3D mammography (DBT-Digital Breast Tomosynthesis) has been promoted to the public as the “latest and greatest” form of mammographic imaging. Mammography centers have been slowly converting their systems to 3D units, as many feel pressure to keep up with their imaging competitors. Research has shown that 3D imaging significantly decreases call-back rates, however the cancer detection rate has only been shown to increase by 1-2 incidences/1000 patients. This month a study published in the American Journal of Roentgenology found no significant difference in the cancer detection rate of 2D full-field digital mammography vs. 3D mammography. Perhaps those who are being persuaded to have 3D mammography should look further into the necessity of such imaging. It is important to note that in most cases a 2D image is also acquired when a 3D image is obtained, thus doubling radiation dose. Additionally, many insurance carriers do not cover the cost of screening with 3D. Be aware of your care!
Yesterday I lost a good friend and comrade, Nancy Cappello. There are not enough words to describe such an amazing woman. Nancy’s loss to the breast imaging community, to every woman she saved from aggressive breast cancer, and to each heart she touched, is beyond imagination. Nancy was diagnosed this September with Myelodysplastic Syndrome, as a result of her chemotherapy treatments 14 years ago for her late stage breast cancer. Nancy’s accomplishments during those 14 years are more than most can hope to achieve in a lifetime. As a resident of Connecticut, Nancy championed the first ever dense breast notification law in our state. Currently there are 36 states that now have the notification law in place, thanks to the perseverance and tireless efforts of Nancy. The thousands of lives saved, due to early detection of breast cancer by means of breast ultrasound or MRI, in patients with dense breast tissue, can be attributed to Nancy’s never ending fight to let the patient be their own advocate. I am honored to have known Nancy, to have given lectures with her, to have attended many “Are You Dense?” events, and to have been named her breast “Champion” in 2016. While Nancy can never be replaced, all of us who loved and supported her will be here to continue her fight. One day, the entire United States will be “Pink” with notification laws. Nancy, you will be dearly missed, but your memory will live on in present and future generations.
I recently returned home from Las Vegas where I attended the annual Society of Breast Imaging conference. While I always gain important knowledge about current technology, imaging methods and treatment advances, this year I was surprised to see a new topic discussed. Saturday morning was solely devoted to talks on patient experience and radiologist engagement. The importance of direct communication between the radiologist and the patient was stressed and it has been shown that 90% of patients prefer communication of breast imaging results directly from the radiologist. Surveyed patients have commented on their desire to establish a relationship with their doctor, such that their feelings are acknowledged, their questions are encouraged, and their results are explained. I am pleased to say that at J Gershon Breast Imaging, these wishes are granted! We take the time to meet with every individual, to answer all questions and to discuss imaging results. We aim to take the stress out of annual screening mammography and hope to create a comfortable, reassuring environment. Patients should feel free to call at any time, with any concern and with an understanding that their correspondence will be promptly acknowledged. Lastly, I leave you with a final take home message from the meeting, one that is of utmost importance...Annual screening mammography should begin at age 40, and continue every year thereafter! Give us a call, we look forward to seeing you soon!
I recently wrote this article for Beekley Medical and it was published on their blog page. Enjoy!
At the current American Roentgen Ray Society conference in New Orleans, researchers in Rochester, NY found that ultrasound imaging in dense breast tissue detected significantly more cancers than digital breast tomosynthesis (3D mammography). Author, Dr. Stamatia Destounis, stated “Seventeen cancers were found on ultrasound only. If we had only performed tomosynthesis, we would have missed these. Overall, ultrasound outperformed 3D mammography in identifying cancer in this group.” The average lesion size was also significantly smaller on the ultrasound studies, thus reconfirming the added value of screening breast ultrasound in patients with dense tissue. The detected small cancers are typically early stage and can be successfully treated. For more information take a read...ARRS: Don't Underestimate Breast Ultrasound in Cancer Arsenal
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On Thursday, February 23rd, I attended a hearing at the Connecticut State Capitol for Senate Bill 810. The bill is up for review and would entitle women with dense breast tissue the right to a screening breast ultrasound with no out-of-pocket payment. The proposed bill states that regarding insurance coverage "No such policy shall impose a copayment or deductible for an in-network mammogram or comprehensive ultrasound examination." I spoke in support of this bill, along with Jan Kritzman and Heidi Grise. Both Jan and Heidi are breast cancer survivors who have dense breast tissue and their cancers were detected only by screening breast ultrasound. I cannot stress enough the value of screening breast ultrasound in dense breast tissue. Small, invasive cancers are frequently found on ultrasound in patients with a negative mammogram. Early detection allows for easier treatment to the patient and saves lives. Every woman with dense breast tissue should be able to undergo screening breast ultrasound without the worry of additional cost. In addition to our in-person testimonies, there were 18-20 written testimonies also submitted in support of the bill. The next step is the State Senate. Let's keep our fingers crossed that the bill passes and all women with dense breast tissue will be covered by insurance for their screening breast ultrasound!
This past Saturday evening I attended the 8th annual Are You Dense? Music Fest, as both a guest and an award recipient. I was honored with the "Champion" award and my close friend, and breast cancer advocate, Jan Kritzman, was given the "Queen Esther" award. It was a truly memorable evening and I am very appreciative to Dr. Nancy Cappello for acknowledging myself and Jan at such a wonderful event. Nancy has advanced the field of breast imaging across the U.S. and worldwide, through the use of screening breast ultrasound in patients with dense breast tissue. I encourage women to view her website, www.areyoudense.org, and learn for yourself the great impact of breast ultrasound in detecting cancers in patients with dense breast tissue.
The American Cancer Society released new recommendations yesterday for screening mammography. They are recommending that women of average risk begin screening mammography at age 45. With the new recommendations, women ages 45-54 should be screened annually, and 55 and older should begin biennial screening, with the opportunity to screen annually if they wish.
The American College of Radiology and the Society of Breast Imaging continue to recommend that women have yearly mammograms beginning at age 40.
As a practicing breast radiologist, I have diagnosed breast cancers in women of all ages, many younger than 40. I have seen late stage cancers in older women who skipped a yearly mammogram, or two. I have followed many women who are breast cancer survivors, thanks to early diagnosis and treatment. I am a strong believer that mammography saves lives. I urge women to be knowledgeable about their care and understand the benefits of screening mammography. Please take the time to check out these two websites for more information.
End the Confusion and Mammography Saves Lives
As I was going through my emails, I came across an article written by Dr. Amy Thurmond, director of Women's Imaging in Lake Oswego, OR. This article states everything I believe in and I could not have said it better myself! As a breast imaging radiologist, I am happy to be able to offer my patients the same level of care that Dr. Thurmond provides for her patients. Please take a moment to read...
"Breast Imaging Providers Must Lead Density Education"(click here).
Julie S. Gershon, M.D.