How can I make an appointment with Dr. Myers at Texoma Breast Care?
Yes, all you need to do is call for an appointment between 8:30am - 5:30pm, Monday through Thursday or 8:30am to 2pm on Fridays. However, if you do not have a physician referral, Dr. Myers will be noted as your primary breast physician and recommend treatment accordingly.
Can I have a mammogram taken care of at Texoma Breast Care?
No, Dr. Myers no longer does breast imaging. The Breast Center of Texoma imaging is now with Solis Mammography Wichita Falls in the suite adjacent to Texoma Breast Care.
Mammography is the best screening test to find an early breast cancer. If you prefer an appointment for mammography with Solis Mammography Wichita Falls, an appointment can be made at 866-717-2551or www.solismammo.com.
Mayo Clinic Video on Mammography:
What other services do you offer?
We offer breast specific molecular imaging in conjunction with Kell West Regional Hospital at Texoma Breast Care and Breast MRI in conjunction with KWRH at KWRH. However, the greatest service we offer patients seen in the Breast Center is a complete coordination of care from scheduling through diagnosis.
When is a mammogram not enough?
Dense breast tissue presents a challenge in breast cancer evaluation. While mammography is the best screening tool, it can only see 80-85% of early cancers. Some dense breast abnormalities can only be palpated on an physical examination while others can only be seen by other tests as ultrasonography, MRI, BSMI and biopsy.
How is a needle aspirate or needle core biopsy helpful?
A needle aspirate or needle core biopsy can be a very useful tool in diagnosing early cancers as well as preventing unnecessary surgery in others. The aspirate is slightly less accurate of the two. It evaluates a smear of cells while the core evaluates an actual block of tissue. Both can be performed on abnormalities found by the physician exam, mammogram or ultrasound, and all can be done at Texoma Breast Care with Dr. Myers. Even as accurate as they may be, they are not 100% diagnostic. Only an excisional biopsy (removing the entire abnormality) is considered 100% accurate.
What is the benefit of stereotactic imaging?
With stereotactic imaging you can localize, pinpoint and biopsy abnormalities as small as a few millimeters. By stereotactically localizing a mammographic abnormality, the lesion can either be core biopsied at the time of the stereo or pinpointed for a complete surgical excision.
Who gets breast cancer and can I prevent it?
All women are at risk for breast cancer. Known risk factors like having a family history of breast cancer, starting menopause after age 55 or never having children account for only a small number of new cases. That means that most women who get breast cancer have no known risk factors except for getting older. There is no prevention to breast cancer, but there are steps that can be taken to make developing breast cancer less likely: eating healthy, exercising regularly, and limiting alcohol intake. For women at higher risk, antiestrogen treatment can also help reduce the risk of developing breast cancer.
Does a family history mean I will get breast cancer?
Not necessarily. Just because other family members have had breast cancer does not mean that their disease was inherited. Some breast cancers are inherited from your parents but only 5-10% of all cancers happen because of inherited mutations.
If I get breast cancer, what are my chances of surviving?
In general, pretty good. The 5-year survival rate for all women diagnosed with breast cancer is 85%. Your chances are better if you are diagnosed early. In fact, when breast cancer is confined to the breast, the 5 year survival rate is over 95%. This is why it is important to take steps to detect breast cancer in its earliest stage.
What types of surgeries are done for breast cancer?
There are two main types of surgeries done for breast cancer: breast conserving surgery (lumpectomy) and mastectomy. Lumpectomy removes the breast cancer only and mastectomy the whole breast. Both operations require surgical evaluation of the lymph nodes under the arm, may require radiation and may require some form of chemotherapy. Especially when diagnosed early, most ladies have the option of breast conserving surgery. ( For more details see Articles: Breast Cancer Surgery and Reconstruction - Overview)
What is the significance of a breast lump?
Most breast lumps are benign - especially in the younger lady. Fibrocystic change is a very common problem creating a lumpiness texture and is commonly associated with hormonal changes. Other benign breast lumps are cysts (fluid filled sacs usually in ladies over the age of 30 and rarely cancer) and fibroadenomas (solid lumps common in teens and younger women). Fibrocystic changes do not increase a woman’s risk for developing breast cancer - it may simply make it harder to detect an early one. However, the likelihood of a solid lump being cancer increases as a woman ages, so if you think you have a lump, a vist to your physician or Breast Center is the next immediate step.
Do men get breast cancer?
Yes, but breast cancer in men is uncommon. The overall ratio of female to male breast cancer in the U.S. is 100:1. Although it sounds like a small number, that is still roughly 1,500 men who will be diagnosed, and 400 who will die of the disease yearly. The treatment for male breast cancer is the same surgically and medically as that of a woman. A benign condition called gynecomastia is the male counterpart to the female fibrocystic change. It is usually hormonal or medicine related, self limited, and creates a benign lump that must be differentiated from cancer.
What is chemotherapy?
Chemotherapy is the use of anti-cancer drugs to treat cancer. If it is given after surgery it is called adjuvant chemotherapy or before surgery, neoadjuvant. It is given to reduce the risk of the cancer returning. There are many different drugs used today. Some drugs work better in combination than alone, so your doctor may give you more than one to take. Some drugs are given by mouth and some IM or IV. Chemotherapy is usually offered in some form to almost all ladies with breast cancer. Chemotherapy usually starts within 4-6 weeks after surgery and is commonly given on a 21 or 28 day cycle. The length will vary, but typically lasts form 4 to 6 months. Some common side effects are nausea and vomiting (controlled with meds), hair loss (grows back after Rx concludes), early menopause (maybe permanent), and fatigue (helped with a good diet and exercise).Chemotherapy is the reason breast cancer 5 year survival has made such positive strides in recent years.
Why radiation therapy?
Radiation therapy is the use of high-energy rays, usually x-rays, to kill cancer cells. Radiation is very effective in killing fast growing cells like breast cancer. Some healthy cells are also damaged during the radiation, but these can recover. Radiation reduces the chance of the cancer returning. For example, women who have had a lumpectomy without radiation have as much as a 40% chance of recurrence while those with radiation have only a 10% chance. Radiation is almost always recommended for patients following lumpectomy and occasional for those following mastectomy. Side effects include skin irritation and reddness to the area (like a sunburn and rarely significant burns), breast swelling and soreness (usually resolves after Rx but can be long term), fatigue (usually minimal and self-limiting), and lymphedema (swelling of the arm or hand increases if the axilla is treated). Not wanting radiation is the number one reason ladies in my practice who are lumpectomy candidates choose mastectomy.
What are lymph nodes?
Lymph nodes are part of the lymphatic system which carries waste products and other materials away from the cells in your body. Lymph nodes filter this material before it returns to the blood stream. They also store WBCs (lymphocytes) and help fight infection. The nodes under your arm are called axillary nodes and are important in determining the breast cancer stage and spread. If cancer cells are present in the axillary nodes there is a higher chance that the cancer may have spread. This is an important consideration in determining further medical management of the cancer.
What is my risk of getting breast cancer?
The chance of a woman getting breast cancer increases with age. For a woman born today, her risk
by age 30: 1 out of 2,000,
by age 40: 1 out of 233,
by age 50: 1 out of 53,
by age 60: 1 out of 22,
by age 70: 1 out of 13,
by age 80: 1 out of 9.,
ever: 1 out of 8.
Factors you can control: having more than one drink a day, being overweight after menopause, taking BCP longer that 5 years, taking HRT more than 10 years, or being exposed to large amounts of radiation.
Factors you cannot control: getting older, a personal history of breast cancer, a biopsy showing atypical hyperplasia or DCIS, < 12yrs at
What are the types of breast cancer?
Most breast cancers occur in the milk ducts that carry milk to the nipple, called ductal carcinoma. A second, but less common occurs in the lobules where milk is made, called lobular carcinoma. Much less common are Paget\'s, medullary, mucinous, and tubular. Surgical and chemotherapy treatment regimens for ductal and lobular carcinoma are the same with the same mortality rates. The main difference between the two is that lobular has more of a tendency to occur bilaterally.
