Barnabas Health Medical Experts Decode Breast Cancer
Screening & Treatment Options
Long Branch, NJ, September 25, 2014-----There are currently 2.8 million breast cancer survivors in the U.S., according to the American Cancer Society (ACS). Breast cancer fatalities have been in decline since 1989 – around the same time National Breast Cancer Awareness Month was founded, in October 1985 – with larger decreases in death of women under the age of 50.
Breast cancer is still the most common form of cancer among American women and is the second-leading cause of cancer deaths in women, exceeded only by lung cancer. More than 232,000 new cases of invasive breast cancer will be diagnosed in 2014, with about 40,000 women dying of the illness.
During Breast Cancer Awareness Month in October, Barnabas Health focuses on the importance of increasing awareness of the disease and encourages women to take charge of their health. Regular screenings are the best way to detect breast cancer in its early stages, when the prognosis is best, but many women are unclear about when they should be screened, what their screening options are and what the screenings entail. Here, Barnabas Health medical experts weigh-in to set things straight.
Screening & Diagnosis
Mammography, currently the gold standard in breast cancer screening, is a low-dose x-ray procedure that allows visualization of the internal structure of the breast. According to board-certified diagnostic radiologist Jorge Pardes, M.D., director of breast imaging for the Jacqueline M. Wilentz Breast Centers at Monmouth Medical Center in Long Branch, it's Southern Campus in Lakewood, and the Women's Imaging Center at Community Medical Center in Toms River, women should begin mammogram screening at age 40 and receive subsequent mammograms annually. Those at a higher risk for breast cancer – with first-degree relatives who have been impacted by the disease, and/or other risk factors – should discuss their options with their physician.
Typical mammograms are two dimensional – the breast is compressed in two different planes, for a total of two views per breast. While mammography may feel uncomfortable, Dr. Pardes states that it should not be painful. "The technician will compress your breast up to the point where you can tolerate it. The idea is that if you thin out the breast by compression, it's easier to see if anything is hiding there. It also helps to limit patient movement so images are clear, not blurred," says Dr. Pardes.
A newer form of mammography utilizes multiple images to assess the breast. It can be used in a variety of situations, including women receiving a baseline mammography or those who are at high risk for developing the disease. Tomosynthesis, or 3D mammography, takes 15 short exposures, resulting in a volumetric (3D) image.
"Imagine a book – if you take one photo of the book as a whole, you see two planes. If you take several photos of the book as you flip the pages, you get a more comprehensive picture," says Dr. Pardes. "That's how tomosynthesis works – it produces 1 millimeter paper-thin images or 'slices' that allow breast imagers to more easily detect subtle abnormalities."
Women with dense breasts often have difficulty with the reliability of screening with mammography alone. For these women, additional diagnostic tests such as whole breast ultrasound or Breast MRI are sometimes recommended. Another test, called breast specific gamma imaging (BSGI), is an alternative for women who cannot undergo MRI.
As of May 1, a new law in New Jersey requires insurance providers to cover a second screening modality for women with extremely dense breast tissue. It is to be pointed out that the only way to establish the degree of breast density is by mammography.
Dr. Pardes says that radiologists are mandated to classify breast density using four categories when evaluating mammograms. The categories describe the relative proportion of fibroglandular tissue (which is white on mammography) to fat (which is gray on mammography) in the breast.
"When breasts are predominately fatty (or the least dense), mammogram images are fairly simple to interpret. When more glandular tissue is present (or when breast density is higher), mammography images become more difficult to read," says Dr. Pardes. "On a mammogram normal glandular tissue is white, and tumors are also white, making it difficult sometimes to discern between healthy and potentially harmful tissue."
In New Jersey, the new regulations allow women who are classified as having extremely dense breast tissue are eligible to receive another screening modality in addition to a mammogram such as an MRI or a breast ultrasound. At Barnabas Health facilities, ultrasound is the preferred choice for average risk women, while MRI is the preferred choice for high-risk women.
Treatment & Surgery
Today, women have more options than ever if abnormality is detected, many of which are less invasive.
According to Sumy H. Chang, M.D., a fellowship-trained board-certified breast surgeon on staff at Monmouth Medical Center, Monmouth Medical Center Southern Campus and Community Medical Center, women play a role in determining their treatment approach.
"Traditionally, if you had breast cancer, you would have a mastectomy, or removal of the diseased breast. Today, women who are diagnosed with breast cancer in one breast may decide to undergo bi-lateral mastectomies, or removal of both breasts," said Dr. Chang.
While she notes that the decision is a personal one that should be discussed with each woman's physician, Dr. Chang states that recent studies have determined there is no difference in the survival rate of normal-risk women who choose breast conversation surgery, single or bi-lateral mastectomy.
"Many women may think that if they have breast cancer on one side, they should have both breasts removed to increase their chances of avoiding breast cancer down the line," said Dr. Chang. "The theory is misguided, as women who do not have the BRCA genetic mutation that indicates high risk of the disease may not benefit from removing the healthy breast."
In fact, Dr. Chang says the risk-benefit is unclear, "and the risk of complication is something that women need to understand. This is a different story in patients who are BRCA-positive because the risk of eventually developing breast cancer in the other breast is higher."
Those who do undergo single- or bi-lateral mastectomies have more options for reconstruction, including beginning the reconstruction process at the time of surgery. "It's becoming the standard of care," says Dr. Chang. "Again, it's each woman's personal choice, weighed against her individual situation and risk factors."
"We're also doing fewer surgeries because we're removing fewer lymph nodes – innovations and advancements in chemotherapy, radiation and medications are helping lessen the need to surgically remove lymph nodes."
Previously, all lymph nodes were removed if any cancer was detected, increasing the risk of lymphedema, or sever swelling caused by fluid retention. Now, select patients are able to undergo a procedure to have only the diseased (cancerous) lymph node removed if the amount of disease in the lymph nodes is minimal, rather than all the lymph nodes – greatly reducing the patient's risk of developing lymphedema.
While there is no "magic bullet" in terms of preventing breast cancer, women can reduce their risk for developing the disease by not smoking, maintaining a healthy weight, limiting alcohol consumption, and eating a balanced diet – all of which can help aid the recovery process if cancer is detected.
To schedule an appointment at the Jacqueline M. Wilentz Comprehensive Breast Center in Long Branch, or at one of its satellite breast centers in Howell, Lakewood or Colts Neck, please call 732.923.7700. To schedule an appointment at the Women's Imaging Center in Toms River or Whiting, please call 732.557.8150.
For more information about breast health and breast cancer awareness month, please visit the Barnabas Health Pink Crusade website at www.thepinkcrusade.org.
About Barnabas Health
Barnabas Health is the largest not-for-profit integrated health care delivery system in New Jersey and one of the largest in the region, with more than two million patient visits and delivery of more than 20,000 babies annually. The system includes seven acute care hospitals, two children's hospitals, a trauma center, a freestanding behavioral health center, ambulatory care centers, geriatric centers, the state's largest behavioral health network, comprehensive home care and hospice programs, retail pharmacy services, a medical group, multi-site imaging centers and several accountable care organizations. As the second-largest private employer in New Jersey, Barnabas Health includes more than 20,000 employees and over 5,000 physicians – or one-fifth of the actively practicing physicians in New Jersey. For more information, visit www.BarnabasHealth.org.
Contact: Carrie Cristello