Mammography Matters

More Mastectomies?

2008-05-16T12:47:00Z

It is always interesting to go back and look at statistics once a new type of imaging has been utilized to help detect breast cancer. Researchers at Mayo Clinic did just that and came up with some very interesting results.

The doctors at Mayo Clinic started using breast MRIs for patients with breast tumors in 2003. The use of MRI in these type of patients has doubled from about 11% to 22% during that same time period. When looking at mastectomy rates from Mayo Clinic from 2003 to now, the rates have gone up from 30% to 43%.

Mayo Clinic had 5,500 women in their study and almost 50% of the women who had a MRI opted for a mastectomy. This number is compared with 38% of women opting for a mastectomy that have not had a MRI. Allen Lichter, the oncology society's chief executive officer says that many of these mastectomies may be unnecessary because researchers have shown that up to half of suspicious findings on a breast MRI are not cancer. Julie Gralow, associate professor at the University of Washington, stresses that it is important to perform additional biopsies on these areas in question before a mastectomy is performed.

Many women choose a mastectomy for many different reasons. For some living in rural areas, radiation therapy may be hundreds of miles away. One other interesting consideration is that because women who did not have a breast MRI also chose to have mastectomies more frequently, this may be due to improvements in reconstructive surgery. Also, with genetic testing now available, many women that find themselves predisposed to breast cancer are also choosing to have prophylactic mastectomies.

I must also wonder whether insurance coverage is any consideration in some of these cases also. It is an unfortunate truth that rate of uninsured patients keeps going up. I know that for many patients who skipped a year or two on their annual mammograms more and more are saying that they did not have medical insurance during that time. There are many difficult decisions that need to be made once a women is diagnosed with breast cancer. Lets hope that diligent research keeps providing us with more and more options to beat this form of cancer.

Beans, Beans the Magical Fruit….

2008-05-13T12:32:00Z

According to a recent study published in the International Journal of Cancer, beans may offer some protection for pre-menopausal women against developing breast cancer. Researchers from the Harvard School of Public Health in Boston examined data received from 90,000 women regarding their dietary habits. Women who ate beans and lentils at least twice a week had a 24% lower risk of developing breast cancer, compared with women who ate beans and lentils less than once a month.

A second study was conducted that examined the link between breast cancer and the glycemic index, as well as other factors in the diets of about 50,000 Canadian women. The glycemic index of a particular food varies based upon how it is processed and prepared. For the most part, foods that are high in fiber, such as beans, vegetables and fruit, have a better glycemic rating than more processed or starchy foods. The results of this study were a little unusual. Researchers found that there was no link between the glycemic index and breast cancer in the general population. Where it seemed to matter was in postmenopausal women. They found that postmenopausal women with diets that had a high glycemic index had an 87% greater risk of breast cancer.

As with most studies, additional research must be conducted before any definitive conclusions can be made. But it sounds like adding a few more servings of beans and lentils to your weekly diet may not be a bad idea!

An Aspirin a Day...

2008-05-08T13:42:00Z

There has been a new study published in the online edition of Breast Cancer Research that examines the possible benefits of taking an aspirin a day to help prevent some types of breast cancer. By taking a daily dose of aspirin, women may decrease their risk of getting the most common form of breast cancer---estrogen receptor-positive breast cancer---by about 16 percent. Estrogen receptor-positive breast cancer is the most common form of breast cancer and is responsible for about 75 percent of breast cancer diagnoses.

Aspirin effects were studied along with other NSAIDs (nonsteroidal anti-inflammatory drugs). Aspirin shows to have different biological effects when compared with other NSAIDs, the researchers at the U.S. National Cancer Institute have found. There was no decrease in estrogen receptor-negative breast cancer found by taking any of the NSAIDs, aspirin included.

The researchers cautioned that much more work must be done to clarify these initial results and since long term aspirin use may have serious side-effects, like gastrointestinal bleeding, patients must always consult their physician before starting on any type of medication. There are contraindications for many patients to begin aspirin therapy.

While it is not advised for women to start taking aspirin based on this initial study, it does seem like new information has again been found regarding breast cancer and how different types of breast cancer react differently to different types of medication. The more that is found out in regards to breast cancer, the closer we are to someday, hopefully, being able to prevent it.

