The Best Defense
In the battle against breast cancer, the Breast Center at Overlook Hospital has emerged as a leader in detection and diagnosis.

First, the good news: More women than ever before are scheduling regular mammograms, the technologies for detecting breast cancer are better than ever, and breast cancer survival rates are inching northward. Now, the interesting paradox: Because women are more vigilant and because technologies have improved, "breast cancers nowadays are smaller and have become more difficult to diagnose," explains Sue Jane Grosso, MD, medical director of the Breast Center at Overlook Hospital. "It's becoming more challenging. To diagnose cancers that are smaller in size, you have to be well trained."

Explained that way, the paradox makes perfect sense—which is why, when it comes to breast health, it's crucial to seek out the very best care. "You want to know you have a place to go to that is proficient in evaluating any kind of abnormality," says Grosso. "Our Center is evolving and emerging as a state-of-the-art premier breast center with the ability to diagnose breast cancer. We're more of a diagnostic center than other breast centers, but we're also here for women who need routine screening. After all, most of the women who visit our Center are healthy, and no abnormality will be found on their mammograms. We developed our Center as the kind of place you can rely on for high-quality imaging and diagnosis, because of our state-of-the-art equipment and outstanding staff. We have experienced, dedicated, and compassionate mammography and ultrasound technologists."

Grosso emphasizes that the Breast Center is both a screening center and a diagnostic center: "Women are very busy," she says, "and we try to accommodate the women in our community by offering screening mammograms on nights and weekends. During the day, we're very busy with diagnostic evaluations. We're procedure-oriented, and perform all different types of image-guided procedures."

Road to Survival

The road to surviving breast cancer begins with detecting breast cancer. "Mammography is still the gold standard," says Grosso. "It's a proven tool for decreasing mortality." At Overlook, mammograms are all digital (in fact, a third digital machine is being added to accommodate patient flow) and are coupled with computer-assisted detection (CAD). CAD acts as an extra set of eyes, flagging for the radiologists such abnormalities as calcium deposits and masses. It is important to note, however, that this computer program is no substitute for a skilled breast imager. All of the radiologists at the Breast Center are Board-certified and experienced in breast imaging. For women who require follow-up imaging after their initial mammogram, there are three ultrasound units operated by dedicated technicians who do only breast ultrasound. Breast MRI also is available.

A Better Biopsy

If your mammogram reveals a potential abnormality and follow-up imaging cannot definitively rule out cancer, a biopsy will be recommended. The Breast Center proceduralists are fellowship-trained breast imagers who are highly skilled to perform minimally invasive, image-guided interventional procedures, including biopsy (the removal of cells or tissues for further examination) and ductography (a special type of contrast-enhanced mammography used for imaging the breast ducts), and the Center has a nurse who monitors and cares for all patients involved in image-guided procedures. Her background in oncology nursing gives her the ability to focus on the emotional and clinical needs of the patient. "If someone tells you that you have something abnormal, how are you, the patient, going to know where to go?" Grosso asks. "You need a high-quality breast center like ours, with experienced staff, state-of-the-art technology, and accessibility. Our radiologists are proceduralists—biopsies are their expertise."

The radiologist determines which form of biopsy is best for each patient, depending on her unique situation. For lesions seen with mammography, the radiologist will use stereotactic biopsy, utilizing a computer to guide the biopsy needle to the area in question. Similarly, ultrasound-guided biopsy is used for lesions seen only by ultrasound, and MRI-guided biopsy is used for lesions detected by MRI. "Whatever modality sees the lesion best, that's what we use," says Grosso. Regardless of which type of biopsy is called for, most are performed with a vacuum-assisted technique to optimize the extraction of cancer cells. "Because of the type of needles we use, we tend to obtain a larger volume of tissue, which allows for a more accurate diagnosis by the pathologist," Grosso says. "The pathologist's interpretation is only as good as the procedure. If I don't do a good job as a proceduralist, the pathologist can't do a good job in diagnosis."

With the arrival of the additional digital mammography machine, the Center anticipates that most biopsies can be performed within a week, if not less. "We don't want patients to wait," says Grosso. "We understand that they're anxious and want a timely diagnosis."

The role of the radiologist does not nd with the biopsy, however. Grosso explains that Breast Center radiologists review every pathology report and confer with the pathologist if needed. "Once the pathology comes back, we correlate to make sure the diagnosis from the biopsy makes sense. We can look at results and make sure they are concordant with what we expect. For most patients who have a biopsy the results are normal, but we usually know which patients will require additional treatment."

The radiologists also are trained to be able to stage cancer, using breast MRI to evaluate the extent of disease. "You need to know who your pathologist is, and you need to know who your radiologist is too," says Grosso, who has been named a Top Doctor by New York magazine. "The radiologist is a very important part of patient care and diagnosis to help to stage disease. Referring physicians and surgeons rely on us to help diagnose patients. We're here to help surgeons and oncologists with patients who have abnormal findings. We use a multidisciplinary team approach to figure out a treatment plan, making sure there is no cancer left behind and making sure the patient gets the right treatment."

Next Steps

Even for patients diagnosed with breast cancer, the relationship with the Breast Center does not end—and Grosso stresses that care is close at hand. "We are connected in every way to the Carol G. Simon Cancer Center at Overlook Hospital," she explains. "Our Breast Center navigator makes sure that a patient doesn't leave here without knowing what to do next. She ensures that patients are connected to the right people. Patients don't have to go anywhere else; it's all here."

Grosso praises the entire Breast Center staff for elevating the level of patient care and the patient experience. "Patient satisfaction is high and continues to rise," she says. "Our patients say we're warm and fuzzy; the people are kind, the robes are soft, the background music is spa-like—every area of what's important has been addressed.

"People seek us out," Grosso continues. "Surgeons seek us out. It's all about taking care of the patient. This might be the day that her life will change, and we want to be there for her."

For more information call 908-522-5762.

The Breast Center at Overlook Hospital

located in the MAC II Building, is a premier screening and diagnostic facility featuring state-of-the-art technologies and an experienced staff in a comfortable, spa-like setting. The Breast Center recently expanded its hours to meet the needs of our community.

Monday-Thursday 8:00am to 8:00pm
Friday and Saturday 8:00am to 4:00pm