The Tribune Democrat, Johnstown, PA

Breast Cancer

October 1, 2012

From digital images to self-exams, doctors make use of it all in finding breast cancer

JOHNSTOWN — Mammograms are best known as a tool for screening and early diagnosis of breast cancer, but they are part of an arsenal of imaging technologies used throughout the diagnosis treatment and therapy processes.

In addition to mammography, radiologists and surgeons use ultrasound and magnetic resonance imaging to fine-tune diagnosis and treatment options. Oncologists use the tests to track progress in shrinking tumors during treatment, said Dr. Michelle Cacek, a radiologist at Laurel Highlands Advanced Imaging, 1450 Scalp Ave. in Richland Township.

Laurel Highlands Advanced Imaging is jointly owned by Cambria Somerset Radiology and Conemaugh Memorial Medical Center. Its team of experts reads X-rays, MRIs, CT Scans and other images for Conemaugh Health System and Windber Medical Center, among others.

Mammograms are still the best tool for early detection of breast cancer, Cacek said. She joins the other physicians contacted during this project in recommending annual mammograms for any woman beginning at age 40, with earlier screenings for those considered at high risk for breast cancer.

American Cancer Society, American College of Radiology and American Society of Breast Surgeons all consider annual mammograms as the best defense, along with an annual breast exam by a medical professional, Cacek said.

In addition, Cacek continues to advise women to do monthly breast self-exams, despite studies that show no change in mortality rates or chance of reducing complications.

“I can’t tell you how many women come in with a completely normal mammogram and they felt something,” Cacek said. “Twenty percent of cancers we can’t see on a mammogram. That’s the importance of breast self-exams and the annual professional exams.”

Conemaugh Health System’s addition of digital mammography has raised the standard, and Laurel Highlands’ program allows for consistency in screening and diagnostic followup across the six locations in Cambria and Somerset counties.

“We have one radiologist dedicated to screening mammograms,” Cacek said, adding another specialist takes all follow-up mammograms during the diagnosis stage of care.

Mammograms are helpful in localizing certain types of breast cancer, but ultrasound and magnetic resonance imaging become more important for other cancers, Cacek said. Ultrasound is useful when the woman or her doctor find a lump that is not visible on a mammogram. It is also used in conjunction with mammography for pinpointing the cancer’s location, Cacek said.

“The two together give the best to detail what the lesions are,” she said.

MRI is a standard screening supplemental tool for women at high risk for breast cancer because of previous cancer, family history or other factors.

All three imaging modalities are used to guide the radiologist’s or surgeon’s instruments during a needle biopsy, Cacek said. Ultrasound-guided biopsies are often preferred over stereotactic mammography-guided procedures because the breast doesn’t have to be placed back into the mammography machine’s compression plates, Cacek said. MRI-guided biopsies don’t require a compression either.

MRI can be used to identify how much cancer might be in tissue around a tumor, showing surgeons how much of the margin should be removed during a lumpectomy, Cacek said.

“It is the most sensitive breast imaging we have to help with presurgery,” Cacek said. “It might change what you do from a lumpectomy to a mastectomy.”

Once the cancer is surgically removed, MRI updates provide the medical oncologist with an idea of how the tumor is responding to chemotherapy or hormone therapy, Cacek added.

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