QC, Cushion Pads and the FDA

2008-05-02T12:59:00Z

The facility that I work at does not use cushion pads when performing exams. We tried them many years ago and for many different reasons chose not to use them. Every once in awhile a patient will ask if we use them and occasionally a vendor will stop by to entice us into using them on our patients.

When I was reading the recent updates for mammography from the FDA, there were some interesting points brought up about the use of cushion pads and quality control. Since we don't use the pads, I have never thought about their use in regards to quality control.

Prior to full-field digital mammography (FFDM), it seems that if you routinely used the cushion pads on most of your patients, the FDA required you to perform your weekly phantom and the annual phantom and dose QC tests with the cushion. This was done to simulate your typical clinical conditions.

With the widespread use of FFDM, the FDA had to reexamine this rule. The FDA has changed their wording and intent slightly on this issue now. The FDA still recommends that the phantom test be done under clinical conditions, but they only require the pad be used if the manufacturer of your mammography unit requires that it be used during the quality control testing. In other words, the quality control testing, like phantom imaging, is tested in the manner that your image receptor manufacturer recommends.

For many of us mammographers, this change will not affect our quality control process because we do not use the cushion pads. If you routinely use these pads make sure you read the updates on the FDA website, and consult your physicist and vendor if you still have questions.

Fill Mine to the Rim

2008-04-30T12:51:00Z

I am sure that I have shared with all of you just how much I love a good cup of coffee in the morning. My shift starts at 6am, and without a good, robust cup of coffee, I would definitely be in trouble!

Many times the media tries to make us feel guilty about enjoying that enticing and invigorating morning favorite. That is, until I read an article published in the journal Cancer Epidemiology, Biomarkers and Prevention.

Researchers from Lund University and Malmo University in Sweden say that depending on a particular variant of gene CYP1A2 a woman has, drinking two or three cups of coffee a day may reduce your risk of getting breast cancer or delay the onset of breast cancer. The benefits of drinking coffee vary depending upon which variant of the gene women have.

Of the women in the study group, half had a gene variant called A/A, and the rest of the women either had an A/C or C/C variant. Women who had one of the C variants and drank at least three cups of coffee a day had a significantly lower risk of breast cancer--- 2/3 the risk of women who had the A/A variant and drank the same amount of coffee.

Women with the A/A variant who drank at least two cups of coffee a day seemed to delay their initial onset of breast cancer by about ten years. This, of course, was different if they had received hormone replacement therapy.

The lead author, Erika Bageman, and her co-researchers stressed that these results need to be further researched and analyzed.

Although it is much too early to start changing our coffee consumption habits based upon this one study, maybe we can stop feeling quite so guilty about refilling our cup one more time.

Now if they could find some positive benefits of those chips...

“When Can I Stop Having Mammograms?”

2008-04-25T12:43:00Z

How many times have your older mammography patients asked you this question?

My guess is quite often!

With aging comes a huge onslaught of additional things that need to be done in a timely manner. Bone densities, colonoscopies, pap smears, lots of blood work, dental visits, eye doctor appointments, electrocardiograms... The list could go on and on of all of the methods that keep us healthy as we journey into that "Golden Age."

No wonder our patients ask us when they can stop having mammograms. I try to answer them with a little bit of humor and tell them that I would miss seeing them far too much and they really do need to come back to see me next year.

In a study published in the Journal of Clinical Oncology, researchers from the University of Texas M.D. Anderson Cancer Center suggest that mammography benefits may have no age limits.

Researchers studied older women and breast cancer and found that only 22 percent of women age 80 and over were regularly screened with mammography. "Regularly screened" was defined as having at least three mammograms in the past five years.

Twenty nine percent of women in this age bracket had only one or two mammograms during the past five years. A total of 49 percent of women in this age bracket had no mammography in the five years before their diagnosis.

The more often a woman was screened, the more likely she was to be diagnosed with an earlier stage breast cancer than those women who were not as compliant. The researchers did say that you must also realize that women who are getting screened more frequently are possibly in better physical condition than those who are not because of other health issues.

About seventeen percent of breast cancers are diagnosed in women age 80 and above. So armed with a little bit of data, perhaps we can persuade those women to indeed come back again next year!

Welcome Sunshine!