Breast cancers are classified as insitu (contained in the duct or lobule) or invasive (spread outside the duct or lobule into the surrounding breast tissue). Insitu is precancerous and has no metastatic (spread to distant organs) potential. Invasive describes a true breast cancer with metastatic potential. Regional spread denotes spread to local lymph nodes and distant spread denotes spread to other body parts.
What is a prophylactic mastectomy?
A prophylactic mastectomy (also called a preventive mastectomy) reduces a woman’s chances of developing breast cancer by surgically removing her breasts even before cancer is discovered. Women sometimes choose this for the following reasons: she has had
See under Articles: Prophylactic Mastectomy: An option for breast cancer prevention
Why do I need an infusaport for chemotherapy?
One of the most difficult things about chemotherapy is accessing a vein to inject the drug. The drugs are caustic to the veins and this in itself can make each treatment traumatic. An infusaport prevents this anxiety by creating an easy access for the injection. The device sits just under the skin on the upper chest wall by the shoulder and can easily be accessed for the treatments. It is placed in as an outpatient and when the chemo treatments are completed, it can easily be removed. Ports are recommended on almost all patients getting IV chemotherapy. (see Articles: Infusaport - Long Term IV Access for more details)
What is gene testing and do I need to do it?
A woman with a significant family history of breast and/or ovarian cancer has a higher risk of getting these cancers. You have a significant family history if:
•You have two or more close family members who have had breast and/or ovarian cancer, and/or
•The breast cancer in the family members has been found before the age of 50.
Talk with your doctor or other health care professional trained in genetics about your family history. He or she can help you know if you have a significant family history of breast and/or ovarian cancer. This information may help you learn about your cancer risk and help you decide if genetic testing is right for you.
Sometimes genes do not function properly because there is a mistake in them. If a gene has a mistake, it is said to be mutated or altered. When a gene with a mistake is passed along in family members, it is called an inherited altered gene. All people have altered forms of some genes. Certain altered genes can increase your risk of illnesses such as cancer. Gene alterations have been found in many families with a history of breast cancer. Some women in these families have also had ovarian cancer.These alterations are most often found in genes named BRCA1 and BRCA2 (BReast CAncer Gene 1 and BReast CAncer Gene 2). Both men and women have BRCA1 and BRCA2 genes, so alterations in these genes can be passed down from either the mother or the father. More genes like these may be discovered in the future. A woman with a BRCA1 or BRCA2 alteration is at higher risk for developing breast, ovarian, and other cancers than a woman without an alteration. However, not every woman who has an altered BRCA1 or BRCA2 gene will get cancer, because genes are not the only factor that affects cancer risk.Most cases of breast cancer do not involve altered genes that are inherited. At most, about 1 in 10 breast cancer cases can be explained by inherited alterations in BRCA1 and 2 genes.
(see Articles : Genetic Testing in Breast Cancer for more detailed information)
What is the significance of breast tenderness?
Breast tenderness is one of the most common complaints seen in the breast center. There are several names for diffuse breast tenderness: fibrocystic changes, mastodynia, and mastalgia to name a few. It is usually diffuse but may be localized and is most prevalent in the upper outer breasts. It is most often related to hormones or hormonal changes. It can be related to medications but less so than hormonal swings. It is commonly seen in pregnancy, during menstruation, during breast feeding and at the onset of menopause. It is uncommonly associated with breast cancer but when so maybe associated with an aggressive inflammatory breast carcinoma. It is usually self limited and can be treated with anti-inflammatories, caffeine and chocolate cessation, changing the exogenous hormonal status, eating a high fiber diet low in fat, and/or taking Vit. E (with the understanding of the possible adverse cardiac effects). Sometimes a biopsy is needed to relieve a painful nodule, but mostly this is a fibrocystic variant that can be followed.
What is the significance of a nipple discharge?
Nipple discharges that are non bloody, non palpable and not seen by either mammography or by ultrasound are uncommonly of significance unless they are a nuisance by messing up clothing. Most cancers that involve the nipple ducts are bloody, palpable and/or imaged via mammography or by ultrasound. The greenish and yellowish dischages are usually associated with retroareolar cysts or hyperplastic ducts and can usually be followed. Bloody discharges are almost always biopsied to rule out an underlying cancer or papilloma even if the palpable and imaging exams are otherwise normal. Milky discharges may proceed to a galactorrhea evaluation to rule out a prolactin secreting tumor. A crusting nipple with or without discharge may need to be evaluated and biopsied for Paget\'s disease. The definitive diagnosis of a suspicious discharge is made by a biopsy of the retroareolar ducts. Nipple discharge cytology may be of benefit in the early investigation but is never definitive.
Breast reconstruction - what are my options?
Breast reconstruction is a definite possibility following mastectomy. It is commonly started at the same time of the mastectomy especially when the surgery is done for DCIS, small cancers, and other benign lesions. It is possible with any mastectomy and needs to be discussed with your surgeon prior to beginning the cancer treatment process. It is usually done as a combined procedure with the breast cancer surgeon and a plastic reconstructive surgeon. (For more details see Breast Cancer Treatment and Reconstruction - Overview under Articles.
Osteoporosis - what is it and who does it effect?
Osteoporosis is a disease in which bones become fragile and more likely to break. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones, also known as fractures, occur typically in the hip, spine, and wrist.
Any bone can be affected, but of special concern are fractures of the hip and spine. A hip fracture almost always requires hospitalization and major surgery. It can impair a person\'s ability to walk unassisted and may cause prolonged or permanent disability or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity.
Millions of Americans are at risk. While women are four times more likely than men to develop the disease, men also suffer from osteoporosis.
Osteoporosis - how do I find a calcium supplement that is right for me?
Many people consume all the calcium they need from their diet, but others rely on a combination of calcium-rich foods and calcium supplements or on supplements alone to meet their daily needs. There are many supplements from which to choose, allowing each person to find the one that is easiest for her/him to use. Calcium supplements are available as pills, capsules, chewable tablets, chewable candies, powders and tablets that dissolve in water.
In nature, calcium is found only in combination with another substance, such as carbonate, citrate or gluconate. These combinations, or compounds, form calcium “salts” that vary in the amount of actual (elemental) calcium they contain. For example, calcium carbonate is 40 percent elemental calcium and calcium citrate contains 20 percent elemental calcium.
If a tablet contains 1250 mg of calcium carbonate, it contains 500 mg of elemental calcium (40 percent of 1250 = 500 mg).
An easier way to figure out how much calcium each preparation contains is to look at the label and find the heading titled, “percent daily value.” If the percent daily value is 20, add a ‘0’ to the 20. Taking the recommended number of tablets will provide 200 mg of elemental calcium.
If the percent daily value is 40, add a ‘0’ to the 40. The recommended number of tablets will provide 400 mg of elemental calcium.
If the percent daily value is 50, add a ‘0’ to the 50. The recommended number of tablets will provide 500 mg of elemental calcium.
Suggestions for choosing a supplement that is right for you:
1.Determine your daily calcium intake from foods.
2.If calcium intake is around 1200 mg a day, keep up the good work. If additional calcium is needed from a supplement, determine which supplement provides closest to the amount needed. (One that provides 200 mg, 400 mg, or 500 mg per pill)
3.Decide the form of calcium that will be easiest for you to take.
4.You now know how much calcium you need and the form you would prefer. Choose a recognized brand name or check with the pharmacist in a local store.
5.Calcium is easier to absorb when it is consumed in small doses throughout the day. Think about dividing your calcium intake between breakfast and dinner or bedtime. Most calcium supplements, with the exception of calcium citrates, are better absorbed if taken with food.
