Tuesday October 7, 2014
The month of October has arrived on our doorsteps. Its arrival blesses us with crisp cool air, the smell of burning leaves and children’s laughter as they trickle down our streets in disguise loading up bags with free sugar.
Our days, once cooled with green, begin to warm us with vibrant orange, red and yellow. Autumn is here.
Alongside the arrival of autumn, for the past nearly three decades the month of October has also brought breast cancer awareness to the forefront.
Most of us are cognizant of the fact that October is designated as National Breast Cancer Awareness Month, widely symbolized with the color pink. NBCAM is a nationwide campaign, composed of various medical associations, government agencies and public service organizations, dedicated to promoting awareness of breast cancer in an effort to educate the public on the importance of early detection and provide more access to services, including screening exams.
The campaign has continually grown over the years, bringing in community support from across the nation through fundraisers like the Susan G. Komen’s "3-Day" — a 20-mile walk spread across three days. One of the reasons for this growth is breast cancer is the second leading cause of cancer death in women.
The American Cancer Society reported in its 2011-2012 "Breast Cancer Facts & Figures" that, while men are generally at low risk for developing breast cancer, breast cancer is the most common cancer found in women outside of cancers of the skin, and accounts for 1 in 3 cancers diagnosed in U.S. women.
What is breast cancer?
As defined by the ACS "cancer is a group of diseases that cause cells in the body to change and grow out of control ...breast cancer begins in the breast tissue." One of the most prominent issues in treatment is that breast cancer generally does not produce symptoms when it is most treatable in its early stages.
The purpose of breast cancer screening exams is to attempt to diagnose the cancer as early as possible, when it has the most hope for being treated successfully.
How can it be detected early?
The ACS guidelines for early detection of breast cancer are contingent on age, and include clinical breast examination, breast self-exam, mammography (X-ray), as well as magnetic resonance imaging for those individuals at high risk.
The ACS recommends that women age 40 and older have a mammogram every year so long as they are in good health (good health is noted because an X-ray exposes one to potentially harmful radiation).
Women in their 20s and 30s are recommended to have a CBE as part of their regular health exam, which should be performed every three years.
Beginning at age 40 it is recommended that women have a CBE annually. The BSE is recommended as an option to women in their 20s. (To find more information on these screening exams, visit the ACS at cancer.org.)
Many of us have heard of a mammogram, but what is a breast MRI? MRI scans use magnets and radio waves instead of X-rays to produce very detailed, crosssectional images of the body. Because it provides soft tissue contrast, it can assist in the search for malignancies in the breast. In the 1990s, it was mostly used to determine if a breast implant had been ruptured, but exam results soon began to show tumors in dense breast tissue. In light of this discovery, physicians began using MRI as a follow up test to a suspicious mammogram. The breast MRI is now part of the ACS guidelines for early detection.
The ACS recommends women at high risk get a breast MRI annually in addition to a mammogram. As defined by the ACS, women at high risk include those who:
- Have a known BRCA1 or BRCA2 gene mutation.
- Have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves.
- Have a lifetime risk of breast cancer of 20 percent to 25 percent or greater, according to risk assessment tools that are based mainly on family history.
- Had radiation therapy to the chest when they were between the ages of 10 and 30 years.
- Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have one of these syndromes in first-degree relatives.
Breastcancer.org, a nonprofit organization dedicated to providing information and community to those touched by this disease, lists three main uses for the breast MRI: screening for high-risk women; gathering more information about an area of suspicion found on a mammogram or ultrasound; and monitoring for recurrence after treatment.
In regard to diagnosis and monitoring, breastcancer.org reports that a breast MRI can be useful in gathering more information about an area in the breast that is suspicious or already confirmed to be cancerous.
Breastcancer.org also lists the following other uses for the breast MRI:
- Evaluating a person who has a palpable mass (a mass that can be felt) that isn’t visible with ultrasound or mammography.
- Evaluating a lesion in the densely glandular breast of a young woman. (Young women tend to have dense breast tissue, which makes it difficult to see abnormal areas on imaging studies.)
- Evaluating a person who has breast cancer cells in an underarm lymph node, but no breast mass that doctors are able to feel or to see on a mammogram. In these cases, where mastectomy is typically recommended, MRI can help find the precise site of the cancer’s origin within the breast. Finding the cancer’s site of origin can expand a woman’s treatment options from only mastectomy to include lumpectomy plus radiation.
- Determining if a cancer is limited to one area of the breast, or if it is “multicentric" and involves more than one area. Knowing this affects treatment choices, since mastectomy is necessary for multicentric disease. MRI can be particularly useful for women with invasive lobular cancer, which has a tendency to be diffuse or multicentric.
- Checking a woman’s other breast for signs of cancer after she receives her initial cancer diagnosis.