2008-04-21T13:24:00Z

I absolutely love this time of year in the Midwest! It is like someone brought out the crayons and started coloring the world. What was drab and dreary has turned green and full of life. Trees that were bare and dead-looking are literally ready to burst out in a welcoming display of flowers and leaves. In Michigan, we also get to see a lot more of the sun, which has been sorely missed!

I am sure that most of you already know that the sun helps our bodies produce vitamin D. While I was reading the other day, I ran across yet another possible benefit of vitamin D.

There has been more research that seems to show a link between vitamin D and the risk of developing breast cancer. The study was conducted by the German Cancer Research Center, collaborating with the University Hospitals in Hamburg.

After studying 1,394 breast cancer patients, as well as an equal number of healthy women after menopause, women with a very low level of vitamin D in their blood had a far greater risk of breast cancer. (However, the researchers did admit that some of the cancer patients may have had a lower blood level due to chemotherapy or perhaps because of a long hospital stay.)

By counteracting the estrogen's growth promoting capabilities, it is thought that vitamin D is able to exert a cancer-preventing effect.

Dairy products and seafish both are rich in vitamin D, however, my personal plan is just to spend a little bit more time outside this spring, knowing that the sunshine makes me feel better emotionally and maybe even physically!

Examining the Media's Coverage of Breast Cancer

2008-04-18T12:43:00Z

Researchers at Michigan State University presented an interesting look at the media in regards to breast cancer in a paper published in the latest edition of the Journal of Health Communication.

National media coverage was examined over a two year period. Thirty one percent of the stories dealing with breast cancer focused on treatment, while only eighteen percent focused on prevention.

The concern is that women may get complacent regarding breast cancer because they believe that a cure may soon be discovered with all the break-through research currently being done.

Many articles focus on breast cancer patients and their struggles, which are very compelling and interesting to viewers, but lack the information women need to further the cause of cancer prevention. According to the researchers, articles on eating healthy and exercising make for very boring stories.

When you think about it, we are very influenced by what we hear and see in the media. Breast cancer survivor stories are a true source of inspiration for myself and continually remind me of how fortunate I am each and every day.

While we, as women, have little or no control over many of the risk factors for breast cancer---like our age and our family history---there are many steps we can take to lower our overall risk of cancer.

Exercise, eating right and avoiding certain substances in the environment that are known to contribute to breast cancer, do make less than captivating articles, but perhaps the media is indeed underestimating us.

I know that sometimes I tend to skip over or speed read some articles that contain information regarding cancer prevention. But I also know many brave women face the very real diagnosis of breast cancer everyday.

So, we owe it to ourselves, our children and our society as a whole to fight this cancer from both sides, not only with treatment, but also with as many preventative measures that we currently know of.

Making Mammography Greener

2008-04-14T12:56:00Z

Earth Day is soon approaching. On April 22, people from all over our great planet will come together celebrating our earth and promoting positive changes that we all can make that will help our environment.

Like most people, I have made a few changes in my personal life that I hope will have a positive impact on the environment. Many of these changes are money savers too, and we all know that the cost of energy is not getting any cheaper.

I've also started thinking about where I work and possible changes that could be implemented there that might make a difference.

About six months ago, our department was issued a challenge to try to save money in some way in regards to ordering supplies. Like most departments, we usually run quite lean and really don't order a huge amount of supplies to begin with. As we were all brainstorming this challenge, someone noted that we were all drinking our coffee out of styrofoam cups.

Although it may seem like a very small change to some, we decided that we would stop ordering Styrofoam cups and we would all bring in a coffee mug from home. At first, a few people needed reminding, but eventually all of us now have our own mugs that we use everyday.

Although I am sure that this small change will not make a huge impact on the bottom line of the hospital, it is one change that will also help the environment. This change made me think of other changes we could make that would have a positive impact on our environment.

Most of us already recycle magazines from home and bring them in for our waiting room; these magazines tend to be a little more interesting than the normal ones! The hospital started a program a few years ago to recycle all paper products, so we don't produce a lot of paper waste anymore.

With all of our incredibly sensitive mammography equipment, we are not able to adjust our thermostats by very much. Turning out the lights in the rooms at the end of the working day is another small step. What type of changes has you or your workplace put into affect that could be viewed as green? It would sure be interesting to hear some of the great ideas that others have thought of and it may be a source of inspiration for many others.