6.Remember, calcium alone does not protect your bones. Vitamin D (400-800 IU/day) is necessary for calcium absorption, but the vitamin D does not have to be included with the calcium. Many people take a daily multivitamin that provides 400 IU of vitamin D. Other sources of vitamin D include fortified foods, fatty fish and skin production with sun exposure. Exercise also plays an important role in lifelong bone health.
Osteoporosis - who is at risk?
There are many factors that determine who will develop osteoporosis. The first step in prevention is to determine whether you are at
Age. The older you are, the greater your risk of osteoporosis. Your bones become weaker and less dense as you age.
Gender. Your chances of developing osteoporosis are greater if you are a woman. Women have less bone tissue and lose bone more rapidly than men because of the changes involved in menopause.
Family History and Personal History of Fractures as an Adult. Susceptibility to fracture may be, in part, hereditary. Young women whose mothers have a history of vertebral fractures also seem to have reduced bone mass. A personal history of a fracture as an adult also increases your fracture risk.
Race. Caucasian and Asian women are more likely to develop osteoporosis. However, African American and Hispanic women are at significant risk for developing the disease.
Bone Structure and Body Weight. Small-boned and thin women (under 127 pounds) are at greater risk.
Menopause/Menstrual History. Normal or early menopause (brought about naturally or because of surgery) increases your risk of developing osteoporosis. In addition, women who stop menstruating before menopause because of conditions such as anorexia or bulimia, or because of excessive physical exercise, may also lose bone tissue and develop osteoporosis.
Lifestyle. Current cigarette smoking, drinking too much alcohol, consuming an inadequate amount of calcium or getting little or no weight-bearing exercise, increases your chances of developing osteoporosis.
Medications/Chronic Diseases. A significant and often overlooked risk factor in the development of osteoporosis is the use of certain medications to treat chronic medical conditions. Medications to treat disorders such as rheumatoid arthritis, endocrine disorders (i.e. an under-active thyroid), seizure disorders and gastrointestinal diseases may have side effects that can damage bone and lead to osteoporosis.
One class of drugs that has particularly damaging effects on the skeleton is glucocorticoids. The following drugs also can cause bone loss:
•excessive thyroid hormones
•antacids containing aluminum
•gonadotropin releasing hormones (GnRH) used for treatment of endometriosis
•methotrexate for cancer treatment
•cyclosporine A, an immunosuppressive drug
•cholestyramine, taken to control blood cholesterol levels.
For many people, these are life-saving or life-enhancing drugs, and their use may be the only way to achieve a better quality of life. That\'s why it is important to discuss the use of these medications with your physician and not stop or alter your medication dose on your own.
It is important to take action now to find out your risk for developing osteoporosis. Your doctor can help you determine whether you should have a BMD test Your doctor may order a BMD test for:
•all postmenopausal women under age 65 who have one or more additional risk factors for osteoporosis (in addition to being postmenopausal and female)
•all women age 65 and older regardless of additional risk factors
•postmenopausal women who present with fractures (to confirm
•women who are considering therapy for osteoporosis if BMD testing would facilitate the decision.
Osteoporosis - what is BMD and DEXA, and can the BCOT test me for osterporosis?
Bone Mineral Density
A bone mineral density (BMD) test measures the mineral density (such as calcium) in your bones using a special x-ray, CT scan, or ultrasound. From this information, an estimate of the strength of your bones can be made.
Calcium is constantly being added to and taken away from bone. When calcium is taken away faster than it is added, the bones become lighter, less dense, and more porous. This makes the bones weaker and increases their risk of fracture.
Loss of bone mass occurs as part of the natural process of aging. Bones naturally become thinner (called osteopenia) as you grow older, because existing bone is broken down faster than new bone is made. As this occurs, the bones lose minerals, heaviness (mass), and structure, making them weaker. With further bone loss, osteopenia develops into osteoporosis. The thicker your bones are, the longer it takes to develop osteoporosis. Although osteoporosis can occur in men, it is most common in women older than age 65.
Regular X-rays cannot detect mild bone loss. A bone must lose at least a quarter of its weight before a regular X-ray can detect the problem.
Controversy exists over which bones are best to use for BMD measurements. The bones most commonly used are those in the lower spine and hip These bones generally have the greatest amount of bone loss and are at the highest risk of fracture. In special cases, bones in the wrist may be used. Ultrasound testing is done on the bone in the heel.
If your bone density is lower than normal, you can take steps to increase your bone strength and reduce your risk of fracture. Some ways to increase bone density and strength include taking calcium and vitamin D supplements, doing weight-bearing exercise (such as walking), weight training (such as lifting weights or using weight machines), and using medications such as calcitonin (Miacalcin), alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), teriparatide (Forteo), or hormone replacement therapy (usually for women past menopause).
Several different techniques can be used to measure BMD. DEXA is utilized to measure your bone density of the hip and lumbar spine, and is a common modality used to test.
•Dual-energy X-ray absorptiometry (DEXA). DEXA uses two different X-ray beams to estimate bone density in your spine and hip. The amounts of each X-ray beam that are blocked by bone and soft tissue are compared to each other. Bones with higher mineral density allow less of the X-ray beam to pass through them. DEXA is the most accurate method for measuring BMD. DEXA can measure as little as 2% of bone loss per year. It is fast and uses very low doses of radiation but is more expensive than ultrasound testing. Single-energy X-ray absorptiometry (SXA) may be used to measure heel and forearm bone density, but SXA is not as commonly used as DEXA.
•Peripheral dual-energy X-ray absorptiometry (P-DEXA). P-DEXA is a modification of the DEXA technique. It measures the density of bones in your limbs, such as your wrist—it cannot measure the density of the bones most likely to fracture (the hip and spine). If hip or spinal bone density is measured, peripheral measurement is not needed. P-DEXA machines are portable units that can be used in a doctor\'s office. P-DEXA also uses very low doses of radiation, and the results are faster than conventional DEXA measurements. P-DEXA has limited usefulness (compared to DEXA) for monitoring the effect of medication used to treat osteoporosis.
•Ultrasound. Ultrasound is generally used as an initial screening test. If results from an ultrasound test indicate that bone density is low, DEXA is recommended to confirm the results. Ultrasound uses sound waves to determine BMD, usually in your heel. Some machines pass the sound waves through air and some pass them through
What are the different types of chemotherapy drugs used for breast cancer treatment?
As each person\'s individual medical profile and diagnosis is different, so is his/her reaction to treatment. Side effects may be severe, mild, or absent. Be sure to discuss with your cancer care team any/all possible side effects of treatment before the treatment begins. Most side effects disappear once treatment is stopped. The following are common chemotherapeutic drugs usued to treat breast cancer.
Doxorubicin (Adriamycin) is an intravenous medication. Doxorubicin is red in color, and it turns urine red for several hours following treatment. Women who receive doxorubicin often experience mouth sores and hair loss. This drug is most often given with cyclophosphamide. This drug combination is referred to as “AC.” Four to six cycles of treatment over three to six months are commonly administered for breast cancer.
Cyclophosphamide (Cytoxan) is an anticancer drug that can be given either intravenously or orally in tablet form. The intravenous drug is clear. Cyclophosphamide can cause irritation of the lining of the urinary bladder and often nausea and vomiting. This drug is most often given with doxorubicin. This drug combination is referred to as “AC.” Four to six cycles of treatment over three to six months are commonly administered for breast cancer.
•methotrexate (Folex, Mexate, Amethopterin)
Methotrexate is an anticancer drug that is usually given intravenously for women with breast cancer. The drug is yellow in color. Some women who receive methotrexate experience mouth sores following treatment. This drug is most often given with both cyclophosphamide and fluouracil. This drug combination is referred to as “CMF.” Four to six cycles of treatment over three to six months are commonly given for breast cancer.
Fluorouracil (5FU) is an anticancer drug that is given intravenously. The intravenous drug is clear. For some women, fluorouracil can cause mouth sores and diarrhea. This drug is most often given with both cyclophosphamide and methotrexate. This drug combination is referred to as “CMF.” Four to six cycles of treatment over three to six months are commonly given for breast cancer.
