on what they’ve discussed with their doctor, and you sit in the waiting room, make sure that the pictures are all right. That’s a terrible wait. Then you wait for your results, which is also a terrible wait, and you hope that you do not get that call. Then if you do get the call and you have to come back in for a diagnostic mammogram, what happens if something suspicious is found? Then what’s the next step?
Dr. Tumyan: At City of Hope, if the patient comes back for a diagnostic mammogram, they will have additional imaging based on the radiologist’s recommendation. Then they may or may not, depending what the finding is, have an ultrasound of the breast. Once they have all the imaging, the radiologist will review everything at the same time while the patient is still there. The radiologist most of the time will go and talk to the patient and will give them the results. The patients do not leave our department until they get the final result of their diagnostic workup, which helps with anxiety, and our patients are truly appreciative of that.
Melanie: What are some of the potential limitations of screening mammograms? Do we get results? And if someone has dense breasts, for example, Dr. Tumyan, is there a difference in how these results are read?
Dr. Tumyan: Yes. There are different densities of breast parenchyma, and the younger we are, we have more fibroglandular tissue, which means we have denser breasts. Unfortunately, fibroglandular tissue on a mammogram is white. Cancer is also white, which means that with dense breasts, cancer can hide. When they get screening mammograms, we read them and we will give -- every screening mammogram gets breast density, some sense of breast density, what they are, and what the limitations of the mammogram are related to that. If the patient has fibroglandular, heterogeneously dense breasts, they will get a sentence in their mammogram that says that the sensitivity of mammography is lower. In addition to that, since we are living in California, last April, the law was enacted that now patients get a letter. In the letter, it will state that they have dense breasts and that they should discuss this with their referring provider and that the mammogram is not as sensitive for them as previously thought.
Melanie: If you see something, then when does it come to biopsy? What is the followup after a diagnostic mammogram and you see something suspicious? Then what’s the next step. Tell us a little bit about biopsies.
Dr. Tumyan: After we do the diagnostic workup, which includes either a mammogram or ultrasound, I come into the room and I talk to the patient and I discuss all the findings. I will go through every single part of it, and we will discuss what the findings are and what we’re going to do. If there are suspicions and we’re going to do a biopsy, at that point, I will discuss with them what the biopsy will entail. There are actually three different modalities that we can use for biopsy: ultrasound, mammograms or stereotactic biopsy, or MRI biopsy. Majority of the biopsies are done with ultrasound. I will go through with them every step of the way how the biopsy is done. With ultrasound, we will be doing this real time. I will be visualizing the needle and the lesion the whole time. We give them local anesthesia, same thing that you would get at the dentist. It’s going to pinch and burn momentarily, and then the breast is going to be numb. We’ll put in the biopsy device, take a couple of samples, and samples will go to pathology. It takes at our institution about 72 hours for pathology results to come back. The pathology results are going to come to me and to the referring physician.
Melanie: Once the results come back, which doctor does the patient speak with about these results, you or the primary care physician?
Dr. Tumyan: Once the pathology results come back, I look at the imaging and pathology results and make sure that there is concordance. As long as there is concordance, I will give my recommendation, and that report will go to their primary or referring physician. The patients discuss their findings with their referring physician.
Melanie: Tell us about some new techniques being studied to improve the accuracy of breast cancer screening.
Dr. Tumyan: I’m really glad you asked me about that one. The future is digital tomosynthesis. What this does is, as I’ve told you before, we’re taking a three-dimensional breast and we’re taking two images and making them into two dimensions. But, just like everything else that’s three-dimensional, we are getting a lot of overlapping tissue, and if you have dense breasts, there’s a lot of overlap and it may simulate a mass when there isn’t a mass, or it may hide cancer. What the digital tomosynthesis does, it takes multiple x-rays of breast at 15-degree angles, and then it will reconstruct it into three dimensions. Now, we can view this breast in three dimension, which means that even with denser breast, we can see the lesion. This helps us tremendously because it not only decreases the recall rate, which is always a great thing, decreases anxiety, but it also increases our overall cancer detection rate. It also increases our overall detection rate of invasive cancer. That’s our breakthrough so far. There are other new technologies. One of them is whole breast ultrasound screening. In denser breasts, ultrasound is a good modality to supplement a mammogram. The new technology is that it can be done automated, in which case, the technologist doesn’t have to do that. You put in the machine and then it will take all the images and then the radiologist will review it. These are the two big modalities that are making new strides in breast cancer.
