Breast Cancer Awareness Month - Assessing Breast Health

October is Breast Cancer Awareness month and I thought that I would discuss some of the most important detection methods for assessing breast health.

While the safety of mammograms continues to be assessed, other imaging tests to consider include: ultrasound, thermography, or MRI for early screening. Remember to perform breast self-exams once a month. Over 80% of most breast problems are found through self-examination. A summary of the various detection methods is discussed below.

Mammography

A mammogram is an x-ray of the breast and is commonly used to screen for breast cancer. It typically picks up lesions as small as 0.5 cm, which are usually not palpable through a breast exam. Mammograms can detect approximately 85% of all breast cancers whereas an experienced physician can detect 61 to 92% of breast cancers through a routine breast exam.

However, some women are choosing other screening tools for several reasons. One reason is that mammograms may be less accurate in picking up lesions in smaller breasts and can miss up to 25% of tumors in women 40 to 49 years of age. The other dilemma is that mammograms do require small doses of radiation, which can accumulate over time and increase the risk of developing breast cancer. It may take 40 years for cancer to show up after exposure to radiation, so for women under the age of 50 receiving annual mammograms, this may pose a risk.

Breast Ultrasound

An ultrasound uses sound waves to produce images of structures deep within the body, and can help determine whether a breast abnormality is likely to be a fluid-filled cyst (typically non-cancerous) or a solid mass (may be cancerous).

Ultrasounds are ideal at examining a lump or area of concern that has already been identified by a physical exam or mammography, but are not so useful as a whole breast-screening tool. They are generally safe and there is no radiation exposure.

If the ultrasound finds a lump that is filled with fluid, a biopsy is not necessary.

However, if it shows that the mass is solid, then a biopsy is conducted to determine whether the lump is a fibroadenoma or cancer. An ultrasound may be used before a mammogram when a cyst is suspected and therefore, a patient can be spared exposure to radiation.

MRI

An MRI uses magnet and radio waves to create pictures of the interior of your breast. MRIs are more useful and accurate in women in their 20s and 30s who may have denser breasts and a higher genetic susceptibility. MRIs do not use radiation but instead use a huge magnet to image tissues after a contrast dye is injected intravenously. The dye is typically absorbed more easily by cancer cells than by normal or benign tissues. Some disadvantages to the breast MRI are that they are expensive, they produce a high level of false positive results and there is much interpretation needed by doctors and technicians.

Breast Thermography

Breast Thermography, also known as Medical Digital Infrared Thermal Imaging, is a noninvasive diagnostic technique that allows the examiner to visualize and quantify changes in skin surface temperature. A specialized digital infrared camera is used and provides a detailed ‘picture’ of the heat levels and patterns of the breast tissue.

It is non-invasive, no radiation is emitted to the patient and there is no contact to the breasts in contrast to the mammogram. By using the digital infrared imaging scans, the function, physiology and metabolism of the breast tissue can be assessed.

Abnormal cells are usually hotter than normal cells. This is because malignant tissue needs more blood supply and new blood vessels grow to feed this increased demand. This is called angiogenesis (“angio” meaning blood vessel and “genesis” meaning creation). Thermography will show the difference between normal breast tissue and problem areas.

Thermography fills a gap in clinical diagnosis. While x-rays, CT scans, ultrasound and MRI are tests of anatomy, thermography is unique in its capability to show physiological change and metabolic processes. It has also proven to be a very useful complementary procedure to other diagnostic modalities.

Canadian studies done at the Ville Marie Breast Center in Montreal have found that thermography was positive for 83% of breast cancers, compared to 61% for clinical breast exams alone and 84% for mammograms. When thermography was used in combination with a mammogram, the detection rate was increased to 95%.

Biopsy

A biopsy will confirm the presence of cancer if the above tests have not been definitive. During a biopsy, a tissue sample of the suspicious breast cells is taken and sent for lab testing to determine whether the cells are cancerous. Sometimes a lumpectomy is performed if the breast mass has been identified early and it has been confirmed that the cancer has not spread. The whole mass is then removed, with a large enough margin of normal tissue to be certain that all the cancer cells have been included.