Time For Tea?

2008-04-11T15:11:00Z

I love a good cup of coffee, and people who know me well know to steer clear until I've had my morning cup. Recently, however, there has been a lot of news out there regarding the benefits of green tea. Tea's antioxidant qualities have been linked with a lot of great benefits, some of which include slowing the aging process, assisting in weight loss, possibly lowering cholesterol, as well as helping keep blood pressure in check.

And now, University of Mississippi Medical Center researchers have found an interesting link between green tea and breast cancer. One of the antioxidants in green tea---epigallocatechin-3-gallate (better known as EGCG)---has been shown to significantly inhibit the growth of breast cancer in female mice.

The antioxidant has been credited with perhaps decreasing tumor blood vessel formation as well as lowering the amount of nutrients in the tumor that promote growth and proliferation. These findings were presented at this year's annual meeting of the American Physiological Society in San Diego.

So, although I doubtfully can give up my coffee habit anytime in the near future, I may need to start incorporating a little bit of green tea into my everyday routine.

A Positioning Tidbit

2008-04-07T13:00:00Z

Recently I was asked to give a talk on mammography positioning for the Michigan Society of Radiologic Technologists. I was initially very honored, and because I really do love talking and have been performing mammograms almost since the beginning of time, I readily agreed.

But panic set in when I started to wonder if I really had enough information to fill a whole hour!

I then started to gather all of my research material. When I started breaking down all of the different views that are part of mammography, I soon realized that crunching all of that information into only an hour presentation would be a challenge.

For the most part, positioning has not changed a lot since 1989 (although I always have to remind myself to position from the medial aspect on the CCs). Even so, it really is a good idea to either read over some basic positioning material or attend a seminar. I guarantee you will rethink how you currently position.

While I was reading over all of my positioning research material, I ran across a small sensible tidbit that may help some mammographers out there.

Using a BB marker for orientation on large breasts is such a simple idea, but one that I had not heard of before. Mark the center of the breast with a metallic BB. Then make sure that each film demonstrates the BB, when taking multiple films for each view. This guarantees that you have included all breast tissue.

I would add that it is probably a good idea to document that the BB was used for positioning only and not marking something of interest. Many of you out there are probably already using this idea, but it may be new to some. It will sure make you feel confident that you have covered all of the patient's breast tissue.

So it really doesn't matter how long we have been doing our jobs---there is always something to be learned. When I shared the above technique with some co-workers, the newer technologists were very familiar with it, while those like myself, had never heard of it.

By the way, the presentation went very well, except for when the computer and Power Point presentation turned off in the middle of my presentation! After a few panicked moments, I realized that in my diligence in making sure all connections were connected, I had failed to plug in the computer to a power source!

What Your Patient May Not Be Asking

2008-04-04T12:50:00Z

The results of a British study appeared in Quality & Safety in Health Care recently regarding how comfortable patients feel asking doctors and nurses specific questions. The results were interesting and I believe can make us all better healthcare workers.

Questions regarding length of hospital stay, anticipated time off work and details about the procedure they were going to have were relatively easy questions for patients to ask their doctors. When the same patients were asked how willing they would be to ask their healthcare providers specific safety and medical error questions, the response was much lower.

Patients were much less willing to ask their doctor or nurse how many times they have performed a specific procedure and if they have recently washed their hands. The study did find that women were more likely to ask the more difficult questions opposed to men, and both men and women felt more comfortable questioning a nurse.

This study validates what many of us working in healthcare have known for a long time: Patients do feel more comfortable, in many instances, asking us questions instead of their doctor.

In mammography, patients always asking us why they were called back for another mammogram. Trying to redirect these types of questions back to the referring physician can be tricky at times.

Another question that participants felt uncomfortable asking was "Who are you and what is your job?"

These questions can easily be put to rest by our initial introduction to the patient. By washing your hands and wiping the mammography unit down in front of the patient, we can hopefully answer some of the questions they were thinking about but were too afraid to ask.

Knowing what types of questions our patients are uncomfortable asking gives us the opportunity to instill a degree of confidence in our skills by answering these questions before they are spoken.

Not Just Pink

2008-04-02T14:39:00Z

I was reading a breast cancer survivor story the other day. Like far too many cases, the patient initially put off going to a physician after finding the breast lump. When the patient finally sought treatment, their worst fears were confirmed.