Melanie: In just the last minute, Dr. Tumyan, tell people why they should come to City of Hope for their breast cancer screening.
Dr. Tumyan: Well, City of Hope is very unique. We have multidisciplinary approach to breast cancer screening. We have oncologists, primary care physicians; we have surgeons that have dedicated their life and their career to breast cancer only. That’s all they do. In addition to that, we are very cognizant of our patients, and we give them results the day that they come into our facility, and we don’t make them wait. We have just purchased tomosynthesis, so this will be installed in the next month or two. We will be doing tomosynthesis on our patients, so patients that come in with denser breasts will get state-of-the-art mammogram and will get best possible results.
Melanie: Thank you so much. You’re listening to City of Hope Radio. And for more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Have You Had Your Breast Cancer Screening?
Melanie Cole (Host): Breast cancer screening is an important tool to help detect cancer in its early stages, when it is more easily treatable. As a dedicated team of breast cancer experts, City of Hope focuses on compassionate, patient-centered, leading-edge care to save the lives of women. My guest today is Dr. Lusi Tumyan. She’s an outstanding specialist in breast imaging at City of Hope. Welcome to the show, Dr. Tumyan. At what age should healthy women begin having regular mammograms, and how often should they have them?
Dr. Lusi Tumyan (Guest): That’s a very controversial topic at this point because various different organizations recommend different things. The American Radiology Society recommends starting at age of 40. United States Task Force, which came out in 2009, they recommend starting at age of 50. Obstetrics and gynecology groups are recommending to start at age of 40. I think it should be an individualized discussion between the patient and the referring provider that would determine their overall risk factors and determine their level of comfort of starting at age 40 versus at the age of 50, taking into account the risks and harms of screening mammogram as well as the benefits of mammogram.
Melanie: We’ve all heard about mammograms, and if women have had them, they’re not nearly as bad as you imagine that they are. But what’s the difference between a screening mammogram and a diagnostic mammogram?
Dr. Tumyan: Screening mammogram only does two views of the breast. What we’re actually doing is we’re taking a three-dimensional breast and we are taking two images and recreating in two dimensions. And we only get two views. With diagnostic mammogram, that’s usually for patients that have a specific problem, whether its patient is coming in for palpable lesion or patients coming in for surgical planning or other things. For those, we take additional images. It could be one image. It could be multiple images, but it is a problem-solving mammogram.
Melanie: Women go in for their annual mammograms depending on what they’ve discussed with their doctor, and you sit in the waiting room, make sure that the pictures are all right. That’s a terrible wait. Then you wait for your results, which is also a terrible wait, and you hope that you do not get that call. Then if you do get the call and you have to come back in for a diagnostic mammogram, what happens if something suspicious is found? Then what’s the next step?
Dr. Tumyan: At City of Hope, if the patient comes back for a diagnostic mammogram, they will have additional imaging based on the radiologist’s recommendation. Then they may or may not, depending what the finding is, have an ultrasound of the breast. Once they have all the imaging, the radiologist will review everything at the same time while the patient is still there. The radiologist most of the time will go and talk to the patient and will give them the results. The patients do not leave our department until they get the final result of their diagnostic workup, which helps with anxiety, and our patients are truly appreciative of that.
Melanie: What are some of the potential limitations of screening mammograms? Do we get results? And if someone has dense breasts, for example, Dr. Tumyan, is there a difference in how these results are read?
