During this uncertain time, when a typical face to face consult is not possible, our genetic counselor is available for appointments via teleconference.
You can safely participate in a virtual genetic counseling session from the comfort of your home. If you have a current appointment scheduled, our staff will reach out to you to discuss converting the appointment to a teleconference. If you prefer a more traditional in person consultation, we will certainly reschedule your visit until later this year.
If you have any questions, please call us at (585) 758-7041 or send a secure EWBC portal message to the Genetics/MRI Department and a staff member will reach out to you.
EWBC’s research department has been busy preparing to present data from our clinic at the biggest radiological conference of the year; the Radiological Society of North America 2019 Annual Meeting in Chicago December 1–6, 2019.
Dr. Destounis, on behalf of the research team, will proudly be presenting data supporting the benefits of screening breast ultrasound in an oral presentation entitled, “Is there value to screening breast ultrasound as a supplement to mammography in women at average risk in comparison to those with known risk factors?” The team examined data from screening ultrasound and screening mammogram appointments in women with dense breast tissue over a four-year period, dividing the data by patients with one or more known risk factors (family history, hormone replacement therapy, etc.) and those without known risk factors. The study found screening ultrasound in patients with known risk factors detected a substantial number of cancers not seen on mammography (3.2/1000 additional cancers); 1.4/1000 cancers were detected in patients with no known risk factors.
These results support that goal of screening, and the use of screening ultrasound, in detecting additional malignancies previously undetected by screening mammography. Finding cancer early when it is small allows patients to have less invasive and less intensive treatments with the highest success rates.
Dr. Destounis and the EWBC research team have published past studies and articles which also support the use of screening ultrasound, but this study more clearly expresses that screening breast ultrasound is beneficial for all women with dense breasts, with or without known risk factors. At Elizabeth Wende Breast Care, we give the option of screening ultrasound to all patients who have mammographically dense breast tissue regardless of the presence of additional risk factors, or lack thereof. As a patient here at EWBC, if you are informed that you have dense breast tissue, you are one of the almost 50% of women – ask us today for more information on the benefits of screening ultrasound.
The landscape of genetic testing for cancer susceptibility is changing rapidly. Today, testing via a cancer gene panel is commonplace. However, the size and clinical utility of those panels is expanding. It is important for you, with the help of your physician, to carefully consider which option is best for you. Panels can be as small as only including those breast cancer causing genes with associated management guidelines or as large as 80+ genes. The larger panels are often without clear-cut risk information and management guidelines as the data about specific genes is newly emerging.
The year 2020 will likely include dramatic changes both in panel size and technology. It will certainly be the year of new advances in the field of genetic testing. This new technology will improve both detection and interpretation and will be an exciting era for those of us in direct patient care. The soon to be approved testing will provide better sensitivity and clarity for a significant portion of patients with previously identified variants of unknown clinical significance.
Risk assessment models are a tool we use to predict your future risk of breast cancer. One tool has recently been refined and as a result, you will have access to a more personalized medical management plan. Risk assessment models are used on women who have no personal history of breast cancer. One such model, Tyrer-Cuzick version 8, now includes your breast density. A 5-year, 10 year and lifetime risk of breast cancer can be calculated. This provides you and your healthcare team with a valuable tool in navigating the sometimes-complex field of breast imaging and surveillance. If you’re a high risk patient with dense tissue, you are likely eligible for a screening ultrasound and MRI in addition to your yearly screening mammogram.
As always, genetic counseling can help you determine the best personal course of action. Am I candidate for genetic testing? Am I candidate for MRI? I was previously tested, do I need a larger panel? Will my insurance cover genetic testing?
If you have questions, please reach out to our Cancer Risk Assessment and Genetic Counseling office at Elizabeth Wende Breast Care. Our certified genetic counselor, Jessica Salamone and her staff would be happy to assist you. (585) 758-7041.
Elizabeth Wende Breast Care is proud to announce the opening of the Webster office at 55 Barrett Drive in early March 2020 for screening mammography and screening breast ultrasound for women with dense breasts. Appointments are being taken now online at portal.ewbc.com or by calling (585) 442-2190.
Dr. Stamatia Destounis talks with Deanna Dewberry from Channel 13 News about the mammography guideline debate.
A screening mammogram is an important step in a woman’s preventative healthcare routine. Unfortunately, there is a lot of misinformation regarding screening mammography and breast cancer. Below are the most frequent myths I encounter when dealing with my patients.
Dr. Lisa Paulis, Elizabeth Wende Breast Care
Annual screening mammography is only important for patients with a family history of breast cancer.
Seventy-five percent of women diagnosed with breast cancer have NO family history of the disease. In the general population 12% of women will develop breast cancer in their lifetime and 42,000 Americans will die from breast cancer this year.
Women who are at a higher than average risk due to personal or family history, prior atypical biopsy results, certain genetic factors etc. may benefit from additional screening (ultrasound, MRI) and/or genetic counseling. However, the absence of risk factors should not prevent a patient from pursuing screening imaging. In our local patient population only 4% of the patients we diagnosed last year had a known gene mutation.
Screening mammography should not be performed in younger patients (ages 40-50) due to false positive results.
A false positive is an area that appears abnormal on initial imaging but represents normal tissue on subsequent studies. False positives can generate additional testing in order to determine a true result. In mammography, false positive results can mean anything from additional mammographic views, after which most patients will not require further workup, to ultrasound or minimally invasive biopsy procedures. Out of every 100 women who have a mammogram; 95 will be told that their mammogram results are normal, and 5 will be asked to return for additional mammogram and/or ultrasound testing. We feel strongly that women should be aware of these statistics to make an informed decision on how they weigh the risk of being one of the women who potentially needs additional workup versus the risk of not screening. Of note, 12% of the cancers we diagnosed in our community in 2018 were in women in their forties.
Mammography is ineffective in screening for cancer in women with dense breast tissue.
Breast density is determined by the proportion of fat and glandular tissue in the breast. The more glandular tissue a patient has, the more “dense” the tissue is graded. Each patient is assigned a breast density classification on their mammogram which ranges from entirely fatty tissue to extremely dense glandular tissue. Small breast cancers can be harder to identify on traditional mammograms in patients with dense tissue, however a newer technology called tomosynthesis (3D mammography) spreads out the tissue to improve detection. Additionally, screening breast ultrasound provides another way to “see through” the density and find small masses. Mammograms remain the most accurate tool available to diagnose ductal carcinoma in situ or DCIS which can be the earliest form of breast cancer we can identify. In patients with dense tissue, consideration should be given to screening mammography accompanied by ultrasound to offer the most comprehensive benefits of imaging.
Dr. Wade Hedegard talks about the mammography guideline debate with Channel 13 news (April 10, 2019)
Dr. Stamatia Destounis debates new mammography guidelines on Channel 8 news (April 9, 2019)