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Digital Mammography
Digital Mammography allows for
sharper images, as well as image manipulation after the exam where
contrast can be adjusted and small regions enlarged without loss of
quality. This reduces the number of repeat X-rays, though special views
are still sometimes necessary. From the patient’s standpoint, the
procedure is virtually identical to traditional mammography, but the
exam is shorter, with less radiation exposure. Also, procedures such as
needle localizations are much quicker using digital mammography. A
landmark, multi-institutional study has shown that digital mammograms
detect more cancers in younger woman and woman with dense breast tissue.
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Ultrasound
The usual role of Ultrasound is to serve
as back-up to clinical exam, mammography and, more recently, MRI. When
abnormalities are detected through any of these methods, targeted
ultrasound to the area in question gives further information, helps with
the diagnosis, and may serve as the patient- friendliest from of biopsy,
if needed. Ultrasound can also be used to screen all the breast tissue
in asymptomatic patients, usually younger woman and those with dense
breast tissue, though this role has been eclipsed largely by breast MRI.
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Stereotactic and Ultrasound Mammotome™ Biopsy
Stereotactic and Ultrasound Mammotome™ Biopsy are two ways to determine
if cancer is present in the breast without a surgical biopsy. The
Mammotome™ is a needle device having a larger diameter than the original
core biopsies, allowing for more accurate pathology. In addition, the
needle is introduced only one time (as opposed to the original method of
multiple insertions), then vacuum-assistance allows the tissue to be
removed through this small nick in the skin, all of which is performed
in the office under local anesthesia. The Mammotome™ device can be used
for abnormalities identified on Ultrasound or by Mammography (stereotactic).
Since the introduction of the Mammotome™, there have been many
variations introduced to the market, but they all accomplish the same
thing – more accurate pathology than the original small-diameter core
biopsies or fine needle aspirations. Occasionally, it is still necessary
to perform open surgical biopsies, especially if the Mammotome™ biopsy
results are equivocal and more serious pathology is suspected in the
breast.
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Breast MRI
Breast MRI is a noninvasive procedure
that examines the inside of the breast through hundreds of serial
images, where an injected contrast agent called gadolinium will enhance
a cancer. There is no flattening or compression of the breast during MRI,
and there is no radiation exposure. Regardless of breast density, if
cancer is present, breast MRI will detect it 95-95% of the time in
reported series. This is compared to mammograms, which detect cancer 70%
of the time, depending on breast density, but this number can go below
50% if the breasts are markedly dense on mammography.
Click HERE for
more information on Breast MRI
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Breast MRI-guided Biopsy
Breast MRI-guided Biopsy is
available for the first time through the Aurora™ breast-dedicated MRI,
with FDA approval occurring February 2003. The technical difficulties
encountered in allowing MRI-guided biopsies held back the use of breast
MRI in clinical practice for many years. It is still easier on the
patient (and doctor) to perform biopsies of abnormalities using
ultrasound or X-ray guidance. However, if an abnormality (“area of
enhancement”) appears only on breast MRI and requires biopsy, this can
now be done using the breast-dedicated MRI equipment.
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Risk Assessment Program, Risk Reduction Counseling,
and Genetic Testing
Risk Assessment Program,
Risk Reduction Counseling, and Genetic Testing is available under the
direction of Alan B. Hollingsworth, M.D. Dr. Hollingsworth pioneered risk assessment in the state of
Oklahoma and serves on the National Breast Cancer Risk Assessment
Working Group.
Risk assessment involves multiple mathematical
models that take into account a woman’s entire health history (not just
focusing on a single risk factor), providing an estimate of personal
risk over a defined period of time.
Risk reduction counseling and treatment involves a
discussion of lifestyle changes to reduce risk, consideration of (and
prescribing) medications for chemoprevention, and carely, surgical
prevention through preventive mastectomy and/or removal of the ovaries.
Genetic counseling and testing is a natural product
of risk assessment, though only a minority of women with a family
history for breast cancer will actually prove to have an alteration in
one of the two BRCA genes. If, however, such an abnormality is
discovered, the entire family becomes involved in the process and many
decisions are faced. Click HERE for more information
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High Risk Surveillance Program
High Risk
Surveillance Program was a concept launched in Oklahoma in 1993 when Dr.
Hollingsworth felt that women with risk factors should have the option
of aggressive surveillance with frequent clinical exams and liberal use
of ultrasound to augment mammography. The role of ultrasound has
expanded in this group and, more recently, breast MRI has been added to
the tools that can diagnose those cancers missed by screening
mammography. Dr. Hollingsworth makes recommendations for interval
screening with ultrasound and/or MRI based on a formula derived from the
degree of mammographic density coupled with degree of risk elevation.
However, realizing that the majority of women who develop breast cancer
have NO identifiable risk factors, Dr. Hollingsworth has spent the past
decade trying to facilitate the work of basic scientists who seek a
screening blood test for detecting early breast cancer. “Eventually, it
will be blood-based testing that tells us which women needs breast MRI,”
states Dr. Hollingsworth.
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Sentinel Lymph Node Biopsy
Sentinel Lymph Node
Biopsy is now considered a standard of care in the management of
patients with early breast cancer. A radioactive dye and/or a blue dye
is injected at the tumor site (or beneath the nipple) prior to surgery,
and the dye(s) lets the surgeon know which lymph node or nodes are most
likely to harbor cancer. In this way, the number of lymph nodes removed
from the armpit can be reduced drastically compared to surgery done in
years past if the sentinel node is negative. To our knowledge, Mercy
Health Center is the only Oklahoma hospital to carry out its own
in-house research protocol on Sentinel Node Biopsy. Now that it is
considered “standard of care,” Mercy has credentialing requirements for
surgeons to assure that all breast cancer patients treated at our
hospital have surgeons skilled in this procedure.
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Interdisciplinary Approach
Interdisciplinary Approach is
unique to those breast centers that are associated with hospitals or
cancer centers. Breast diagnostics are intimately linked to
therapeutics. Breast diagnostics involve radiologists, surgeons, and
pathologists. Breast therapeutics involve these same specialties, with
the addition of medical oncology, radiation oncology, and plastic
surgery, as well as support systems. It is difficult to practice quality
breast care in a vacuum – each and every step can impact the other
specialties and can ‘burn bridges’ if not coordinated. The coordination
of seven specialties is a monumental task, to say the least, but Mercy
Women’s Center is dedicated to this approach. Click HERE for more
information
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Blood Testing and other Research Opportunities
Blood
Testing and other Research Opportunities: Now that breast MRI can find
virtually all breast cancers, we are left with a very difficult problem
– MRI is far too expensive to use to screen the general population. And,
if we limit screening to high-risk patients only, we automatically
refuse study on the MAJORITY of women who are going to develop breast
cancer. To that end, Dr. Hollingsworth has been pursuing a blood test to
detect breast cancer at its earliest stage, effectively selecting
patients for breast MRI (if standard imaging is normal), independent of
risk factors. At Mercy, patients undergoing MRI and/or biopsies will
have the opportunity to participate in these research studies (Click
HERE for more information.)
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Bone Densitometry
Bone densitometry may seem out of
place at a breast center, but bone density comes into play (along with
breast cancer risk factors) regularly when making decisions about
hormone replacement therapy or SERMS (selective estrogen receptor
modulators), both of which can improve bone density, but have different
effects on breast cancer risk. Non-hormonal measures for improving bone
density are also important to know.
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