Ellence is a new drug similar to doxorubicin and is given intravenously.
•paclitaxel (Taxol®), docetaxel (Taxotere®), paclitaxel (Abraxane™)
These drugs belong to a group of drugs called taxanes. Taxol has been approved for treating early and advanced breast cancer. Taxotere has been approved for treatment of locally advanced or metastatic breast cancer. Abraxane is approved for use in advanced or recurrent breast cancer. Abraxane is a new formulation of paclitaxel that can be given over thirty minutes as opposed to three hours for Taxol and there is less likelihood of an adverse reaction to the drug.
•Xeloda is an oral chemotherapy that is converted into fluorouracil at the cellular level and is sometimes used for advanced cancer.
An antimetabolite used in treating advanced breast cancer.
•Navelbine is sometimes used to treat advanced breast cancer.
What is Inflammatory Breast Cancer?
Inflammatory breast cancer is a rare but very aggressive type of breast cancer in which the cancer cells block the lymph vessels in the skin of the breast. This type of breast cancer is called “inflammatory” because the breast often looks swollen and red, or “inflamed.” IBC accounts for 1 to 5 percent of all breast cancer cases in the United States. It tends to be diagnosed in younger women compared to non-IBC breast cancer. It occurs more frequently and at a younger age in African Americans than in Whites. Like other types of breast cancer, IBC can occur in men, but usually at an older age than in women. Some studies have shown an association between family history of breast cancer and IBC, but more studies are needed to draw firm conclusions.
Symptoms of IBC may include redness, swelling, and warmth in the breast, often without a distinct lump in the breast. The redness and warmth are caused by cancer cells blocking the lymph vessels in the skin. The skin of the breast may also appear pink, reddish purple, or bruised. The skin may also have ridges or appear pitted, like the skin of an orange (called peau d orange), which is caused by a buildup of fluid and edema (swelling) in the breast. Diagnosis of IBC is based primarily on the results of a doctor’s clinical examination . Biopsy, mammogram, and breast ultrasound are used to confirm the diagnosis. Treatment consisting of chemotherapy, targeted therapy, surgery, radiation therapy, and hormonal therapy is used to treat IBC. Prognosis describes the likely course and outcome of a disease—that is, the chance that a patient will recover or have a recurrence. IBC is more likely to have metastasized (spread to other areas of the body) at the time of diagnosis than non-IBC cases.
Another good overview from the Mayo Clinic website:
What role do hormones play in breast cancer treatment?
Hormone receptors are like ears or antennae on a cell. Estrogen sends signals through the receptors that tell breast cancer cells to grow. Cells with estrogen receptors grow and multiply when estrogen attaches to the receptors.After a breast cancer is removed, the cancer cells are tested to see if they have hormone receptors. If either estrogen or progesterone receptors are present, a response to hormonal therapy is very possible. The more estrogen or progesterone receptors present on those cells, the more likely that hormonal therapy will work against the particular cancer. If high levels of both estrogen and progesterone receptors are present, an even greater response to hormonal therapy is likely.
The other name for hormonal therapy is \"anti-estrogen therapy.\" The goal of therapy is to starve the breast cancer cells of the hormone they thrive on, which is estrogen.
What percentage of breast cancers have hormone receptors?
•About 75% of breast cancers are estrogen-receptor-positive (\"ER-positive\" or \"ER+\").
•About 65% of ER-positive breast cancers are also progesterone-receptor-positive (\"PR-positive\" or \"PR+\").
•About 25% of breast cancers are ER-negative (\"ER–\") and PR-negative (\"PR–\") or of \"unknown\" status.
•About 10% of breast cancers are ER-positive and PR-negative.
•About 5% of breast cancers are ER-negative and PR-positive.
•If cells have receptors for both hormones OR receptors for one of the two hormones, the cancer is consider hormone-receptor-positive.
•In this context, \"positive\" means that a significant number of cancer cells have receptors in them. \"Negative\" means that the cells do not have significant numbers of receptors.
The definition of \"significant\" varies from one hospital or testing center to another. If 5–10% or more of the cells have hormone receptors, that\'s usually reported as a positive result. But if a report says \"negative\" or \"borderline,\" it\'s still important to look at HOW positive the level is. For example, the laboratory may label a 5% level of being positive for hormone receptors as \"negative,\" but even cancers at that level may have a good response to hormonal therapy.
Sometimes, a report will come back from the laboratory saying that the hormone status is \"unknown.\" This may mean one of several things:
•The test was never ordered or done.
•The sample of tissue that the laboratory received was too small to get reliable results.
•Few estrogen and progesterone receptors were present.
•If there are no hormone receptors present, or they cannot be measured or seen, or the status is \"unknown,\" the cancer is called hormone-receptor-negative.
How do the hormones work?
Estrogen and progesterone travel through the bloodstream and find their matching receptor sites on both healthy cells and cancer cells. Receptors are very specialized protein molecules that sit on the outside or inside of the cells in your body. They act like an on–off switch for a particular activity in the cell. If the right substance comes along that fits into the receptor—like a key fitting into a lock—the switch is turned on and a particular activity in the cell begins.
Many breast cancers are hormone-dependent—which means that estrogen and progesterone stimulate their growth by \"turning on\" hormone receptors in the cancer cells. Without these hormones, the cancer cells are not stimulated to grow. They wither, and eventually they may die.
Estrogen and progesterone play roles in the development of certain breast cancers:
•Estrogen is a very important \"key\" for the estrogen-receptor (ER) sites throughout the body AND on some breast cancer cells
•Progesterone receptors (PR) can also be involved in turning on breast cancer cell growth
•When a cancer shows few or no estrogen receptors (when it is \"ER-negative,\") hormonal therapy is usually not effective. But if there ARE progesterone receptors, hormonal therapy may sometimes be helpful anyway. Women whose cancers are PR-positive but ER-negative have about a 10% chance of responding to hormonal therapy. If you have an ER-negative breast cancer, you and your doctor should discuss whether the possible benefits of hormonal therapy are worth exploring for YOU.
•How will you respond to hormonal therapy?
If hormone receptors are present in your breast cancer cells, you will probably have a good response to hormonal therapy. The more receptors, the better your response:
◦If both estrogen and progesterone receptors are present (ER+/PR+), your chance of responding to hormonal therapy is about 70%.
◦If you are estrogen-receptor-positive only (ER+/PR–) OR progesterone-receptor-positive only (ER–/PR+), you have about a 33% chance of responding.
◦If the receptor status is unknown, there is about an overall 10% chance of responding.
•Estrogen has many different functions, including helping you develop dense, strong bones. It\'s good to have strong bones (and other good things that estrogen helps to provide, like lower cholesterol and a sense of well-being), but it\'s best not to have the breast-cell growth stimulation that goes along with the higher estrogen levels.
Some studies have shown that elderly women with high bone mineral density (strong bones) have an increased risk of breast cancer, particularly advanced cancer. This has led to rumors about dense breasts and dense bones causing breast cancer. But it\'s not the extra thickness of the breasts or the thickness of the bones that causes an increased risk of breast cancer. Relatively high estrogen levels in the body probably produce all three things: denser breasts, stronger bones, AND a higher risk of breast cancer.
Can nipple crusting or irritation be a significant problem?
Nipple changes can be the first signs of an underlying breast cancer. Sometimes nipple abnormalities can be due to problem called Paget\' disease.
Paget’s disease of the breast is an eczema-like change in the skin of the nipple, and 9 out of 10 women who have this have an underlying breast cancer. The underlying breast cancer may be an invasive breast cancer or ductal carcimnoma in situ (DCIS). In DCIS, the cancer cells are completely contained within the milk ducts.
Around half of the women who have Paget’s disease will have a breast lump that can be felt at the time it is diagnosed.
