Marion Lord is a testament to the importance of detecting breast cancer at an early stage. The Jacksonville resident said hers was caught when it was 6 millimeters, or slightly smaller than a garden pea.
That was 2? years ago, when she was 68. Since it was found early, she had a lumpectomy and radiation and was able to forgo chemotherapy.
Lord is a strong proponent of annual mammograms, in part because she was once director of imaging services at Baptist Medical Center downtown and saw so many cancers diagnosed.
?A lot of us are alive today and doing well because our cancer was caught early,? Lord said.
In recent years, improvements in mammography, alternative diagnostic techniques and greater awareness have made early detection easier.
Mammograms, which use X-rays to scan the breasts, are still the first-line test to find tumors in their early stages, Jacksonville radiologists said. For decades, the only option was mammograms that record breast images on film. But in 2003, the Food and Drug Administration approved the use of digital mammograms, which store and analyze the information on a computer, making them easily retrievable for reviewing, said Christine Granfield, medical director of breast imaging at Baptist Health.
Though the digital version can run $375,000 compared with $80,000 for the film unit, Granfield said, Jacksonville hospitals have made the switch.
The digital unit?s higher resolution allows it to better detect cancers while delivering a lower dose of radiation to the patient, Granfield said. In addition, the images can be contrast-adjusted so the technologist doesn?t need to repeat them as often.
Since spring 2011, Baptist?s Hill Breast Center has offered an option known as molecular breast imaging (MBI) that is very accurate at showing small cancers due to abnormal cell activity, Granfield said. It identifies tumors that may not be visible on a mammogram in women with dense breast tissue.
In a trial of more than 1,000 patients at Mayo?s Rochester Clinic, it found the cancers more than 90 percent of the time, she said. Currently, she said, MBI is used more for problem-solving and as a screening tool in women with a family history of breast cancer.
?There are studies being done to evaluate whether all women with dense breasts ? not just those with a strong family history ? should have annual mammography alternating with MBI to better evaluate for small tumors,? Granfield said.
Tomosynthesis is another technique that?s recently become available, said Michelle McDonough, assistant professor of radiology at Mayo Clinic Jacksonville. It takes multiple X-ray pictures of each breast from many angles and then sends them to a computer to create three-dimensional images. Mayo in Rochester, Minn., has a unit used for research purposes, she said.
Shands Jacksonville?s Breast Health Center acquired tomosynthesis in August 2011.
?We?ve been using it a lot in the past year,? said Martha Wasserman, chief of the center?s Division of Women?s Imaging. ?We?ve had great success with it. We?ve already uncovered lesions that we could not see on the standard mammogram.?
Its niche probably will lie in making cancers easier to see in dense breast tissue, McDonough said. About 40 percent of women have dense breasts, according to the U.S. National Cancer Institute.
The FDA added another imaging system to the arsenal in September when it approved the first ultrasound device to detect breast cancer in women with dense tissue. It?s to be used along with standard mammography for women with no breast cancer symptoms.
There are other studies under way, particularly in the nuclear medicine arena, to further aid early detection, McDonough said.
Mammography still remains the first line of defense because it?s readily available and inexpensive, McDonough and Granfield said.
?The other reason is that there are things that we find in mammography that we don?t see in ultrasound or even in an MRI [magnetic resonance imaging],? McDonough said.
A mammogram also is key to determining the next exam needed to evaluate a specific problem, Granfield said. Ultrasound and MRI are generally used as problem-solving tools in women with abnormal mammograms, she said.
MRI also is used as a higher-risk screening tool in patients with a strong family history and an initial cancer diagnosis to better evaluate the extent of the tumor, Granfield said.
She cited a recent major study from Sweden, where almost all women 40 and older undergo screening mammography.
It showed that the single greatest factor over the past 30 to 35 years in improving survival was the widespread use of mammograms to find cancers at an earlier stage.
To make it easier for some women to get mammograms, St. Vincent?s HealthCare has a mobile digital mammography unit.
?The reason that?s important for detection is that we take the unit to different areas and provide screening mammography for women either at their work places or in their neighborhoods,? said Cynthia Farah, St. Vincent?s oncology service director.
Above all, improved awareness is key, Granfield and others said.
?There are parts of the world where it is not talked about, and consequently, it is the No. 1 killer in those regions,? said Granfield, adding that she is grateful to live at a time in the United States where it is widely discussed. ?If a woman is diagnosed with breast cancer now, the odds are in her favor that she will survive the disease.?
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Sandy Strickland: (904) 359-4128
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