By Karen S. Gorby, RN, MSN, MBA, CENP, FACHE
October is Breast Cancer Awareness Month. One in eight women will receive this diagnosis at some point during their lives, but fortunately, deaths due to breast cancer are going down. The decrease is in large part due to constantly evolving advanced imaging technology.
AMC’s own Regional Radiology Manager, Lori Smith, MBA, RT(R), RDMS, RDCS, RVT, notes that even the COVID-19 pandemic is not a good reason to put off one’s mammogram. “Everyone who comes to us for screening is safe during this time, because we screen all who enter our facility for COVID-19 symptoms, we require universal masking and we’ve adapted how we perform screenings so everyone is protected.”
Smith was diagnosed with breast cancer in early 2019 and is thankfully healthy now, but she notes that her insight into the patient’s perspective changed when she was, as she puts it, “sitting on the other side of the table.” After getting a mammogram, an ultrasound, a biopsy, an MRI and later surgery, her enhanced awareness has changed the way she looks at her daily work. “Even though I don’t deal directly with patients in my role, I feel like I approach it with more empathy now, and that my experience allows me to bring deeper insight when collaborating with my colleagues,” Smith says.
Scott M. Petty, MD, Medical Director of Radiology at Angel Medical Center and Highlands-Cashiers Hospital, explains that 3D mammography, also called diagnostic breast tomography, or DBT, enables the radiologist to look at thin slices of the breast tissue, not just the entire breast in one image. “In the same way that chest CT and abdominal CT examinations allow radiologists to see the internal structures of a patient with much greater detail than regular chest or abdominal X-rays, DBT allows the radiologist to detect breast cancers when they are smaller and less advanced, which results in earlier and more successful treatment of breast cancer,” he explains. “DBT also reduces ‘call backs,’ which occur when patients are asked to return for additional views of the breast when potential abnormalities are detected.”
Dr. Petty adds that DBT is helpful for all mammograms, but is especially helpful for imaging women with “dense” breasts. “The breast is primarily composed of glandular elements for milk production and fat. Fat is very radio-lucent, meaning that X-rays easily penetrate fat and that fat looks dark on X-rays such as mammograms. Glandular breast tissue is radio-dense, meaning that X-rays have a much harder time penetrating glandular tissue and that this tissue looks bright on X-rays such as mammograms,” he shares. He adds that most breast cancers are radio-dense, and that in a breast with mostly fatty tissue, the radio-dense cancer is easier to detect against a dark background of fatty tissue. In a breast with mostly dense tissue, radio-dense cancers are more difficult to detect, as they tend to blend in with — and are obscured by — the denser glandular tissue.
“Another confounding factor,” notes Dr. Petty, “is that women with dense breasts are more likely to develop breast cancer than women with more fatty breasts. So, the women most likely to develop breast cancer tend to have the most difficult breast tissue to image with mammography. DBT, by creating thin image ‘slices’ of the breast, effectively removes a lot of the overlapping dense tissue from the image, which increases the rate of detection of small breast cancers, especially in women with dense breast tissue.”
Ultrasound imaging of the breast is the other primary tool of radiologists for evaluating breast abnormalities and detecting breast cancers. Dr. Petty relates that ultrasound uses ultra-high frequency sound waves, well above the frequency detectable by human hearing, to create images of the breast and other body tissues. “Ultrasound can be used as the primary tool of the mammographer,” he says, “but it is usually used, when necessary, after mammography has been performed. Ultrasound of the breast allows the radiologist to better characterize abnormalities seen on the mammogram. It also allows the radiologist to detect masses that are felt by the patient or physician, but cannot be visualized on the mammogram.” Both Angel Medical Center and Highlands-Cashiers Hospital offer the latest and most advanced breast ultrasound services.
Dr. Petty lists other diagnostic technologies that are available in the Mission/HCA Healthcare system, which include automated breast ultrasound (ABUS), contrast enhanced digital mammography (CEM or CEDM) and breast MRI. “These newer technologies are typically used when additional characterization of breast abnormalities is needed and are not, at least at this time, primary ‘frontline’ tools for detection of breast cancer,” he says. “They are invaluable, however, when DBT and breast ultrasound are unable to fully define a breast abnormality.”
Our staff members’ caring and expertise, combined with this impressive advanced technology, allow AMC to provide the best in preventive and diagnostic care for the women of our community.
In closing, I want to remind you to stay safe. COVID-19 continues to be present, and it is important that we continue to practice social distancing, wearing a mask and washing our hands.
Karen S. Gorby, RN, MSN, MBA, CENP, FACHE, is Chief Executive Officer and Chief Nursing Officer of Angel Medical Center.