Paget’s disease occurs in about 1–2 out of every 100 women with breast cancer. It usually occurs in women in their 50s, but can occur at an earlier or later age. It can affect men but this is extremely rare. It usually first appears as a scaly, red rash affecting the nipple and sometimes the dark area of skin surrounding the nipple (the areola). The rash always affects the nipple first, and may then affect the areola. It does not go away and may become sore. The area may bleed slightly.
(For more details about Paget\'s disease see Articles: Paget\'s Disease)
Stages and grades of breast cancer - what do they mean?
Staging and grading
Staging of breast cancer
The stage of a cancer describes its size and whether it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps the doctors to decide on the most appropriate treatment.
In some people, cancer can spread to other parts of the body, either in the blood stream or through the lymphatic system. The lymphatic system is part of the body’s defences against infection and disease. The system is made up of a network of lymph glands, or nodes, that are linked by fine ducts containing lymph fluid. Your doctors will usually look at the nearby lymph nodes when staging your cancer.
Generally breast cancer is divided into four stages, from stage 1, which is small and localised, to stage 4, where the disease has spread to other parts of the body. If the cancer has spread to distant parts of the body, this is known as secondary or metastatic cancer.
A commonly used staging system is described below:
•Stage 1 The tumor measures less than 2 cm across. The lymph glands in the armpit (axilla) are not affected and there are no signs that the cancer has spread to elsewhere in the body.
•Stage 2 The tumor measures 2–5 cm across, or the lymph glands in the armpit are affected, or both. However, there are no signs that the cancer has spread further.
•Stage 3 The tumor is larger than 5cm across, and may be attached to surrounding structures such as the muscle or skin. The lymph glands are usually affected, but there are no signs that the cancer has spread beyond the breast or the lymph glands in the armpit.
•Stage 4 The tumor can be of any size, but the lymph glands are usually affected and the cancer has spread to other parts of the body. This is known as secondary breast cancer.
Grading of breast cancer
Grading refers to the appearance of the cancer cells under the microscope. The grade gives an idea of how quickly the cancer may develop. There are three grades: grade 1 (low-grade), grade 2 (moderate-grade) and grade 3 (high-grade). Low-grade means that the cancer cells look very like the normal cells of the breast. These cancer cells are usually slow-growing and less likely to spread. In high-grade tumors the cells look very abnormal. They are likely to grow more quickly, and are more likely to spread.
The following Mayo Clinic site has an excellent slide show on staging of breast cancer:
Phylloides tumor - is it cancer?
Phyllodes tumors of the breast are very uncommon.
Phyllodes tumors are made up of a mixture of the fibrous tissues and lining cells of the breast and so they are sometimes called fibroepithelial tumours. They range in their behaviour from being completely benign (non-cancerous) to malignant (cancerous) growths. The majority, however, are benign tumours. Even the malignant tumours tend to stay confined within the breast, only a minority, perhaps 1 in 3 to 1 in 4, spreading elsewhere in the body.
Those phyllodes tumors that are malignant are very different from other breast cancers, they behave like sarcomas (cancers of fibrous and supportive tissues in the body) rather than carcinomas (the usual type of breast cancer). This means that when they spread they usually send seedlings to the lungs, and only rarely involve the lymph glands under the arm; they are not influenced by female hormones and they do not respond to the same types of chemotherapy that are used for other breast cancers.
Phyllodes tumors tend to be well-defined, smooth, firm lumps in the breast, often growing to quite a large size and sometimes breaking through the skin of the breast, causing ulceration.
The treatment of these tumors is surgery which cures the great majority of these tumors. However, even the benign tumors have a tendency to come back, probably due to microscopic remnants left behind after the operation, so it is always important that they are removed with a good margin of surrounding normal tissue. For larger tumors this may mean that a mastectomy is needed.
Radiotherapy is not part of the usual treatment of these growths and chemotherapy is usually only used when the tumor is malignant and has spread to the lungs or elsewhere outside the breast. Phyllodes tumors can be differentiated from benign fibroadenomas or giant fibroadenomas only by a biospy and pathological evaluation.
What are tumor markers?
A tumor marker is a substance, which is produced by cells in response to the presence of a tumor. There are different markers for different cancers. Tumor markers may be raised if a particular type of cancer is present. However, tumor markers can also be elevated due to non cancerous (benign) conditions.
Tumor markers can be useful for a number of reasons:
•they might help in early detection of a cancer, if the marker becomes abnormal when the growth is still very small and not easily detected by other tests (like x-rays or scans).
•they might help to decide the best treatment for a particular type of cancer.
•they might help in predicting the outcome of treatment and the long term chances of cure.
•they might help to keep a check on the progress of treatment and monitor whether it is working or not.
Over the years there has been a constant search for useful tumor markers for breast cancer. A number of possible markers have been discovered. Some of these can be detected by taking blood tests that can be measured on a regular basis, to monitor any changes in the markers.
In some breast cancers the levels of the proteins CA27-29, CA15-3 and CEA can be raised in the blood. These proteins may also be produced by other cancers. The CA27-29 is the current marker folllowed for breast cancer. Its elevation does not necessarily mean the cancer has spread, but does indicate the need for further testing.
There are other tests carried out on the cancer itself. These help guide decisions about which treatment may be given.
Tests on the cancer:
•measurement of how rapidly tumor cells are dividing by looking at the DNA content of tumors (DNA flow cytometry) or measuring proteins like Ki67, MIB1 or KiS1 (quite complicated tests requiring fresh breast tumor tissue).
•measurement of the tumor suppressor gene p53.
•measurement of the enzyme cathepsin D.
•measurement of the protein receptor HER-2.
•measurement of the estrogen and progesterone receptors in the tumor tissue.
Measurement of estrogen and progesterone receptors are useful for selecting the best treatment. If estrogen receptors are present (ER+) then a benefit from hormone treatments is much more likely than if the tumour lacks estrogen receptors (ER-). When a breast cancer is removed samples of the tumor will almost always be tested to see whether it is ER+ or ER-. Once this has been done there is no benefit in repeating the test (indeed, if the tumor has been completely removed, as would normally be the case, then it is impossible to repeat).
Measurement of HER-2 receptors is a more recent test. Once again it is useful in deciding on treatment. People who have HER-2 receptors in their breast cancer (HER-2 positive tumours, HER-2+) may respond to the drug trastuzumab (Herceptin®). Those who do not have the receptor (HER-2 negative) will not.
It\'s still the case that factors like the size of the breast cancer at the time of diagnosis and whether it has spread to lymph nodes under the arm (stage), along with its appearance under the microscope (grade) and its hormone and HER2 status are the best predictors we have of the outcome of treatment.
Metastatic - what does it mean?
The term, metastatic, describes a cancer that has spread to distant organs from the original tumor site. Metastatic breast cancer is the most advanced stage (stage IV) of breast cancer. Cancer cells have spread past the breast and axillary (underarm) lymph nodes to other areas of the body where they continue to grow and multiply. Breast cancer has the potential to spread to almost any region of the body. The most common region breast cancer spreads to is bone, followed by lung and liver. Treatment of metastatic breast cancer generally focuses on relieving symptoms and extending a woman’s lifetime.
What is Computer Assisted Detection (CAD) in mammography?
The computer-aided detection (CAD) is a program that searches mammograms for suspicious features or irregularities that could be caused by cancer. When the computer finds anything unusual it indicates it on a screen for the radiologist to look at. It is considered a computerized second opinion for the radiological reading. Study results published today show that mammogram readings by a single expert plus the CAD system may be as good as those read by two expert radiologists, and in some cases the new combination could be even more successful. The results showed that the cancer detection rate by a single reader using CAD was at least as good as that when the films were originally read by two readers. We offer CAD readings on all of our mammograms at the Breast Center of Texoma for increased quality in our mammographic interpretations.
