It’s a message that can’t be stressed often enough or emphatically enough: When it comes to beating breast cancer, early detection is key.

Fortunately, more women than ever before are heeding this call to action. An increase in the number of mammograms, combined with improvements in screening methods and diagnostic tests, has yielded an unmistakably positive effect on breast cancer survival rates. At the Breast Center at Overlook Hospital, state-of-the-art equipment, including the very best in digital mammograms, ultrasound, and breast MRI, help to save lives every day.

Screen for Survival: Digital Mammography

A yearly mammogram remains the gold standard in breast cancer screening. In fact, thanks to their ability to detect cancer in its earliest, most treatable stages, mammograms have lowered the mortality rate for breast cancer by 30 to 40 percent. And digital mammography is now helping to inch that number north by as much as 15 percent. Explains Sue Jane Grosso, MD, medical director of the Breast Center at Overlook Hospital, “Digital mammography has been found to improve the detection of cancer and other breast abnormalities in women who are pre-menopausal or peri-menopausal, or in women with dense breasts.” Density refers to the amount of fibroglandular tissue, or active breast tissue, which tends to decrease after menopause. This explains why digital mammograms are especially valuable for younger women: When a radiologist looks at a traditional mammogram, fatty tissue appears black and breast tissue appears white. But cancer also shows up on the film as white, making it easily missed in breasts with more densely packed tissue. (To determine whether your breasts are dense, ask your doctor to check your mammogram report.)

Of course, the benefits of digital mammography extend beyond breast density and apply to women of all ages.

• Digital mammograms are faster than traditional screens, so the breasts are compressed for less time. “Many patients say it’s actually less painful,” says Grosso.


• Since the results are digital instead of printed on film, radiologists have the ability to manipulate mammogram images and magnify any suspicious spots or make them darker or lighter, which can be a valuable tool in achieving clearer results.


• Unlike traditional mammogram films, which are often misplaced, digital mammograms can be permanently stored in a hospital’s system, so results can be compared for years to come.
  


• Doctors reading digital mammograms can also call upon computer-aided detection (CAD), which helps direct radiologists to potential areas of abnormalities.

Adding Ultrasound

Breast ultrasound uses sound waves (rather than X-rays or radiation) to transmit pictures of tissue in all areas of the breast, including those closest to the chest wall, which is often difficult to examine with a mammogram. “Breast ultrasounds cannot replace mammograms, but rather are a valuable complementary tool for diagnosing both benign and malignant conditions,” explains Grosso. “Ultrasound is mainly used for women who have symptoms of cancer, such as pain, swelling, or redness, or who have had an abnormal mammogram or MRI.” For example, if a lump is detected during a routine mammogram, an ultrasound can be used to determine if the lump is filled with fluid (a cyst) or if it is a solid lump requiring a biopsy. Ultrasound can also be used to monitor the size and changes of a suspicious cyst.

During an ultrasound, a small handheld machine, known as a transducer, is passed back and forth over the breast. A computer then translates the sound waves into a picture called a sonogram or ultrasound.

If you’re referred for a breast ultrasound, here’s what to expect: You’ll be asked to undress above the waist and a gown will be draped over your shoulders (be sure to remove any jewelry you happen to be wearing around your neck). A cool gel will be applied to your breast so the transducer can pick up the sound waves as it moves back and forth. You may feel light pressure from the transducer as it passes over your breast, but there shouldn’t be any discomfort unless your breast is tender because of an abscess or other infection. You will not hear the sound waves as the transducer does its job, but a picture of your breast tissue can be seen on a monitor and will be printed out for your doctor. A breast ultrasound usually takes between 15 and 30 minutes, although more time may be needed if a breast exam or biopsy is also planned. After the test you’ll be asked to wait while a radiologist reviews the pictures; additional ultrasound views may be necessary before you head home. Complete results are usually sent to your doctor in a few days.

Moving to MRI

A breast MRI (magnetic resonance imaging) is another diagnostic tool used to distinguish between benign (non-cancerous) and malignant (cancerous) lesions. When used properly, it has been found to reduce the number of biopsies used in the evaluation of suspicious breast masses—which means fewer painful procedures for patients. Despite the recent buzz around breast MRIs (it was instrumental in detecting actress Christina Applegate’s breast cancer last year), Grosso is quick to point out that MRI is not a screening tool to be used by all women; rather, it’s a diagnostic weapon. “The American Cancer Society has clear indications for the use of breast MRI,” she explains. “Your doctor is the best person to decide if you should have a breast MRI, and will suggest it only if he or she feels such a costly test is truly necessary.” A physician may prescribe MRI to determine the extent of disease in women already diagnosed with cancer in one breast, and to determine if the cancer is affecting the other breast as well. It may also be recommended for women with a significant family history of breast cancer or the BRCA 1 or BRCA 2 gene.

One of the benefits of MRI is that, unlike other tests, it can evaluate the blood flow in the breast. “Since cancer lesions have very high blood flow,” says Grosso, “they are easier to spot on an MRI.” Also, unlike mammograms, the density of a woman’s breasts does not affect MRI results. Still, MRIs cannot be used in every case. Women with such devices as pacemakers, cochlear implants, artificial joints, or heart valve replacements are advised not to have MRIs. In these situations, an ultrasound would be done instead. What’s more, not all cancers can be seen on an MRI. “MRIs are very good at picking up invasive or later-stage cancers that mammograms can miss,” says Grosso, “but they’re not as effective with earlier, smaller cancers, and in some cases have even yielded false positive results.”

If you’re scheduled for an MRI, you should allow approximately 90 minutes for the exam. You’ll be asked to change into a hospital gown and remove any jewelry or hearing aids. You may also be given an injection of contrast to help identify certain anatomic structures on the scan images. Once the test is underway, the machine will make muffled thumping and clicking sounds as it scans. Other than this noise and the discomfort you may feel for being in the enclosed space, the test is completely painless. Once the test is complete, you can return to your normal activities.

For more information on imaging services available through the Breast Center at Overlook Hospital, call (888) 876-0796. Fatty tissue appears black and breast tissue appears white. But cancer also shows up on the film as white, making it easily missed in breasts with more densely packed tissue. (To determine whether your breasts are dense, ask your doctor to check your mammogram report.)