Category: Mammography

No Need to Quarantine Screening Mammograms

Stamatia V. Destounis, MD, FACR, FSBI  | Elizabeth Wende Breast Care

The emergence of COVID-19 in the winter of 2020, and the subsequent shut-down in many areas of the country, led to the cancellation of many routine screening examinations, screening mammography included.

At the peak of the pandemic, the Centers for Disease Control and Prevention (CDC) [1], along with individual institutions, and societies such as the American Cancer Society (ACS) and American College of Radiology (ACR) [2], recommended women postpone attending screening to not expose themselves unnecessarily to the virus. At the time, reports showed that screening rates for breast, colon, prostate, and lung cancer were already declining, ultimately revealing a significantly lower attendance rate than the baseline rates of previous years [3].  Specifically, the report from the Epic Health Research Network showed that between March 15 and June 16 an estimated 285,000 breast cancer screenings were missed [3].

As the intensity of the virus subsided, many communities were able to re-open screening services, yet apprehension over visiting doctors’ offices persisted for many, and women have continued to be faced with the decision of whether to attend their annual mammogram appointment or to further delay screening to avoid potential exposure to the virus.

Breast cancer is the most common cancer in American women (except for skin cancers), with an estimated 276,480 new cases of invasive breast cancer expected to be diagnosed in women in the U.S. in 2020 [4]– but because of the reduced volume attending screening, there was nearly a 50% drop in new breast cancer diagnoses, according to a recent study published in the Journal of the American Medical Association (JAMA) [5]. Data from the National Cancer Institute (NCI) estimates that reduced screening for six months due to COVID-19 and the resulting delays in diagnosis and treatment could lead to nearly 10,000 extra deaths from breast and colorectal cancer alone in the next decade [6].

Detecting breast cancer at routine annual screening mammography is vital to diagnose breast cancer early, when it is in its most treatable form; small, and has not spread to the lymph nodes or other parts of the body, providing the highest chance of survival. Delays in screening attendance ultimately can lead to delays in diagnoses, contributing to larger, advanced cancers being diagnosed, requiring more invasive and taxing treatment.

Understanding all the facts is crucial when deciding to attend screening or delaying screening attendance further. While postponing was prudent at one time, continued delays in routine screening does pose health risks. The risk of developing cancer does not go away just because there is a pandemic. While many women rightfully decided to put off mammograms due to immediate COVID-related concerns, it is important to be aware that medical imaging centers have safely resumed offering screening mammograms. The future spread, duration, and peaks of COVID-19 remain unclear, however, getting back in for screenings is so important for early detection. Remember, early detection saves lives.

References
  1. Coronavirus Disease 2019 (COVID-19). (2020). Available at https://www.cdc.gov/coronavirus/2019-ncov/index.html. Accessed November 2020.
  2. ACR COVID-19 Clinical Resources for Radiologists. (2020). Available at  https://www.acr.org/Clinical-Resources/COVID-19-Radiology-Resources. Accessed November 2020.
  3. Epic Health Research Network: Preventive cancer screenings during COVID-19 pandemic. Available at www.ehrn.org/wp-content/uploads/Preventive-Cancer-Screenings-during-COVID-19-Pandemic.pdf. Accessed November 2020.
  4. American Cancer Society. Breast Cancer Facts & Figures 2019-2020. Atlanta: American Cancer Society, Inc. 2019.
  5. Kaufman HW, Chen Z, Niles J, et al. Changes in the Number of US Patients With Newly Identified Cancer Before and During the Coronavirus Disease 2019 (COVID-19) Pandemic. JAMA Netw Open. 2020; 3(8): e2017267.
  6. Sharpless NE. COVID-19 and Cancer. Science 2020; 368(6497): 1290.
About the Author

Stamatia V. Destounis, M.D., FACR

Stamatia Destounis, MD is a practicing radiologist at Elizabeth Wende Breast Care and Clinical Professor of Imaging Sciences at the University of Rochester School of Medicine and Dentistry.

Dr. Destounis is an ACR ultrasound and MRI accreditation reviewer and the chair of the ACR Breast MRI Quality Committee and Breast Economics Committee. She serves as chair on the SBI Patient Care and Delivery Committee and is the chair of the RSNA Breast Educational Exhibits Committee. Dr. Destounis serves as a reviewer for several peer-review journals.

Dr. Destounis is actively involved with research, acting as the principal investigator on several clinical trials conducted at her practice. Dr. Destounis’s personal research interests include digital breast tomosynthesis, screening mammography, breast ultrasound, and breast MRI, and she has published numerous peer-reviewed articles and book chapters throughout her career on these topics.

