Category: News

Dr. Destounis in national spotlight as a co-author of updated screening guidelines just released

Updated breast cancer screening guidelines from the ACR and SBI highlight the importance of annual screening for all women
HIGHLIGHTS include
  • Starting screening at 40 for all women
  • The benefit of a risk assessment by 30
  • Addressing underserved and overlooked populations including transgender people and minority women’

See the full article on Spectrum News 1

 



The American College of Radiology (ACR) and Society of Breast Imaging (SBI) jointly published updated breast cancer screening guidelines in June 2021 in the Journal of the American College of Radiology (JACR). The updated guidelines have a few main points. The guidelines state that all women should have a risk assessment by age 30 – especially minority women. It also emphasizes the importance of screening in overlooked or underserved populations, including transgender individuals and Black women. The ACR and SBI continue to recommend annual screening beginning at age 40 for women of average risk.

The new guidelines point out that certain factors such as sex assigned at birth, hormone use, and surgical histories place transgender individuals at increased risk for breast cancer, and describe that “due to hormone use, biological males transitioning to female are at increased risk for breast cancer compared to other males.” Further, biological females transitioning to a male who does not undergo mastectomy remain at their previous risk for breast cancer – this is important to note as many transgender individuals are less likely to undergo routine checkups and screening. This is true, too, for many minority women, “said Dr. Emily Conant, one of the authors of the guidelines. Minority women are 72% more likely to be diagnosed with breast cancer before age 50, 58% are more likely to be diagnosed with the advanced-stage disease before 50, and 12% more likely to die from the disease, compared with white women.” Therefore, it is vital that all women undergo a risk assessment by age 30 and start screening at age 40 – delaying screening until 50 will result in unnecessary loss of life to breast cancer, particularly in minority women.

Stamatia V. Destounis, M.D., FACR

Since the 1980s, when annual screening mammography became widespread, it has been proven to decrease breast cancer mortality by 40%. To maximize the benefits of screening mammography, annual screening should be followed without an upper age limit. Dr. Stamatia Destounis, one of our very own Elizabeth Wende Breast Care (EWBC) physicians, and author of the new guidelines, and the Chief of the ACR Breast Imaging Commission said, “new evidence continues to support annual screening starting at age 40, with closer attention given to minority women in underserved populations…. mounting data and more inclusive screening recommendations should remove any thought that regular screening is controversial.”

Reference: Monticciolo DL, Malak SF, Friedewald SM, Eby PR, Newell MS, Moy L, Destounis S, Leung J, Hendrick RE, Smetherman D. Breast Cancer Screening Recommendations Inclusive of All Women at Average Risk: Update from the ACR and Society of Breast Imaging. J Am Coll Radiol 2021, article in press.

Read the full article (abstract)

 

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Why going to the same breast center every year is important in mammography screening

It is important to develop a lifelong relationship with your breast imaging specialists dedicated to the early detection of breast cancer.

Most women of average risk will begin having annual screening mammograms at the age of 40. Current guidelines from the Society of Breast Imaging and the American College of Radiology state that patients should continue having annual screening mammograms as long as they are in good health, which for many could be well into their late 70-80s. This potentially means patients could have a 40-year relationship with EWBC! Every year for 40 years! But, WHY?

What is so important about coming to EWBC compared to going to another facility that also does mammograms?  Aren’t all mammograms and radiologists the same? From the first time you call our office to schedule an appointment and step into one of our seven locations, you can tell why EWBC is different. Our professional and supportive staff is led by a team of highly trained breast imaging radiologists who double read every screening mammogram. All EWBC technologists are specifically focused on mammography, and our sonographers are specialized in breast ultrasound.

Our goal is to provide the type of care for our patients that we would expect our loved ones to receive. We take time to explain every step along the way and make sure you are as comfortable as possible. If you have an unexpected problem or concern, we can typically see you within 24-48 hours. Most importantly, we’ve invested in the latest technology to provide you with quick and accurate results. Our doctors go the extra mile to answer questions, review results and provide support. Whenever patients have a biopsy, they leave the office with the doctor’s cell phone number and are encouraged to call if needed.  If you have a diagnosis that requires surgery or treatment, we are always available to answer questions.