- Examining breast tissue in women who have had silicone breast implants. MRI scanning can detect leakage from a silicone-filled breast implant, since it easily distinguishes silicone gel from surrounding normal breast and chest wall tissues.
After treatment for breast cancer undergoing a lumpectomy), MRI can also be useful for checking scar tissue. If significant changes are found, it may suggest a return of the breast cancer.
Details on the MRI procedure
Breast MRI is safe and poses no risk to the average patient if appropriate guidelines are followed.
It is an outpatient procedure that requires the woman to lie face down on the MRI table roughly 45 minutes, with her breasts positioned through cushioned openings.
The exam will typically require the use of a contrast dye (safe and painless) that is injected into a vein in the arm before or during the procedure, which assists in creating clearer images that outline abnormalities more efficiently. As with all MRIs, it requires that the patient lay very still as movement could cause distortion of the images and therefore affect the quality of the images and the exam.
Although breast MRI is not a substitute for mammography, a number of recent studies have found it to be an effective tool for screening high risk women when it is used in combination with mammography. If you think you might be a candidate for the breast MRI screening, as with all health issues, it is imperative to consult with your physician to determine the best choice for your individual health needs.
If you find you are an ideal candidate, you will also need to locate a facility that has MRI equipment that is designed specifically for imaging of the breasts, such as our facility, Northwestern Medical Imaging. Also be sure to verify with your insurance company if the exam will be covered. If the exam is not covered under your insurance policy, or if you are uninsured or have a high deductible, Northwestern Medical Imaging offers competitive self-pay rates and payment plan options.
More about Northwestern Medical Imaging Northwestern Medical Imaging offers superior imaging to patients via our Siemens 1.5 Tesla extra-large short bore (puts claustrophobic patients at ease) MRI and multi-slice CT equipment.
Our radiology services are provided by the prestigious Northwestern Memorial Hospital and Ann & Robert H. Lurie Children’s Hospital of Chicago. Our breast MRI radiology services are provided by Proscan Reading Services, one of the world’s most experienced teleradiology providers.
Northwestern Medical Imaging is at 1946 45th Ave., between Calumet Avenue and Indianapolis Boulevard. For more information, call 219-924-0710.
The Facts and Figures
According to Susan G. Komen, the death rate for breast cancer is 30 percent lower than it was 25 years ago. Here are some of the facts about breast cancer, as reported by the nonprofit Susan G. Komen:
One in eight women in the U.S. will be diagnosed with breast cancer in her lifetime.
Breast cancer is the leading cause of cancer death among women age 40-50 years in the U.S.
Breast cancer is second only to lung cancer in cancer deaths among women in the U.S.
The five-year relative survival rate for all women with breast cancer found at a local stage (cancer that has not spread) in the U.S. is 99 percent, 84 percent for regional disease and 23 percent for distant stage disease.
A case of breast cancer is diagnosed among women every two minutes, and a woman dies of breast cancer every 13 minutes in the U.S.
There are more than 2.9 million breast cancer survivors alive in the U.S. today, the largest group of cancer survivors in the country.
Approximately 5 to 10 percent of breast cancers in the U.S. are due to inherited BRCA1 or BRCA 2 genetic mutations (less than 1 percent of the general population).
Approximately 95 percent of all breast cancers in the U.S. occur in women 40 years of age and older.
Recent studies suggest that many women in the U.S. are not following recommended guidelines for mammography screening by having their first screening later than recommended, not having one at recommended intervals or not receiving appropriate and timely follow-up of positive screening results. This may lead to more advanced tumor size and stage at diagnosis.
Saving lives through research
Because of medical research, the death rate for breast cancer is 30 percent lower than it was 25 years ago and more than 2.9 million women are breast cancer survivors today. Komen’s investment in medical research over the past 30 years has contributed to many of the advances that now help women affected by breast cancer live longer and healthier lives. To date, the non-profit has invested more than $2.2 billion in research and life-saving community programs.
—Information courtesy of Susan G. Komen
5 Resources For More Information
American Cancer Society:
cancer.org — a nationwide, community-based voluntary health organization dedicated to eliminating cancer as a major health problem.
breastcancer.org — a nonprofit organization dedicated to providing up-to-date information about breast cancer. Breastcancer.org was created to address the need for accessible, understandable, and compassionate information about breast cancer treatment issues
Susan G. Komen:
komen.org — works to end breast cancer. To date, the nonprofit has invested more than $2.2 billion in research and life-saving community programs.
National Breast Cancer Foundation Inc.:
nationalbreastcancer.org — NBCF’s mission is to save lives through early detection and to provide mammograms for those in need.
National Breast Cancer Awareness Month (NBCAM):
nbcam.org — dedicated to raising awareness and educating individuals about breast cancer.