The Tribune Democrat, Johnstown, PA

Breast Cancer

October 17, 2012

Annual screenings urged

JOHNSTOWN — Women in rural areas of Cambria and Somerset counties can get their annual mammograms close to home, and be confident they will have the latest technology read by experts in a premier radiology organization.

“We cover from Meyersdale to Miners (medical center), with locations in Richland and Ebensburg,” Dr. Gary Kramer, president of Cambria Somerset Radiology & Nuclear Medicine Group Inc., said at Memorial Medical Center in Johns­town, where he is radiology department chairman.

“They are all integrated by the highest-level work stations. We can read these studies from anywhere.”

Cambria Somerset Radiology’s 18 board-certified radiologists include 14 accredited for mammography and five with breast magnetic resonance imaging accreditation.

Radiologists are usually the specialists who diagnose breast cancer.

“What we offer the area is state of the art,” diagnostic radiologist Dr. John Wherthey said. “You go to the Mayo Clinic, Cleveland Clinic, Johns Hopkins; whatever major center you name – we are giving the same technology that you can get there.”

The expertise should encourage women older than 40 – as well as men and younger women in high-risk groups – to get annual screening mammograms, Kramer said.

“This is a curable disease if caught early,” Kramer said. “Mammography is the primary mechanism to get them early.”

“Annual screening gives a 30 to 40 percent decrease in mortality,” said Dr. Stanley Golden, diagnostic radiologist and director of women’s imaging at Memorial.

Annual mammograms allow doctors to quickly identify changes from the previous study, Wherthey noted.

“That is the importance of getting your mammogram every year,” Wherthey said. “You look at the oldest, and then the next, and the next, and the next. We are looking for subtle changes.”

Conemaugh Health System’s new $2.6 million digital mammography network includes eight units at six locations throughout Cambria and Somerset counties. Cambria Somerset Radiology doctors staff most of the locations, but their schedules do not limit women’s access to the expertise.

“The benefit is if you are in Meyersdale, you have the same thing as Johnstown,” Wherthey said. “If someone from our group isn’t there that day, we can look at it (in Johnstown) right away and tell you if it’s nothing or if you need a biopsy.

“You don’t have to go out of town. You are getting the same care you would get in a university setting.”

Fear and economics are often given as excuses to avoid annual screenings, but the doctors have answers in both areas. All hospitals in the region have free mammogram programs for income-eligible patients.

For those fearing the results, Kramer stresses that breast cancer is one of the most curable cancers when caught early.

Although radiation from the mammogram is a concern, diagnostic radiologist Dr. Stephanie Morton Simonson said the amount of radiation from the annual screening is at the low end of the exposure spectrum. And digital mammography has reduced the dose even more.

“We are trying to reduce the amount of radiation we use everywhere,” Simonson said. “You are always more conscious in young people.”

A mammography screening adds about four-tenths of a millisievert to a patient’s annual exposure, about the same as an abdominal X-ray, the Centers for Disease Control and Prevention estimates.

A full chest computed-tomography scan will add seven millisieverts.

The average annual exposure from sunlight and background radiation is three millisieverts, the CDC reports.

But many women in the region are apparently finding excuses to skip the life-saving test, Kramer said, estimating that 50,000 women in the two counties are not getting annual screenings. Kramer bases that on a comparison of age-eligible population and the number of mammograms being read by his group, which also includes mammograms done at Joyce Murtha Breast Care Center in Windber. Somerset Hospital’s mammograms are read by Pittsburgh-based Foundation Radiology Group.

Indiana County’s numbers aren’t much better, nurse navigator Susan Majoris said. Using Indiana Regional Medical Center’s mammography network numbers, there are about 15,000 women older than 40 who are not getting annual screenings.

Although most suspicious mammograms turn out to be benign, two-thirds of all breast cancer is found through mammography, breast surgeon Dr. Gerard Garguilo said.

If doctors want more information than the mammogram provides, they can turn to the MRI or ultrasound, which can further differentiate tissues and structures in the breast without radiation, Golden said.

“MRI is part of the screening for breast cancer in specific patients – someone at high risk,” Golden said, listing genetic risk factors such as the BRCA genes, strong family history and prior radiation exposure from childhood cancer treatments.

MRI is also used to check for more lesions before the cancer team decides on a surgical approach, Golden added.

“For someone with known cancer, we can evaluate the extent of the disease before treatment,” he said, explaining that MRIs often find additional small tumors in the same breast or in the other breast.

Ultrasound differentiates solid lesions, including cancer, from liquid pockets that are usually benign cysts. It takes a trained set of eyes to clarify the difference, Wherthey said.

“That’s what the radiologist brings to this, because we look at both of the studies,” Wherthey said. “We can say, ‘This is where it is in the breast on the mammogram,’ so we know where to look in the ultrasound.”

Ultrasound, MRI and mammography are also used to direct the radiologist or surgeon removing tiny samples of the suspect lesion through image-guided needle biopsies, Kramer said.

The procedures leave virtually no scars and usually provide peace of mind, because four out of five biopsies are not cancer, Kramer said.

“This minimally invasive technique has revolutionized care for women,” Simonson said. “That has changed the whole method of diagnosing cancer.”

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