Transcription:
Detecting Breast Cancer Sooner

Melanie Cole (Host): Early detection is the best defense against breast cancer, and we're going to learn today about something called tomosynthesis. My guest is Dr. Carrie Rochman. She's a member of the UVA Breast Care Program, and she is also a specialist in breast imaging and board-certified in diagnostic sadiology. Welcome to the show, Dr. Rochman. Let's speak a little bit about tomosynthesis. What is it, and how does it differ from standard mammography?

Dr. Carrie Rochman (Guest): Hi. Good morning. We are very excited about breast tomosynthesis. It's also known as a 3D mammogram, and it's basically a different way of taking a mammogram image. The mammogram machine moves slightly during the test, and what we are able to create is the 3-dimensional image. And the great benefit of tomosynthesis is that we're able to see through the different layers of normal tissue to get better detail of the breast.

Melanie: Wow. That is exciting. Women, especially first timers, are sometimes afraid to go for their mammograms. Would you do tomosynthesis on somebody right from the get-go, or is it used diagnostically?

Dr. Rochman: Tomosynthesis is showing benefit across all groups of women, all ages, all different types of breast density. The benefit is that it's more sensitive, which means that we find more breast cancers. It's also more specific, which means that we find fewer things that turn out not to be cancer. So it's an overall more accurate test, and the benefits apply to all women.

Melanie: Is it something that you can foresee that we're going to be switching to over standard mammography, or is there still a place for that?

Dr. Rochman: We're gaining more data all the time. The data that has come in so far really shows that it is a more accurate test. In my opinion and with our experience so far, I think that we will be using more and more tomosynthesis in the future, absolutely.

Melanie: Is there anything different that women do? We're told not to use deodorant for our mammogram, and we're told soap, that sort of thing. Is there anything different that you do?

Dr. Rochman: No. For the patient experience, it's actually quite similar. The machine looks identical to a standard mammogram machine. There's just a subtle movement in the top part of the machine during the test, but the test is about the same length of time, and it should be very similar from a patient's perspective.

Melanie: Pain-wise, does it compress the same?

Dr. Rochman: Yes. There is some compression of the tissue. The benefit of that is that it really helps the tissue spread out so that we can see through and find those cancers when they're very small and the earliest detection possible.

Melanie: So you know the dreaded sit and wait, Dr. Rochman, that every woman just really, really hates. You have your mammogram, and then you go sit in the lobby and you wait to make sure that they got the pictures all proper, then you can go home and wait for the results. Is this the same, or do you have results a little quicker? Can you tell right there in the room? Any difference there?

Dr. Rochman: The waiting time is about the same. For a screening exam, the patient will have the pictures taken, and then the patient goes home and the screening exam then is read within a day or so. In the diagnostic setting though, those are for women who have had an abnormal screening or if they have any kind of a breast problem, those are read immediately, while the patient is still there, and all the results are given to her before she leaves our department.

Melanie: Now, because you specialize in breast imaging, tell us what the difference is. I've gone around after my mammogram and stood there with the tech and looked and seen. I can't really tell what's going on there; you look around, you see a bunch of dots and you say, "Oh my goodness," they say, "No no, that's not anything." What would you see that looks different than the standard mammogram? What's the picture like for you?

Dr. Rochman: The picture is that the normal tissue is almost blurred out, and so the normal structures melt away into the background. The abnormal structures, the breast cancers, stand out as a very mass-like finding. As well, what tomosynthesis is great is to see any kind of architectural distortion, where the normal architecture of the breast has been disrupted. Tomosynthesis is just superior at letting the imager see that.

Melanie: That's so exciting. What about radiation? Is there any more or less than standard mammography?

Dr. Rochman: Tomosynthesis or 3D mammogram does have an increased radiation dose relative to your standard digital mammogram. It's about two times the dose, but it's a very low dose. Even though it's two times, it's still two times a very tiny dose, and it's still well within what the FDA allows for screening mammograms. The levels of radiation are similar to what we used to have with mammography about 10 or 15 years ago when we were using analogs. When we switched to digital, we got the dose down, and now, tomosynthesis brings it back up to those levels that we had several years ago. Now, there's a lot of research, though, being done about how to get that dose back down, and I really think within about the next year or so, we'll get it back down to the levels we're at with a standard digital mammogram.

Melanie: And this is something that you can have once a year, just like our standard digital mammogram, and you're hoping, maybe, that this will be what we're using?

Dr. Rochman: Yes, once a year screening. I do. I really think that patients will benefit. I recommend it to all of my friends, family members, and patients. It's just a great test.

Melanie: Now, let's speak about women doing a self-exam. If you're teaching women how to do this and you're telling them, "I really think it's important," when is the best time for women to check their own breasts and to kind of get to know them?

Dr. Rochman: The best time is to do it the same every month. We want to check your breast when your hormone levels are at their lowest. If a woman is still having a menstrual cycle, the hormones are at their lowest in the week after her period, not the time when there'll be fewer areas that are tender, fewer things that are a little bit slow and just because of hormonal influences. So that week after your period is the best time to check your breast, and do it consistently that same time every month.

Melanie: Some of us have dense breasts and cystic, and it's hard to know what you're feeling.

Dr. Rochman: Absolutely. The best thing to do is kind of get an idea with your healthcare provider when you go in for a clinical breast exam and have them help explain to you the areas that feel normal, why they feel normal, and then get a good idea about what you're looking for. And then once you have an idea of what your own baseline exam is, how your normal tissue feels, it gives you a starting point to then look for something that's different.

Melanie: Because I think that's the hardest point that women don't actually do a self-exam is because they don't know what they're supposed to be feeling for, plus we all dread feeling that pea-sized bump if we were going to feel anything. Would it be something that moves around in there? Would it be something that is stationary on the back wall? What would we feel?

Dr. Rochman: The things that we're looking out for on a physical exam is we're looking for an area that feels hard. Breast cancers tend to feel hard like marbles. The other thing that we're looking for is that the tissues around the lump don't slide around it very easy, so we call it a fixed lump. The skin doesn't slide easily back and forth across it, or the tissue doesn't slide back and forth against your chest wall very easily. The other things that we look for are a change. Somebody might say, "You know, this spot was always soft, and now it just feels a little bit thicker." Any of those things would be a red flag. There can be changes on the skin. If there's redness or swelling of the skin or any kind of dimpling of the skin, all of those things should be evaluated. I want to stress, too, if there are ever any concerns that a patient feels or that her doctor feels and that she is concerned about, always come in and get it checked out. We're always happy to see women if there's any concern.

Melanie: The UVA Health System is the first hospital in the region to use tomosynthesis. In the last minute or so, 30 seconds or so, Dr. Rochman, please wrap it up for us about tomosynthesis and the advantages in using this 3D type of screening for breast cancer.

Dr. Rochman: Again, I just really want to stress that it's more sensitive, that it finds more cancers, and then also that it's more specific, that there's fewer recalls for things that turn out to be nothing, so there's fewer false positive. We have a more accurate test, and it's overall just great news for women.

Melanie: And it can certainly help the UVA doctors detect breast cancer sooner. You are listening to University of Virginia Health System Radio. That's UVA Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.