This story, unfortunately sounds only too familiar to many of us who work in the mammography field. The unusual twist to this story was that the patient was male. Breast cancer occurs in women 100 times more frequently than men, but over 2,000 men will be diagnosed this year with breast cancer in the United States.

The patient told how he delayed going to his physician initially because of how embarrassed he was. Mammography and ultrasound tests were soon performed and then a biopsy followed. After the diagnosis of cancer was made, his treatment plan was very similar to that of a female patient. In his story, he noted that when he was receiving his treatment, he was the only male.

At the hospital where I work, we perform about 600 mammograms a week. During the course of that week, we may see one male patient. Most men are very uncomfortable coming in for an exam that is routinely done on women.

Fortunately, we have a male waiting room where patients also wait for general X-rays. Our gowns are not pink, and we can privately usher men into an exam room without attracting too much attention.

I guess my point is that we do need to be sensitive to the needs of all of our patients. Yes, very clearly, the vast majority of our patients are women. But that solitary male, swimming in an ocean of pink ribbons, also needs all of our compassion and skill. I won't be packing away any of my pink scrub tops, bracelets or earrings any time soon, but I will try a little harder to make sure that any male patients get treated with the dignity and respect that all of our patients deserve.

More Call-Backs

2008-03-27T16:07:00Z

Digital technology has certainly brought many changes to the world of breast imaging. Where I work, we got our first digital mammography machine about four years ago and have been slowly converting to an all-digital workplace ever since.

With the onset of this technology, many obvious things have changed. For one, being able to perform screening mammograms much faster has allowed us to reexamine and adjust our patient flow. Most of the changes brought about with this new technology were expected and welcomed.

There were however, some unexpected changes. An increase in the number of technical call backs was noted, and after looking at why these patients were being called back, we realized many were returning to get nipple-in-profile views. That was unusual because I do work with many seasoned technologists.

After reviewing many of the cases, we realized that digital technology was now enhancing the skin line of the breast so much that any slight turn of the nipple was very obvious on the image.

Film-screen imaging burned out much of this and we were never even aware of it. So to combat this, we as a department, are taking many more nipple-in-profile views before we let our patients go.

If anything, this phenomenon has made us much more aware of our positioning during an exam. On the positive side, we are able to finally visualize all of the IMF that I knew we were getting on our films, but were never able to see really well! Also, the cleavage tissue seems to jump out much more on CC views in the digital world.

With a little more diligence in regards to positioning, we are able to produce a much nicer looking image, which makes the radiologist happy, the patients happy and ultimately our job easier! It would be interesting to hear of what unexpected changes your department experienced while converting over to digital.

2007 Action Report Illustrates Mammographers' Commitment to Quality Control & Compliance

2008-03-24T12:50:00Z

While doing some light reading over the weekend, I picked up the 2007 Mammography Facility Adverse Event and Action Report from the U.S. Food and Drug Administration. (My life is really not that boring---the update was sent to my email!)

The first mind-boggling fact was that there are now about 8,800 MQSA-certified mammography facilities operating in the United States.

As my brain started processing all of this, I started thinking about how many mammographers are committed to quality control and compliance issues. Thoroughly testing and accurately charting all aspects of quality control is a huge, and very necessary, part of our job.

From when I first started in mammography nearly 20 years ago until now, this area has seen considerably more attention. In 1992, Congress enacted the Mammography Quality Standards Act (MQSA) requiring mammography facilities to meet strict quality standards. After developing interim regulations, final regulations became effective on April 28, 1999.

With every new technology that is brought to mammography, there are new quality control measures and tests to be learned by the mammographers. I know that when we acquired our first digital unit, the wonderful applications specialist was there to explain every little detail of our new quality control program. At first, I thought for sure that she was speaking in a foreign language---I could not imagine a day when I would be comfortably conversing about SNRs and CNRs. Well, I guess the old adage about teaching an old dog new tricks is not always correct!

While the report does site a few facilities that had to have very serious corrective action taken, my optimistic side has to think of how many facilities there are operating within the strict quality control standards of the FDA. So give yourselves a pat on the back and go back to scoring your phantoms. Just always remember what a truly important service we are providing to our patients!