Women's Imaging

  • Breast Cancer Facts and Statistics

      1. Estimated Breast Cancer Cases per Year
      180,000
      2. Estimated Breast Cancer Deaths per year
      42,000
      3. Lifetime Risk
      1 in 8
      4. Male Breast Cancer
      1% of all breast cancer is in men
      5. Important Statistics
      30% of all diagnosed cancers are breast
      17% of all cancer deaths are from breast
      Leading cause of death in 40-44 y/o women
      30 million mammograms performed yearly
      66 million screens should be done

  • Importance of Early Detection

      Cancers seen on mammograms 2-3 years before palpable

  • Risk Factors

      1. Gender/Age
      2. Genetics
      3. Family History - especially premenopausal
      4. Personal History/Atypical Biopsy
      5. Race/Ethnicity
      6. Dense Breast Tissue
      7. Minor Risk Factors
      Early menarche/late menopause
      Nulliparous
      Endometrial or pelvic cancer

  • ACR Screening Guidelines

      1. Baseline Mammogram by age 40
      2. Mammogram every year beginning at age 40
      3. Clinical Breast exam every year beginning at age 40
      4. Begin screening 10 years earlier than family member
      diagnosed with breast cancer if less than 40

  • ACR Breast MRI Guidelines

      1. >20% Lifetime Risk - GAIL, CLAUS, Tyrer Cuzick Models
      2. BRCA 1 or BRCA 2 gene
      3. 1st Degree Relative
      4. Radiation to Chest Age 10-30
      5. Li-Fraumeni Syndrome
      6. Cowden Syndrome
      7. Bannyan-Riley-Ruvalacaba Syndrome

  • Means of Detection

      1. Monthly Self Exam
      2. Annual Exam by Physician
      3. Screening Mammography
      4. Diagnostic Mammography
      5. Breast Ultrasound
      6. Breast MRI

  • Signs and Symptoms of Breast Cancer

      New mass or lump
      Swelling of the breast
      Skin irritation or dimpling
      Breast or nipple pain
      Nipple retraction
      Redness, scaliness, or skin thickening
      Nipple discharge - clear or bloody

  • Screening Mammography

      1. Screening Trials
      Gothenburg 1982 -40% reduction in breast cancer in
      women 40-49 y/o
      Malmo Sweden Trial - 31% reduction in breast cancer women
      45-49 y/o
      World Screening Trials
      HIP NY -30% decrease in women >50
      Edinburgh - 20% decrease women >50
      Sweden - 35% decrease women >50
      Canadian - no decrease at any age
      2. Study performed in asymptomatic women to detect breast cancer
      at an earlier stage to decrease breast cancer mortality

  • Diagnostic Mammography

      Study performed in women with signs or symptoms of breast cancer

  • Nuclear Medicine Breast Imaging

      Highly sensitive test that improves specificity of mammography

  • Digital Advantages

      Increased inherent contrast
      Post-processing can be done with no increase in patient radiation dose
      Images easily transmitted and efficiently stored

  • New Technologies

      Tomosynthesis - 3D Mammography

  • Breast Ultrasound

      Focused study to evaluate abnormality
      Initial study for work-up of palpable mass in patient <30
      Used in conjunction with mammography
      Size measurements more accurate
      Interventional procedures

  • Radiation Risks

      Large doses necessary to induce breast cancer
      FDA limits dose to 300 mRad per view
      Only increases lifetime risk of getting breast cancer in 45 y/o
      1 in 100,000

  • Breast Biopsy

      1. Ultrasound guided core needle biopsy
      2. Stereotactic Biopsy
      3. MRI guided core needle biopsy

  • Frequently Asked Clinician Questions

      1. What is the goal of breast cancer screening
      Reduce deaths due to breast cancer by detecting breast cancer
      early, when treatment is more effective and less harmful
      2. What is the chance of diagnosis in females in their 40s
      1 in 69 women will be diagnosed with breast cancer in their 40s
      3. What is the cancer detection rate from a single screening
          mammogram

      40-49 - 1.69 per 1000
      any age - 4.0 per 1000
      4. If cancer is present, will it be detected at screening mammogram
      Depends on breast density - fatty breasts - 85-90%
      Dense breasts - 55-70%
      5. What other tests show early breast cancer
      MRI, Ultrasound, and Nuclear Medicine studies
      6. What are the chances that mammogram will save life of woman
          with breast cancer

      Overall 5 year survival rate of breast cancer is 89% white women
      and 78% black women
      7. What is the benefit of mammography by meta analysis of all
          clinical trials

      No reason was given in the US Task Force recommendations.
      No reason to combine studies, it only diminishes true
      approximation of benefit
      8. What is the expected percentage of women with breast cancer whose
          lives will be saved by mammogram screening

      4 - 46%
      9. Is it necessary for women to undergo screening every year
      To achieve the greatest benefit from mammography, yes!
      10. At what age should a woman stop getting regular mammograms
      The potential benefit to screening mammography is present as long
      as the woman is in good health, expects to live at least 5 - 10 years
      and would seek treatment if a cancer is found
      11. What are the downsides of screening mammography
      For every 1000 women screened, 80-100 will be recalled for
      additional imaging, 45-65% of those patients will have nothing of
      concern, 15 will be recommended to have biopsy and 2-5 will
      be found to have breast cancer
      12. What is involved in breast biopsy
      Simple 15 minute procedure using either ultrasound guidance or
      stereotactic equipment. Very little discomfort. A clip is placed to
      identify area of concern. Resume normal activities same day and
      results are available in 2-3 days
      13. Is there reason to worry that radiation exposure will cause
            breast cancer

      Uses low energy ionizing radiation to create an image
      Slight risk of developing cancer 8 or more years after exposure.
      Overall the risk is 0.8 excess breast cancers per 100,000 patients
      14. What is over diagnosis
      A cancer that would not have progressed within a women’s lifetime
      does not require treatment. Reality is that no one knows which
      ones are indolent vs progressive. Overdiagnosis accounts for a
      very small fraction of breast cancers
      15. Are recommendations to reduce mammogram screening based on
            saving money

      The task force does not specifically consider monetary costs,
      though its recommendations are used to determine insurance
      and Medicare coverage. Overall, however, cutting mammographic
      screening is not fiscally prudent
      16. Should women examine their own breasts
      The US task force recommends against teaching breast self
      examination, but awareness of changes in one’s breasts is
      still important.
      17. Should a woman’s physician examine her breasts
      There are many more false positive exams with clinical breast
      exams as with mammography