 |
- Do I really need to get a mammogram EVERY year after age 40?
- Yes! A report from the US Preventative Task Force from November, 2009 disputed this, but has been widely criticized because breast cancer deaths will increase if women decrease usage of mammography. The USPTF is a government panel and includes no breast specialist physicians. Breast cancer is completely curable when found in its early stages; two years between mammograms can be long enough to allow a tumor to progress from a small, removable lump to large malignancy that has already spread beyond the breast.
- How often do I need a mammogram?
- Women over age 40 should be screened annually.
Women with a family history of pre-menopausal
breast cancer may need to start screening sooner.
- What are the risk factors for breast cancer?
- The number one risk factor is simply being
a woman; second is age---the risk is higher
the older you are; family history of breast
cancer, especially pre-menopausal breast cancer
or breast cancer in a first degree relative
like your mother, sister, or daughter; first
pregnancy and child birth after age 30; never
having a full-term pregnancy; early puberty
and/or late menopause; obesity; personal history
of previous breast cancer, ovarian cancer, or
breast biopsy showing atypia or other high risk
tissue; long-term use of post-menopausal hormone
therapy, smoking, alcohol consumption, being overweight,
diabetes, and family history of ovarian cancer.
- What is Computer-Aided Detection?
- Commonly known as CAD, Computer-Aided Detection
uses intelligent software to review mammography
images. Findings which may potentially be signs
of cancer are flagged for the radiologist to
evaluate. Numerous studies have documented that
cancer detection improves when radiologists
use CAD. Dr. Dean has used CAD since 2002, and published
one of the early studies validating its use.
- What if I have breast implants?
- Mammography is safe for women with implants,
and is used both to detect breast cancer and
to check the integrity of the implants. A set
of images is made to include the entire breast
and implant, and a second set of images is made
for the breast tissue. It is not possible to
image all of the breast tissue with mammography
in women with breast implants, and Whole Breast
Ultrasound is recommended in addition
to mammography for these women.
|
- What is Thermography?
- Breast Thermography or Digital Infrared Thermal Imaging is a non-invasive adjunctive imaging test that measures temperatures on the surface of the breasts. Temperature differences between the breasts, the heat patterns produced by blood vessels, and thermovascular changes over time reflect the underlying physiologic processes, such as changes in metabolic activity and vascular structures (blood vessels). These changes may alert us to the presence of cancer, and may even pre-date the development of cancer. A growing body of evidence suggests that the physiologic processes measured by thermography can be influenced by preventative therapies. Thermography gives doctors the opportunity to monitor their patients' breast health over time so proactive breast health therapies can be implemented.
- An abnormal thermogram is a significant marker for being at high risk of developing breast cancer, possibly more significant than having family members with a history of breast cancer. Thermography is used as an adjunct to other screenings to provide early warning of changes that may indicate the development of cancer or an environment conducive to cancer; earlier detection translates to improved breast cancer survival and potentially less invasive treatment.
- Can a thermogram replace a mammogram?
- No. Thermography is a different kind of test designed to assess risk for the development of breast cancer by measuring heat. Increased temperatures may suggest increased blood flow due to inflammation or tumor development. Serial Thermograms are monitored for stability or change over time. Thermography is not considered to be a stand-alone technology, or a replacement for mammography. Thermography is complementary to mammography.
- May I review a Sample Thermogram Report? Click image below (See page 3 for summary)
- What are the differences between Mammography, Ultrasound and Thermography?
 |
 |
 |
 |
 |
|
Mammography |
Thermography |
Ultrasound |
|
How it Works |
Low dose X-Rays produce an image that is a shadow of tissue densities; all tissue is overlapped in each view, so dense breast tissue can obscure some findings. Requires momentary compression of the breast. |
Digital infrared sensors detect surface heat; temperature readings are compiled into an image by specialized software for computer analysis. The process is just like having a picture taken, but lasts several minutes. |
High frequency sound waves are used to image breast tissue as they bounce off tissue interfaces; their echoes create a cross-sectional image, with no overlap. |
|
Strengths |
Can pin point areas of suspicious tissue. Only test to reliably detect microcalcifications, which are one of the earliest signs of breast cancer. Some cancers can be detected at a pre-invasive stage. |
Effective for women of all ages and with all breast densities, including breast implants; earliest alert to physiological changes related to inflammation and increased blood flow. |
Used to locate suspicious tissue; Color Doppler can then be used to see blood flow. Can image well all the way to the chest wall in most women. Can detect many cancers missed by mammography. |
|
Purpose |
Early detection of cancer and diagnosis of lumps. |
Early warning of physiological changes; risk assessment; monitoring stability over time. |
Early detection of cancer and diagnosis of lumps. Clarification of mammography findings. |
|
Weaknesses |
Does not image masses well in women with dense breasts; Misses some tissue in women with implants. |
Cannot pinpoint exact area of suspicion. |
Does not image as well in very large breasts. Very subject to skill of the operator. |
|
|
- Is thermography covered by insurance?