MRI - is it useful in evaluating breasts
Breast MRI uses Magnetic Resonance Imaging (MRI) to look specifically at the breast. It is a non-invasive procedure that doctors can use to determine what the inside of the breast looks like without having to do surgery or flatten the breast (as in a mammogram). Each exam produces hundreds of images of the breast, cross-sectional in all three directions (side-to-side, top-to-bottom, front-to-back), which are then read by a Radiologist. No radioactivity is involved, and the technique is believed to have no health hazards in general. The hope is that such non-invasive studies will contribute to our progress in learning how to predict the behavior of tumors, and in selecting proper treatments. Breast MRI is an evolving technology and should not replace standard screening and diagnostic procedures (clinical and self exams, mammogram, fine needle aspiration or biopsy).
The recent interest in MRI of the breast follows reports that malignant (or cancerous) lesions get brighter following a contrast agent injection. MRI has been shown to detect small breast lesions that are sometimes missed by mammography, and MRI can successfully image the dense breast (usually found in younger women) and breast implants. However, contrast MRI sometimes has a hard time distinguishing between carcinoma and benign breast disease. Some benign breast tissues (such as fibroadenomas) can also get bright after contrast injection, which can cause a false positive result. Research is currently going on at multiple institutions to improve breast MRI. MRI is offerd when needed through the Breast Center of Texoma.
(For more details see Articles: MRI Urged for High Cancer Risk)
What are Breast Implants?
Breast implants are medical devices that are implanted either under breast tissue or under the chest muscle for breast augmentation or reconstruction. There are two major types: saline-filled and silicone gel-filled. Saline-filled breast implants are silicone shells that are either prefilled or filled with saline during surgery, and some of these allow for adjustments of the filler volume after surgery. Silicone gel-filled breast implants are silicone shells prefilled with silicone gel. Breast implants vary in profile, size, and shell surface (smooth or textured).
(For more details see Articles: Breast Implants)
What is a Sentinel Node biopsy and its effectiveness?
Sentinel lymph node biopsy: A new approach to evaluating axillary lymph nodes for spread of cancer is called a sentinel lymph node biopsy. This procedure involves removing a single lymph node or nodes, called the sentinel nodes, which is the first line of lymph nodes to collect excess fluid surrounding the cancer. Prior to surgery, a blue dye and/or a radionucleotide material are injected near the cancer. These materials drain from the area containing the cancer into the nearby lymph nodes, through the sentinel node. The nodes containing the dye and/or radionucleotide are removed during surgery and evaluated under a microscope to determine whether cancer has spread. Sentinel lymph node biopsy is becoming the standard approach for determining whether cancer has spread to the axillary lymph nodes.
Researcher now indicates that sentinel node biopsy appears to be just as effective in determining cancer spread to axillary lymph nodes as an axillary lymph node dissection, and results in fewer side effects in patients with early stage breast cancer. A clinical trial compared the outcomes of patients treated with sentinel lymph node biopsy compared to axillary node dissection. This trial involved 516 patients with breast cancer that was no greater than 2 centimeters in diameter. Results showed that sentinel lymph node biopsy was accurate approximately 97% of the time. Nearly 4 years following therapy, cancer recurrences, spread of cancer, or a possible second breast cancer occurred in 10 patients in the sentinel node group, compared with 15 patients who underwent axillary lymph node dissection. Physical examination showed that no patients who were treated with sentinel node biopsy have developed cancer spread to the axillary lymph nodes. Patients treated with sentinel node biopsy only suffered from less pain, numbness, arm swelling and had greater arm movement than those who underwent axillary node dissection.
Why is an ulltrasound sometimes recommended?
The ultrasound can detect some abnormalities that cannot be visualized on a mammogram or palpated by the examiner. Mammography is limited in its evaluation of very dense breast tissue. Dense tissue shows up as white on a mammogram and so do some early breast cancers; thus, white on white can be misleading in the diagnosis. The ultrasound can sometimes detect a denser lesion down in an area of very dense tissue and in this manner aid in the early detection of lesions that may not be noted on a palpable exam or by mammography. Also, the ultrasound is a good tool to help evaluate an abnormality that is also noted on a mammogram. A mammogram may reveal the presence of a nodule, but cannot tell if it is solid or cystic. The ultrasound can show if the abnormality is solid or cystic - cystic lesions are rarely associated with cancer while virtually all cancers are solid. Biopsies of lesions and aspirations of cysts can also be done by ultrasound guidance.
What is the difference in screening and diagnostic mammograms at the Breast Center?
Screening vs. Diagnostic Mammograms
The following is information we give to our patients regarding screening vs. diagnostic mammograms at the Breast Center of Texoma:
When your doctor or Dr. Myers schedules this facility to do a mammogram they will order either a screening or diagnostic mammogram.
Screening: No breast problems, abnormalities, or history of breast surgery within the last 24 months.
Diagnostic: Symptoms include pain, discharge, mass, nodule, cyst, abnormal nipple, past history of breast cancer, breast surgery within the last 24 months, fibrocystic breast changes, or breast implants.
When doing diagnostic mammograms we will attempt to retrieve your last mammogram so that our radiologist can compare this study with your previous mammograms. In this center we also try do the same for screening mammograms even though it is not required and usually not necessary. It is very important that you attempt to retrieve your previous films and bring them to the center with you to expedite our evaluation as well as increase the quality of your mammographic study.
We are aware that some insurance companies will pay for screening or have no co-pay with screening – likewise, other insurance companies will pay only if it is a diagnostic mammogram. We do not go by what your insurance company says – we will take the order from your doctor only and if we see you have symptoms that place you in the diagnostic area will contact him/her to confirm further instructions or orders. All of this is done to give our patients quality care without necessitating several visits for repeat films.
For quality assurance, screening mammograms will not be done on patients with implants – they will all be diagnostic. We cannot change screening to diagnostic or diagnostic to screening for insurance purposes.
What are breast calcifications?
Breast calcifications are tiny calcium deposits that form in the breast as a woman ages. They are common and can result from a number of different things such as trauma to the breast and inflammation. There is no known relationship between the amount of calcium in a woman’s diet and breast calcifications.
Calcifications are too small to be felt. They can be seen on a mammogram where they appear as little white spots. Most of the time calcifications are harmless. However, sometimes they can be a sign of breast cancer, so they must be looked at carefully.
There are two main types of calcifications, macro and micro.
--Macrocalcifications are almost always benign (not cancer). They appear large and round on the mammogram films and require no further follow-up.
--Microcalcifications are smaller and more numerous than the larger macrocalcifications. They are usually benign, but can sometimes be a sign of cancer. The radiologist will look at the size, shape, and pattern of the microcalcifications to see if they are “suspicious”. More mammograms and/or a biopsy may be necessary. “Suspicious” microcalcifications turn out to be cancer about 20 to 25% of the time.
Mammography is the only tool that can see calcifications, so it is truly the best tool available to diagnose breast cancer at its earliest form.
What is gynecomastia?
What is gynecomastia?
Gynecomastia is a condition in which firm breast tissue forms in males. Gynecomastia may be present on one side or on both sides. This condition may make the breast tender. It is a swelling of the breast, either diffusely or as a nodule, mostly occuring directly behind the nipple. It is sometimes considered the male counterpart to the female fibrocystic change -hormonal or medicine related, self limited, and creating a benign lump that must be differentiated from cancer.
Some men and boys have fat on their chests that makes it look like they have breasts. This condition is called pseudogynecomastia (false gynecomastia). It is not the same thing as gynecomastia.
What causes gynecomastia?
Gynecomastia is usually caused by changes in hormones at puberty or as part of aging. Gynecomastia may be caused by changes in the balance of 2 hormones: estrogen and testosterone. Sometimes, gynecomastia may be caused by prescription drugs (cardiac, high blood pressure meds, etc.), over-the-counter medicines (allergy, asthma meds, etc.), illegal drugs, tumors or disease (as liver problems).
Are tests needed to find the cause of gynecomastia?
