Breast Cancer Awareness and Detection with Santa Barbara Women's Imaging Center
Ultrasound Screening with Santa Barbara Women's Imaging Center
3D Mammography with Santa Barbara Women's Imaging Center
Results of Supplemental Ultrasound Screening in women with and without Dense Breast Tissue
Ultrasound screening is being recommended for
women with dense breast tissue, but little is known
about the diagnostic yield of this procedure.
The initial prospective, blinded trial of SonoCiné
Automated Whole Breast Ultrasound (AWBUS)
compared mammography alone with mammography
plus ultrasound in 6425 paired examinations* cancer
detection rates per 1000 studies were calculated
for women with differing breast densities. Breast
density was assessed visually using ... Click Here to view the flyer.
Breast Implants Linked to Poorer Survival and More Advanced Cancers
Women with cosmetic breast implants who develop breast cancer have a higher risk of being diagnosed with nonlocalized breast tumors and have lower breast-cancer-specific survival than women without implants, according to a systematic review and meta-analysis published online April 30 in BMJ. However, study limitations warrant caution when interpreting the results.
"In the United States...cosmetic breast augmentation was the most commonly performed cosmetic surgical procedure in 2011; 307 000 surgeries were performed, an increase of approximately 800% compared with the early 1990s," write Eric Lavigne, from Centre de recherche du CHU de Québec, Faculté de médecine, Université Laval, in Quebec City, Canada, and colleagues. "Although breast augmentation is popular, controversies about the long term health effects of breast implants remain."
Most evidence from epidemiological studies suggests that cosmetic breast implants are not associated with increased risk for breast cancer. However, the radio-opacity of cosmetic breast implants impairs mammographic visualization of breast tissue, potentially hindering detection of breast cancer at an early stage.*
The investigators conducted a systematic search of Medline, Embase, Global Health, CINAHL, IPAB, and PsycINFO for studies published before September 2012. Inclusion criteria included participants diagnosed with breast cancer who had had cosmetic augmentation mammoplasty.
The first meta-analysis included 12 studies looking at nonlocalized stage of breast cancer at diagnosis in women with implants who had breast cancer compared with women without implants who had breast cancer. The overall odds ratio was 1.26 (95% confidence interval [CI], 0.99 - 1.60; P = .058; I2 = 35.6%), indicating a 26% increased risk.
The second meta-analysis included 5 studies assessing the relation between cosmetic breast implantation and survival. Compared with women who did not have implants, those who had implants had reduced survival. Overall hazard ratio for breast-cancer-specific mortality was 1.38, indicating a 38% increased risk (95% CI, 1.08 - 1.75).
"The research published to date suggests that cosmetic breast augmentation adversely affects the survival of women who are subsequently diagnosed as having breast cancer," the study authors write. "These findings should be interpreted with caution, as some studies included in the meta-analysis on survival did not adjust for potential confounders. Further investigations are warranted regarding diagnosis and prognosis of breast cancer among women with breast implants."
Scholarship grants by the Unité de Recherche en Santé des Populations, Cancer Care Ontario, and the Public Health Agency of Canada supported this study. The authors have disclosed no relevant financial relationships.
BMJ. Published online April 30, 2013.
*This is the reason Dr. Dean recommends Whole Breast Ultrasound Screening for women with implants.
Women to be notified of dense breasts after mammograms
A new law is in effect that will have an impact on up to 50 percent of women who get mammograms in California.
The law that began as Senate Bill 1538 will now make it mandatory for doctors to notify women if they have dense breast tissue.
The National Cancer Institute recommends women age 40 and older get a mammogram every one to two years. But that routine check might not cover everyone.
“Almost always when you hear someone has had a breast cancer diagnosis and they say, ‘And just two months ago I had a normal mammogram,’ it’s a woman with dense breast tissue,” said Dr. Judy Dean, the radiologist at the Santa Barbara Women’s Imaging Center.
On a mammogram, dense breast tissue shows up white, which is the same color as a tumor. That makes it difficult to tell the difference.
“It’s been described as trying to see a snowball in a blizzard,” said Dean.
Forty to 50 percent of women have some degree of dense breast tissue and may not know it. Now, they will be notified when they get their mammogram results if they have the kind of tissue that sometimes covers up cancer.
Dean testified at the California State Senate on why the notification is so important.
She is glad that it’s now the law for doctors to share that information with their patients so they can get further testing.
Some of the other options include 3-D mammography, which shows tissue in overlapping layers, and ultrasounds, which have proven to be effective even when mammograms are not.