- Most private insurances and Medicare do not cover thermography
- Some healthcare savings account plans do cover thermography
- What protocol do I follow before my appointment?
 |
| Click Image to view/print Protocol |
Thermogram Protocols & Preparation
It is very important that you follow these simple instructions carefully to insure your thermographic examination is accurate. If you cannot follow any of the protocols listed below, please call the office prior to your appointment to discuss the matter and receive further instructions. Thank you for your cooperation and welcome to our center. Please check any items that you cannot or did not follow.
- You cannot be sunburned or have a fever at the time of your examination. Avoid prolonged sun exposure for five days prior to the exam.
- You should avoid chiropractic care, physical therapy, massage therapy, analgesic creams or balm, and application of magnets or poultice for 24 hours prior to your examination. Discuss with your physician BEFORE discontinuing any of the above.
- You should not drink coffee, tea, soda or other beverages containing caffeine for 4 hours prior to exam.
- Do not smoke cigarettes, chew tobacco or use any product which contains nicotine the day of your examination unless ordered by your doctor.
- Do not stimulate the nipple in any way for 12 hours prior to your examination.
- Do not shave your under arms for 24 hours prior to your examination.
- Do not wear deodorant the day of your examination.
- Do not use creams, lotions, talcum powder, or other skin products on your breasts the day of your examination unless instructed by a physician.
- Do not perform any rigorous exercise for at least four hours prior to your examination.
- Do not take a bath or shower in HOT water for at least 4 hours prior to your examination.
- Alert the technologist if you have had radiation treatment within the last 6 months.
What is Whole Breast Ultrasound
Screening?
- How is it different from focused
breast ultrasound? Ultrasound has been used for
over twenty years to investigate the cause of breast
lumps or to evaluate findings first discovered by
mammography. Radiologists have been
 aware
for sometime that many cancers not apparent on mammograms
can be seen with ultrasound. Several companies are
now developing equipment designed to make ultrasound
screening of the entire breast a feasible study
for everyday use. Since February, 2005 we have used Sonocine, which collects thousands of ultrasound
images of the breast and formats them for radiologist
review. The published multi-center trial in which Dr. Dean participated
showed that cancer detections were doubled by adding Sonocine ultrasound
findings to mammography.
- What is the cost of Whole Breast Ultrasound?
- When performed at the same appointment with another exam, such as mammography or DEXA, the cost is $300.
- What type of biopsy option are there?
- Pre-Biopsy: For all biopsy procedures
it is preferable to be off aspirin and other
“blood thinner” medications and
supplements for 5 to 7 days beforehand. This
includes aspirin, Excedrin, Advil, Plavix, Naprosyn,
Motrin, extra doses of Vitamin E, Ginko and
many herbal products.
- FINE NEEDLE ASPIRATION BIOPSY:
Using local anesthesia a very thin needle is
used to extract cells, the material is mounted
on slides or preserved in special fluid, and
the samples sent to a laboratory for review
by a pathologist. Also called cytology, this
technique can be done on lumps by manual technique
or image-guided. This test is about 75 –
80 % reliable. Cost of the procedure is $150
to $500 and cost of examination by the pathologist
about $150.00
- CORE NEEDLE BIOPSY: Using local anesthesia
and either ultrasound or mammographic guidance
a large bore needle is used to remove small
shavings of tissue, which are sent to the laboratory
in fluid for a pathologist to examine. A small
skin nick (about 1/8th inch) is made in the
skin and bruising is common. This technique
is 98% reliable. Cost of the procedure is $600
to $850 and cost of the examination by the pathologist
is about $150.00.
- VACUUM ASSISTED CORE NEEDLE BIOPSY:
Using local anesthesia and either ultrasound
or mammographic guidance a larger bore needle
is used to remove shavings of tissue. About
a 1/4th inch skin incision is needed and almost
everyone will experience some bruising. This
technique is 99%-100% reliable and can be used
to completely remove many masses, even up to
an inch in size. Cost of this procedure is $800
to $1500 plus cost of examination by the pathologist
is about $150.00.
- SURGICAL BIOPSY: Using local or general
anesthesia an incision is made in the skin and
the lesion is cut from the breast surgically.
Recovery time is longer but bruising is actually
less frequent than core biopsy because bleeding
can be controlled with cautery, clips, or suture
while the incision is open. This procedure is
considered 98% reliable. Cost of the procedure
varies from $400 to $2000, plus anesthesia,
operating room, and laboratory costs.