Dr. Tumyan: Yes. There are different densities of breast parenchyma, and the younger we are, we have more fibroglandular tissue, which means we have denser breasts. Unfortunately, fibroglandular tissue on a mammogram is white. Cancer is also white, which means that with dense breasts, cancer can hide. When they get screening mammograms, we read them and we will give -- every screening mammogram gets breast density, some sense of breast density, what they are, and what the limitations of the mammogram are related to that. If the patient has fibroglandular, heterogeneously dense breasts, they will get a sentence in their mammogram that says that the sensitivity of mammography is lower. In addition to that, since we are living in California, last April, the law was enacted that now patients get a letter. In the letter, it will state that they have dense breasts and that they should discuss this with their referring provider and that the mammogram is not as sensitive for them as previously thought.
Melanie: If you see something, then when does it come to biopsy? What is the followup after a diagnostic mammogram and you see something suspicious? Then what’s the next step. Tell us a little bit about biopsies.
Dr. Tumyan: After we do the diagnostic workup, which includes either a mammogram or ultrasound, I come into the room and I talk to the patient and I discuss all the findings. I will go through every single part of it, and we will discuss what the findings are and what we’re going to do. If there are suspicions and we’re going to do a biopsy, at that point, I will discuss with them what the biopsy will entail. There are actually three different modalities that we can use for biopsy: ultrasound, mammograms or stereotactic biopsy, or MRI biopsy. Majority of the biopsies are done with ultrasound. I will go through with them every step of the way how the biopsy is done. With ultrasound, we will be doing this real time. I will be visualizing the needle and the lesion the whole time. We give them local anesthesia, same thing that you would get at the dentist. It’s going to pinch and burn momentarily, and then the breast is going to be numb. We’ll put in the biopsy device, take a couple of samples, and samples will go to pathology. It takes at our institution about 72 hours for pathology results to come back. The pathology results are going to come to me and to the referring physician.
Melanie: Once the results come back, which doctor does the patient speak with about these results, you or the primary care physician?
Dr. Tumyan: Once the pathology results come back, I look at the imaging and pathology results and make sure that there is concordance. As long as there is concordance, I will give my recommendation, and that report will go to their primary or referring physician. The patients discuss their findings with their referring physician.
Melanie: Tell us about some new techniques being studied to improve the accuracy of breast cancer screening.
Dr. Tumyan: I’m really glad you asked me about that one. The future is digital tomosynthesis. What this does is, as I’ve told you before, we’re taking a three-dimensional breast and we’re taking two images and making them into two dimensions. But, just like everything else that’s three-dimensional, we are getting a lot of overlapping tissue, and if you have dense breasts, there’s a lot of overlap and it may simulate a mass when there isn’t a mass, or it may hide cancer. What the digital tomosynthesis does, it takes multiple x-rays of breast at 15-degree angles, and then it will reconstruct it into three dimensions. Now, we can view this breast in three dimension, which means that even with denser breast, we can see the lesion. This helps us tremendously because it not only decreases the recall rate, which is always a great thing, decreases anxiety, but it also increases our overall cancer detection rate. It also increases our overall detection rate of invasive cancer. That’s our breakthrough so far. There are other new technologies. One of them is whole breast ultrasound screening. In denser breasts, ultrasound is a good modality to supplement a mammogram. The new technology is that it can be done automated, in which case, the technologist doesn’t have to do that. You put in the machine and then it will take all the images and then the radiologist will review it. These are the two big modalities that are making new strides in breast cancer.
Melanie: In just the last minute, Dr. Tumyan, tell people why they should come to City of Hope for their breast cancer screening.
Dr. Tumyan: Well, City of Hope is very unique. We have multidisciplinary approach to breast cancer screening. We have oncologists, primary care physicians; we have surgeons that have dedicated their life and their career to breast cancer only. That’s all they do. In addition to that, we are very cognizant of our patients, and we give them results the day that they come into our facility, and we don’t make them wait. We have just purchased tomosynthesis, so this will be installed in the next month or two. We will be doing tomosynthesis on our patients, so patients that come in with denser breasts will get state-of-the-art mammogram and will get best possible results.
Melanie: Thank you so much. You’re listening to City of Hope Radio. And for more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.