We adhere to the recommended screening intervals set forth by the Society of Breast Imaging and the American College of Radiology. Their guidance allows us to remain focused on our patients and provide the most appropriate care for each patient. Our experience of opening the first dedicated breast clinic in the nation sets us apart.

Call one of our many offices located throughout the Rochester, NY area at (585) 442-2190 to request an appointment today!

Important information about your appointment

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A NOTICE TO OUR PATIENTS:

In recent months, our patients have been receiving texts and emails from facilities other than Elizabeth Wende Breast Care (EWBC) stating they are due for their mammogram. This has confused patients as it is not yet time for their yearly appointment.

Please be aware of marketing emails or texts sent to you by other facilities suggesting you are due for a mammogram and take note of the medical facility sending that message.

Any communication regarding your scheduled appointment
at EWBC will be emailed from
donotreply@ewbc.com OR via text message.

You can always verify your past and future EWBC appointments on our patient portal or by calling the office at 585-442-2190.

We value you as our patient and thank you for choosing EWBC for your breast care needs.

EWBC with Cancer Services Program has provided 28 years of free cancer screenings

For the past 28 years, Elizabeth Wende Breast Care (EWBC) and Cancer Services Program (CSP) has provided no-cost breast cancer screenings for uninsured patients.

Founded in 1993, CSP-FLR* is part of a larger statewide initiative run by the NYS Department of Health’s Cancer Services Program. CSP-FLR promotes age-appropriate breast exams for the uninsured and underinsured.

Services are provided through arrangements with health providers in each county, allowing screenings offered close to home.

The CSP-FLR does not perform the screenings but pays for clinical breast exams and mammograms. The program also pays for follow-up diagnostic exams if there is an abnormal finding during a screening. In the unfortunate instance that cancer is discovered, the program will enroll eligible patients into the Medicaid Cancer Treatment Program (MCTP) to fully cover treatment services.

EWBC has been a proud participating provider with the Cancer Services Programs across NYS since its inception. Over the years, EWBC has provided breast care for thousands of uninsured women. The physicians at EWBC volunteer a few Saturdays a year to screen, exam and work up patients with breast problems or concerns. This service is unique to the partnership between EWBC and CSP. as no other facility in the area offers CSP patients results and full diagnostic workup on the same day.

Elizabeth Wende Breast Care believes women deserve access to high-quality healthcare regardless of their barriers. Statistics have shown that people without quality health insurance delay receiving care, prolonging diagnosis, or negatively impacting prognosis. EWBC, along with the Cancer Services Programs in NYS, are committed to offering annual screenings to eligible women with the hope to find cancer at its earliest and most treatable stages.

Women with a family history of breast cancer, concerns about their risk, or issues paying for their screening mammogram should take advantage of this free event.

Saturdays 7:30 am until noon:

May 8, 2021
October 16, 2021
December 11, 2021
Other days available for your convenience. Give us a call to make an appointment that works with your schedule

Appointments at 585-442-2190

* The Cancer Services Program of the Finger Lakes Region (CSP-FLR) was formerly known as the Cancer Services Program of Monroe County and previously as the Women’s Health Partnership

Breast Cancer Facts

  • Breast cancer is the most common cancer found in women
  • 1 in 8 women will be diagnosed with breast cancer in their lifetime

Things to know about breast imaging (from Society of Breast Imaging- SBI)

Why 40? Beginning Your Annual Screening Mammography

Starting annual screening mammograms at age 40 saves life. Despite this fact, depending on who you ask, confusing recommendations remain, with some organizations recommending delaying screening until age 50. The thing is, there is no scientific or biological reason that the age of 50 was selected as the age to begin screening. It is scientifically proven that breast cancer incidence increases substantially around age 40, with one in 6 women diagnosed with breast cancer being a woman in her 40’s.