- PRE-OPERATIVE WIRE LOCALIZATION: Using
local anesthesia a thin wire is placed through
the skin to the lesion to be removed surgically.
Also called Wire-Guided Biopsy this technique
is used for non-palpable lesions, like microcalcifications
or lumps that are too deep or too small to be
felt, but need complete removal.
- What is TACT?
- Tuned Aperture Computed Tomography is a tomosynthesis
technique for detailed evaluation of suspected
cancer. It converts a small area of the mammogram
into cross-sectional images. Tomosynthesis of
the whole breast is currently an investigational
device, in development with at least three different
manufacturers. TACT is an FDA approved procedure
which has been available at our office since
2002
- What is Cryoablation?
- Cryoablation is a minimally invasive technique used to treat breast fibroadenomas. It produces no scarring or change in breast size or volume. To perform the procedure a small probe (about the size of a biopsy needle) is inserted into the tumor using ultrasound guidance. The cryo-probe is used to freeze the tumor, stopping its growth and allowing the body to absorb the dead cells naturally over a period of months. As the process is non surgical, it takes about a half hour and uses only local anesthetic. Patients are able to drive afterwards and most experience only minimal pain.
This method is ideal for women with painful fibroadenomas; women with smaller breasts where removing the tumor would result in a visible difference in the patient’s breast size and shape; for women in the cancer age group, as leaving an existing benign tumor may make it harder to differentiate malignant growths from the pre-existing tumor; women with multiple or recurrent fibroadenomas; and for women diagnosed with a fibroadenoma in their teens or twenties where the tumor will likely still grow and could eventually disfigure the breast. In addition to these groups of women, you may want to consider the procedure if you have any anxiety about surgery or do not want visible scarring or decrease in breast size.
The procedure is FDA approved for the treatment of fibroadenomas.
- What is ductogram?
- A ductogram is a procedure used to evaluate
patients with spontaneous, suspicious nipple
discharge. Nipple discharge that occurs without
expressing fluid, and is noticed because of
a stain on clothing, is considered a warning
sign of possible breast cancer, and should be
evaluated. Expressible discharge is a normal
finding and does not warrant further testing.
To perform the test the duct with discharge
must be identified by expressing a small amount
of fluid. A tiny dilator, or series of dilators,
is then used with topical anesthetic to open
the duct sufficiently to instill a small amount
of radiographic contrast material. Mammography
images are then taken to identify the source
of the discharge.
- If you have any more questions please visit
www.komen.org for more information.
- What is DEXA?
- Dual Energy X-ray Absorbitometry
is a test of bone mineral density. To
perform the scan the patient lays on her
back on an open examination table while
the detector moves above her. The whole
procedure takes only a few minutes, and
is the most accurate way to assess bone
density.
|
|
- What are the risk factors for low bone density?
- The most important risk factor is being a
woman, and the second is age. Low bone density
is more common after menopause and the risk
is higher the older you are. Any low estrogen
state, such as surgical removal of the ovaries
or anorexia with loss of menstrual cycles, can
cause low bone density. Other risk factors include
long-term use of several specific medications,
such as thyroid hormone, steroids like prednisone,
and others; nutritional disorders; Chrohn’s
Disease; petite stature; previous chemotherapy
for cancer; and bed-rest or sedentary life style.
- How often should I have a DEXA study? Most doctors
suggest having a first DEXA in your forties,
so that there is time to take action before
menopause if your bone density is low. If your
bone density is normal, it generally does not
need to be repeated until menopause. If your
bone density is low your doctor may ask for
another scan in a year to assess the effect
of intervention. For post-menopausal women with
normal bone density the test should be repeated
every two or three years, or as advised by your
doctor based on your specific risk.
- If my bone density is low what can I do to correct
it?
- First be sure you have eliminated all the
possible causes of calcium loss, like carbonated
beverages, alcohol, caffeine and smoking. Then make sure
your diet contains ample calcium, probably at
least 2000 mg. The most bio-available calcium
is in dairy products like fluid milk, yogurt,
cheese, ice cream, etc. Vitamin C actually promotes
calcium absorption, so calcium fortified orange
juice is a good choice. Vitamin D is important
for healthy bones, and your doctor can order a blood test to determine if yours is adequate.
Many calcium supplements are not well-absorbed,
but can be added if needed. Weight-bearing exercise
is essential to both maintaining and increasing
bone density. Your doctor may also prescribe
medication to correct your low bone density,
but these work best when there is ample dietary
calcium and exercise to stimulate bone growth
.
- If you have any more questions please visit
www.osteo.org
for more information.
|