 

The Role of a Genetic Counselor in Your Healthcare

Genetic counselors play a crucial role in people’s healthcare – from helping them navigate the genetic testing process, to identifying key information in their family health history, to supporting them through an important medical decision.

Genetic counseling and cancer risk assessment can help people better understand their health, make informed healthcare decisions, and shape the future of personalized medicine.

EWBC Genetic Counseling

With genetic counseling, individuals and families can become aware of how their genetics can affect their health.

Genetic counselors, trained not only in medical genetics but also counseling, are the experts in helping people interpret these test results and guiding patients in their next steps.

Specifically, at a genetic counseling appointment, a genetic counselor would help:

  • Explore personal and family health history to become aware of genetic risks
  • Decide what, if any, genetic testing is best for patients and families
  • How a test result might not give you all the information you need
  • Discuss the medical and emotional implications of genetic information
  • Discuss genetic test results and next steps
  • How genetic test results may affect other family members

Genetic testing helps you learn if your family history of breast cancer is due to a specific inherited gene mutation. The test itself is simple – it’s done with a blood or saliva sample. Results come back in about a week. Genetic test results are a factor in determining the overall risk. Results can help you understand your risk of getting breast and ovarian cancers and steps you can take to reduce your risk. A positive test result does not mean you will get breast or ovarian cancer. If you test negative for a specific gene mutation, you still may be at an increased risk for breast or ovarian cancer.

You may wonder about purchasing an at-home DNA testing kit. While at-home DNA test kits can help with understanding genealogy, they can also unearth your potential risk of developing some significant health conditions in the future. That’s why a certified genetic counselor is recommended to discuss their potential risk based on family history and whether testing makes sense. Genetic counselors can also help people understand their results and ensure informed health decisions are being made after testing.

Each year, millions of people are undergoing genetic testing to learn more about their risks for certain inherited diseases, whether they’re a carrier for certain conditions or if they have a genetic mutation, like BRCA, which could lead to cancer. These tests aren’t meant to scare you, rather provide you with the tools you need to make informed health decisions.

Knowing your cancer risk and being proactive about your health may help you take steps to lower your risk of getting breast or ovarian cancer or find it at an early stage.  As always, genetic counseling can help you determine the best personal course of action. Questions you may have for a genetic counselor: Am I a candidate for genetic testing? Am I a candidate for an MRI? I was previously tested, do I need a larger panel? Will my insurance cover genetic testing?

Genetic counseling and testing are recommended for men or women whose family medical history has certain patterns of cancer. 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) 758-7050.

Meet our Genetic Counselor, Jessica Salamone, CGC

 

Do you need a mammogram but don’t have insurance? Come to a special screening Saturday on May 8!

Elizabeth Wende Breast Care (EWBC) together with Cancer Services Program of the Finger Lakes Region (CSP-FLR) provide free screening mammograms and clinical breast exams for women 40 and over who do not have insurance. The program also pays for follow-up diagnostic exams if there is an abnormal finding during a screening.

EWBC is holding special Saturday screening days on May 8, October 16 and  December 11, 2021 at the Brighton office. To schedule an appointment, call 585-442-2190. At this EWBC appointment expect social distancing and enhanced cleaning. If these special screening dates are not convenient, please call 585-442-2190 for additional dates.

Breast cancer is the most common type of cancer in women and is the second leading cause of cancer death in women (after lung cancer). Yearly mammograms starting at age 40 is the best way to find breast cancer early — when it may be easier to treat. We hope to see you soon.

We are here for your breast care needs

Exceptional care redesigned!

At EWBC you can expect social distancing, enhanced cleaning and same day results in a new way.

Patients are screened prior to and also at the time of their appointment. EWBC staff are screened daily.  Everyone is required to wear a mask.

We have spread out appointment times and furniture to help with social distancing. Companions are asked to wait in their car to reduce the amount of people in the building.

Our team is deep cleaning on a continual basis throughout the day. Imaging equipment and exam rooms are disinfected after each patient as well as all waiting rooms, common areas and frequently touched surfaces.

Elizabeth Wende Breast Care continues to offer same day results. Patients can choose to receive messages by email or text.

Our patients and dedicated staff are adapting well to this new patient experience. One patient recently commented:

“The fact that we are going through COVID-19, the staff were very accommodating, extremely cautious with cleanliness, very friendly, and made the experience as a whole welcoming and comfortable!”

Breast Imaging ⁠— it’s all we do. We hope to see you soon!

 

Myths of Mammography

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

Myth

Annual screening mammography is only important for patients with a family history of breast cancer.

The Facts

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.
Mammography Infographic

Myth

Screening mammography should not be performed in younger patients (ages 40-50) due to false positive results.

The Facts

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.

Myth

Mammography is ineffective in screening for cancer in women with dense breast tissue.

The Facts

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.

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