Starting screening at age 40 results in the greatest mortality reduction, with current research proving between 30-40% reduction in breast cancer deaths since mammography screening became widespread in the early 1990s. Not initiating screening at age 40 would be detrimental to women in the 40–49-year age group. Their cancer would clinically present later as a palpable mass, more advanced in stage, and more difficult to treat successfully. As the goal of screening is to detect breast cancer early, it is imperative to screen at age 40 to give women the best opportunity for just that, early detection.

It is confusing for women when major health organizations present different guidelines regarding when to start screening and how frequently. But it is important to note that every major American medical organization with expertise in breast cancer cases (American Congress of Obstetricians and Gynecologists, American Cancer Society, American College of Radiology, National Accreditation Program for Breast Centers, and Society of Breast Imaging) all agree starting at age 40 saves the most lives. Updated breast cancer screening guidelines from the ACR and SBI  (June 2021) highlight the importance of annual screening for all women.

Those in disagreement with this place more importance on the risks they perceive with mammography instead of the benefits. They worry about the anxiety a woman feels after a false alarm, such as a callback, or the potential for overdiagnosis, which identifies a tumor that may not advance during the woman’s lifetime and leads to unnecessary treatment. However, the research does not support these concerns. The anxiety women feel after a call-back is short-term, and in fact, research has shown that even after a call-back, women still support routine screening. The overdiagnosis theory is frequently overhyped, with the real overdiagnosis rate cited by experts as less than 10%.

Science at this time cannot tell for certain which small tumors will progress to deadly cancer versus some that will grow very slowly over time; therefore, all women 40 years and older should be screened annually. Mammography screening beginning at 40 results in the most lives saved and the most life-years gained.

WHY EWBC?  Five Important Reasons

Your First Mammogram. What to Expect!

 

 

 

Enlarged lymph nodes in the underarm after the COVID-19 vaccine

Dr. Destounis talks about enlarged lymph nodes with the COVID-19 vaccine:

Enlarged lymph nodes in the underarm after the COVID-19 vaccine
Stamatia Destounis, MD

A side effect of COVID-19 vaccination can be swollen lymph nodes in the underarm on the side where the COVID-19 vaccination was given. This is seen now about 15-20% of the time after the first and or second vaccination dose. These lymph nodes may be large enough to be found on a breast exam by you or your doctor or seen on your screening mammogram. There is no reason to worry as our breast imaging physicians are very familiar with lymph node enlargement with other vaccinations including for the flu, or shingles, and with infections that involve the breast, chest, or arm.

During the COVID pandemic many women may have delayed their screening mammograms for safety reasons, however, we don’t want you to skip your yearly mammogram. We also don’t want you to postpone your COVID vaccination if you have it scheduled as both are important for your health. Our staff and physicians will be happy to answer any questions you may have about your appointment.

If you haven’t had your vaccination yet our call center staff will do their best to schedule your screening mammogram before your vaccination appointment. This will eliminate any questions regarding swollen lymph nodes that may be visible on your mammogram. If you cannot change your mammogram appointment, because of work or other events and recently had your COVID vaccine don’t worry, come in for your mammogram, it is most important to get screened. The radiologists will interpret your images and review whether there are any enlarged lymph nodes seen in the underarm on the side of your vaccination injection and discuss this with you. Don’t cancel an important cancer screening appointment.

If you have a lump or your doctor has a concern about your breasts, you should schedule an appointment with one of our physicians as soon as possible. Any new problem in the breast needs to be evaluated by our doctors to make sure it is nothing serious.

Dr. Destounis discusses with Beth Adams, the Morning Edition Host/Reporter from WXXI, concerning your mammogram and the vaccine and not putting off either of them.

Society of Breast Imaging (SBI) Screening Mammography Recommendations for Women Receiving the COVID-19 Vaccine

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.

 

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