Sometimes tests are recommended. The most common are mammography and ultrasonography. Whether you need tests depends on your age and what your doctor learns from your history and physical examination. Gynecomastia is common in teenage boys. As many as 65% of 14-year-old boys have gynecomastia. If you are a teenager, you probably will not need tests. Your breast enlargement will probably go away on its own in 2 or 3 years. However, younger boys and adults who have gynecomastia may need to have some tests. In these cases, it is possible that some kind of disease may be causing the problem.
How is gynecomastia treated?
In most cases, no treatment is needed. Your doctor will probably want to check the size of your breast tissue every few months. In 90% of teenage boys, gynecomastia goes away in less than 3 years.
Sometimes the problem can be solved if you stop taking a medicine that is causing gynecomastia or stop using an illegal drug that is causing the problem.
Occasionally, medicines may be used to treat gynecomastia, especially if tenderness is a problem. The medicine will make the extra breast tissue go away. Sometimes, surgery may be necessary to remove the extra breast tissue. Surgery is usually done to stop the pain, get rid of the enlarged breast for cosmetics, or to rule out cancer.
If gynecomastia is caused by a disease or a tumor or disease, then treatment is obviously necessary of that process.
What is mammosite?
Today, more and more women with early-stage breast cancer are able to treat their cancer effectively and preserve their breasts through an option called breast conservation therapy (BCT). This treatment includes the removal of the cancerous tumor, which is called a lumpectomy. The lumpectomy is generally followed by 7 weeks of whole breast external beam radiation therapy. This combination of surgery and radiation works well to prevent local recurrence of the tumor.
However, some patients find it hard to complete almost two months of radiation therapy. It might be difficult to take time from work or other responsibilities, or treatment centers may be far from home. The MammoSite Radiation Therapy System (RTS) is the most widely used method of partial breast radiation that works by delivering radiation from inside the breast directly to the tissue where cancer is most likely to recur. Radiation therapy with MammoSite RTS can be completed in up to 5 days, allowing you to get back to your life.
(See Articles: Mammosite and Partial Breast Radiation)
Breast calcifications: Are they breast cancer?
Breast calcifications are tiny calcium deposits within the breast tissue that appear as white spots on a mammogram. Breast calcifications are common. Many women have at least one calcification that can be seen on a mammogram. Although breast calcifications are usually noncancerous (benign), certain patterns of calcifications — such as tight clusters with irregular shapes — may indicate breast cancer.
The two main types of breast calcifications are:
•Macrocalcifications. They appear as large white dots or dashes on a mammogram. Macrocalcifications are almost always noncancerous and require no further follow-up.
•Microcalcifications. They appear as very fine white specks on a mammogram. Microcalcifications are usually noncancerous but can sometimes be a sign of cancer. The radiologist will look at the size, shape and pattern of the microcalcifications. If they appear suspicious, additional mammograms and a biopsy may be needed.
Noncancerous causes of breast calcifications include:
•Calcium within the fluid of a noncancerous cyst (milk of calcium)
•Calcifications associated with a dilated milk duct
•Previous injury to the breast (post-traumatic fat necrosis calcification)
•Inflammation due to infection (mastitis)
•Skin (dermal) calcifications such as caused by dermatitis or residue from metallic particles in powders, ointments and deodorants
•Radiation therapy for breast cancer
•Calcification of the arteries (vascular calcifications)
•Calcifications in a fibroadenoma, a noncancerous growth
Thermography - can it detect breast cancer?
Thermography, also called thermal imaging, has been studied for several decades. However, there is no evidence that breast thermography is an effective screening tool for early detection of breast cancer, according to the American Cancer Society.
Breast thermography is a way of detecting differences in skin temperature on the surface of the breast with the use of a special heat-sensing (infrared) camera. It is based on the theory that surface temperature increases in areas of increased blood flow and metabolism, such as in a tumor. Breast thermography is noninvasive and uses no radiation.
This technology is most effective in detecting tumors that are close to the skin surface but not tumors deeper in the breast. Also, breast thermography is not sensitive enough to detect small cancers.
Breast thermography is not routinely used for breast cancer detection and should not be used instead of mammograms. Scientists continue to investigate the usefulness of thermography in detecting breast cancer.
What are the types of breast cancer?
Determining what type of breast cancer you have is an important step in treating the disease. Get the facts on types of breast cancer and how they differ.
Your doctor suspects that you have breast cancer. As part of the diagnosis process, your doctor sends a tissue sample (biopsy) to the lab for analysis. After the test results come in, you'll learn whether you have breast cancer and, if so, what type of breast cancer you have.
Knowing what type of breast cancer you have plays a big role in selecting your treatment. Understand the differences among types of breast cancer, including common and less common types.
Common types of breast cancer
The most common types of breast cancer originate in either your breast's milk ducts, ductal carcinoma, or lobules, lobular carcinoma. The point of origin is determined by the microscopic appearance of the cancer cells from a biopsy.
In situ breast cancer
In situ breast cancer refers to a type of cancer in which the breast cancer cells have remained contained within their place of origin — they haven't invaded breast tissue around the duct or lobule.
•Ductal carcinoma in situ (DCIS). DCIS refers to abnormal cells in the lining of a milk duct that haven't invaded the surrounding breast tissue. This is early-stage breast cancer. Some experts consider DCIS a precancerous condition. Almost all women with DCIS can be successfully treated, and no evidence suggests that DCIS affects a woman's life span. However, if left untreated, DCIS may eventually develop into invasive breast cancer.
•Lobular carcinoma in situ (LCIS). LCIS means that abnormal cells are contained within a lobule of your breast, but they haven't invaded the surrounding breast tissue. Whether LCIS is an early form of breast cancer or is just a marker for the future development of cancer remains a point of controversy in the medical community. However, experts do agree that if you have LCIS, you're at an increased risk of developing breast cancer in either breast in the future. In the breast that had the LCIS, you're more likely to develop invasive lobular breast cancer. If cancer develops in the other breast, it's equally likely that it could be invasive lobular or invasive ductal carcinoma.
Invasive breast cancer
Invasive breast cancers are those that break free of where they originate, invading the surrounding tissues that support the ducts and lobules of your breast. The cancer cells can travel to other parts of your body, such as the lymph nodes.
•Invasive ductal carcinoma (IDC). IDC accounts for the majority of invasive breast cancers. If you have IDC, cancer cells form in the lining of your milk duct, break free of the ductal wall and invade surrounding breast tissue. The cancer cells may remain localized — staying near the site of origin — or they can spread even farther throughout your body, carried by your bloodstream or lymphatic system.
•Invasive lobular carcinoma (ILC). Although less common than IDC, this type of breast cancer acts in a similar manner. ILC starts in the milk-producing lobule and invades the surrounding breast tissue. It can also spread to more distant parts of your body. With ILC, you might not be able to detect a breast lump. You may perceive only a general thickening — or a sensation that your breast tissue feels different. ILC can be harder to detect by touch, and it's also less likely to appear on a mammogram.
Breast implants: Do they interfere with mammograms?
Yes, women with breast implants can still have mammograms. However, breast implants may decrease the ability of mammograms to detect breast cancer, because implants can obscure the image of a tumor.
If you have breast implants, you may want to consider getting mammograms at a facility as the Breast Center of Texoma that does a large number of these examinations annually. The mammogram procedure may be slightly different and the images more difficult to interpret in women with breast implants. For these reasons, you may benefit from a radiologist and technologist experienced in such examinations as we have at the center.
There\'s a very slight risk that breast implants may rupture during a mammogram. But the benefits of mammography in the early detection of breast cancer outweigh this risk.
Breast cancer screening guidelines are the same for women with breast implants as for all women. The U.S. Preventive Services Task Force recommends a screening mammogram yearly after age 40, depending on your risk.
What are the advantages of CT 3D Ultrasonography
Computer tomographic (CT) 3D rendering ultrasonography helps fill a void in the evaluation and early detection of breast cancers in patients with dense fibrous breasts where mammography is limited and in younger patients where mammography not indicated.
This advance in ultrasonography of the breast utilizes a 14.5 mm transducer (instead of the standard 3-4 mm hand held transducer) and covers the entire breast with precise 2mm tomographic “cuts” accurately locating abnormalities in relation to the nipple radian and depth. The image is then computer rendered where it can be 3D manipulated in both coronal and sagital views. The studies are computer rendered similar to that of x-ray CAT scan studies. CT 3D ultrasound rendering studies of the breast offer many advantages over the standard 2D studies:
1. Because of the wide field of view with the 14.5 cm transducer, the full extent of the disease and/or abnormality is seen in more detail and in some instances seen only with the 3D rendering technique.
2. With the 14.5 cm transducer and with the nipple being accurately marked on the image, a precise location of the lesion can be recorded – thus reproducibility can be achieved much more accurately than with a manual hand held 3-4 cm transducer. Precise location and reproducibility is not possible manually without this rendering technology.
3. The wide field study identifies more accurately multi-focal and multi-centric disease.
4. The 3D rendering allows a coronal study of the breast in 2mm increments from the nipple to the chest wall that cannot be accomplished manually with 2D studies unrendered. This coronal view follows the anatomy of the breast and gives a more detailed image of the breast and possible disease.
Go to the following site for video information of the study:
What is Breast Specific Molecular (Gamma) Imaging
Breast-Specific Gamma Imaging (BSGI): The Dilon Advantage
Breast-Specific Gamma Imaging (BSGI) is a functional imaging procedure that images the metabolic activity of breast lesions through radiotracer uptake. A small amount of tracing agent is delivered to a patient, and in turn is absorbed by all cells in the body. The tracing agent emits invisible gamma rays, which are detected by the Dilon 6800 and translated into a digital image of the breast. Due to the higher metabolic activity of cancerous cells, these cells absorb a greater amount of the tracing agent and are revealed as "hot spots." This technique can help doctors more reliably differentiate cancerous from non-cancerous cells. While other adjunct modalities, such as MRI and Ultrasound, image the physical structure of the breast, BSGI captures the cellular functioning of the breast tissue.
BSGI is a valuable tool for situations where mammography cannot answer all the questions and further evaluation is needed, especially when patients have:
•Dense breast tissue
•Multiple suspicious lesions or clusters of microcalcifications
•Lesions that can be felt but not detected with mammography or ultrasound
•Post-surgical or post-therapeutic mass
•Been taking Hormone Replacement Therapy
BSGI is made possible by a unique camera - the Dilon 6800. This high-resolution camera creates clear pictures so your doctor can see cancers as small as 3 millimeters. It can detect early stage cancers, see lesions even in dense tissue, and provide multiple angle views. The result is quicker and more accurate detection of breast cancer than with mammography alone.
Breast-Specific Gamma Imaging (BSGI) has been performed on over 8,000 patients in both hospitals and private imaging centers across the country. Because it is compact and portable, the Dilon 6800 can be used in your doctor's breast-imaging center allowing for same-day evaluation at the point of care. Other evaluation techniques can require getting a referral, traveling to another testing site, and waiting for scheduling and results. As a patient, you will appreciate the peace of mind you receive from getting the information you need quickly.
What are the advantages of digital mammography?
The best way answer the question about advantages of digital mammography over film is to summarize data from the DMIST National Cancer Institute Study comparing Digital and film mammograms:
Digital vs. Film Mammography in the Digital Mammographic Imaging Screening Trial (DMIST): Questions and Answers
•The study showed that digital mammography was significantly better that film mammography in screening women who were under age 50, or women of any age who had very dense breasts.
•Digital mammography allows improvement in image storage and transmission because images can be stored and sent electronically.
•Secondary goals measuring the relative cost-effectiveness of both digital and film technologies, and the effect on participant quality of life due to the expected reduction of false positives are still being assessed and will be reported at a later date.
•Death rates from breast cancer have been declining since 1990, and these decreases are believed to be the result, in part, or earlier detection and improved treatment.
What were the main results of DMIST?
DMIST showed that, for the entire population of women studied, digital and film mammography had very similar screening accuracy.
Digital mammography was significantly better in screening women who fit any of these three categories:
•under age 50 (no matter what level of breast tissue density they had)
•of any age with heterogeneously (very dense) or extremely dense breasts
•pre- or perimenopausal women of any age (defined as women who had a last menstrual period within 12 months of their mammograms)
There is no apparent benefit of digital over film mammography for women who fit ALL of the following three categories:
•over age 50
•those who do not have dense or heterogeneously (very dense) breast tissue
•those who are not still menstruating
In addition, there was no statistically significant difference in the accuracy of digital mammography compared to film according to digital mammography machine type, race, or breast cancer risk.
These results suggest that for women who fall into three subgroups (women under age 50, women with heterogeneously dense or extremely dense breasts, and pre- and perimenopausal women), digital mammography may be better at detecting breast cancer than traditional film mammography. Approximately 65 percent of the women in DMIST fit into one of the three subsets that showed a benefit with digital mammography.
Some earlier studies had suggested that digital mammography would result in fewer false positives than film mammography, but the rates of false positives for digital mammography and traditional mammography were the same in DMIST.
Do the trial results indicate that ALL women should get digital mammograms instead of film mammograms for breast cancer screening?
No. The study results indicate that only women who fit in ANY of these three categories would benefit from digital mammography instead of film mammography:
•under age 50 (regardless of level of breast tissue density)
•of any age, with heterogeneously (very dense) or extremely dense breast tissue
•or pre- or perimenopausal women of any age (defined as women who had a last menstrual period within 12 months of their mammograms).
According to the results, women who fit ALL of the following three categories would not benefit from digital mammography instead of film mammography:
•over age 50
•those who do not have dense or heterogeneously (very dense) breast tissue
•and those who are no longer menstruating.
At present, only 8 percent of the mammography units in the United States have digital systems, whereas approximately 40 percent of women undergoing screening mammography have dense breasts. It will be impossible for all women who have dense breasts to receive digital mammograms, at least for the near future. As more digital mammography systems become available, more women in the groups who are likely to benefit from digital mammography will have access to this technology.
MRI vs Molecular Imaging
MRI has shown usefulness as a next-step imaging modality for difficult-to-diagnose cases. Much like x-ray mammography, breast MRI relies on anatomical or structural information, but provides much more detailed images. It is limited however, by its highly variable specificity, which can range from below 37% to 97%. Combined with its high sensitivity, MRI produces a high false positive rate, is an expensive test to administer, is often difficult to schedule and may require multiple days to complete.
The specificity of BSGI/scintimammography has historically been higher than that of breast MRI. In addition, Dr. Petrovitch presented data at the 2005 RSNA showing that in the same patient population BSGI had comparable sensitivity, but higher specificity than breast MRI (High Resolution Molecular Breast Imaging with 99m-MIBI and Magnetic Resonance Imaging in the Assessment of Breast Cancer, 2005). There are also several factors which limit the use of breast MRI in patients.
•First, not all patients can physically comply with an MRI order. Breast size, obesity and various medical implants are just a few of the factors that limit the use of MRI in this patient subset.
•Second, some insurance programs limit the use of breast MRI. This means that there is a large group of patients who could benefit from additional imaging, but are excluded from using MRI due to financial considerations. BSGI is an excellent alternative for both of these cases.
Molecular Imaging vs Ultrasound
Ultrasound is also commonly utilized as a next-step after a questionable mammogram and is good at determining if a suspect mass is solid or fluid-filled. However, ultrasound demonstrates a low specificity that can produce misleading results and indicate biopsy where one may not be needed.
BSGI, as a functional procedure, images cellular activity while both MRI and Ultrasound image tissue density. Functional imaging allows physicians to see the breast more clearly by accessing a map of cellular metabolism. Certain types of breast tissue may interfere with cancer detection. The need for a complementary diagnostic procedure to mammography is filled by a test that provides for improved sensitivity and specificity such as BSGI.