“It’s up to 42 breast cancers that I’ve detected personally with ultrasound that are not evident on their mammograms, and 36 are so small they are not a palpable lump either. They would not have been detected without ultrasound,” Dean said.
With the new law in effect, women will now know if they have dense breast tissue and if they should see a doctor for further screening.
Dr. Dean honored by the European Congress of Radiology for Most Cited Work on Dense Breast Imaging.
Breast Density Notification and Individualized Screening for Breast Cancer
Dr. Judy Dean's Presentation on Breast Density Notification and Individualized Screening for Breast Cancer at Cottage Hospital.
Tomosynthesis / 3D Mammography
Because our primary focus is excellent patient care, we have acquired new, advanced digital equipment for 3D mammography, also known as tomosynthesis. Tomosynthesis was approved by the FDA in 2011, and this office is the only facility to provide it in the Central Coast region.
Tomosynthesis produces a stack of very thin slice images, reconstructed from digital mammography images. Each image is a 1 mm thick layer of breast tissue, so that overlapping structures are separated into hundreds of images, allowing for far greater clarity and detail. This results in superior sensitivity for breast cancer detection, and at the same time fewer recalls for additional imaging due to normal structures. Fine details are clearer because they are no longer hidden by tissue above and below.
The tomosynthesis procedure is performed in the same way as a typical digital mammogram, except that the x-ray source moves to different angles during the procedure. It is performed along with the traditional 2D images, and does not require a separate procedure or positioning. The examination takes about the same amount of time as a typical 2D mammogram.
During all mammograms the breast is exposed to a small amount of radiation. The radiation dose for tomosynthesis is roughly equivalent to the dose for a traditional 2D digital mammogram, and well below the established dose guidelines of the American College of Radiology. This amount of radiation is considered safe, and the benefits of early breast cancer detection far outweigh the theoretical risk for this level of exposure. The additional radiation exposure added with tomosynthesis is equivalent to the difference in natural background radiation between living in Santa Barbara and Denver.
Because tomosynthesis is a new procedure, with no specific billing code for submission to Medicare and insurance carriers, there may be an additional cost to patients for this study ($75). Since our primary goal is superior patient care, We have chosen to use tomosynthesis for all patients seen in my office. If you decide you do not want to have tomosynthesis, you should schedule your mammogram at our Bath Street Office. If you feel you cannot afford the additional cost but would like to have the procedure, please discuss this with the office manager.
Local Doctor Helps Pass New Mammography Law That Takes Effect April 1st
For a certain population of women, mammograms do not always detect cancer. A new, California law has been passed that aims to help these women by changing the way their mammogram results come back.
The law requires women to be notified about their breast density and possible follow up care.
"It's almost like a warning label for mammograms that if you have dense breasts you should not rely on them exclusively," said Santa Barbara Radiologist Judy Dean who helped to push this new legislation along by consulting with lawmakers.
She said research shows women with dense breasts have five times the risk of breast cancer and that the condition also runs them 17 times the chance a mammogram will miss the cancer. Click here to read more.
Breast Cancer Detection Bill (Are You Dense?) Signed by Governor Brown
SACRAMENTO (September 22, 2012) – Governor Jerry Brown has signed a bill to improve breast cancer detection in women with dense breast tissue. Senate Bill 1538, authored by State Senator Joe Simitian (D-Palo Alto), will require that following a mammogram, women with dense breast tissue be informed of the following:
They have dense breast tissue;
That dense breast tissue can make it harder to evaluate the results of a mammogram;
That it is associated with an increased risk of breast cancer;
That information about breast density is given to discuss with their doctor; and
That a range of screening options are available.
Roughly 40% of the women who have mammograms have dense breast tissue. Because dense breast tissue appears white on a mammogram, and cancer also appears white, it can be difficult to see the cancer. A January 2011 study by the Mayo Clinic found that in women with dense breast tissue, 75 percent of cancer is missed by mammography alone.
Shouldn't a woman be informed if she has a condition that increases her risk of breast cancer, and at the same time decreases the chances that mammography can detect it? This information is readily available from mammograms and mammography reports. As a radiologist who reads mammograms, I know. The doctor to whom I send reports knows. The only person who is likely not to know about this condition is the patient herself.
The condition is dense breast tissue --not a disease, not an abnormality, just the way some breasts are constituted. Making women aware of dense breast tissue and what it means for the risk of cancer is the purpose of "Are You Dense? Day," which the California Legislature has declared for Today, August 8, in a resolution authored by Sen. Joe Simitian, D-Palo Alto.
I began notifying women with dense breast tissue in 2005, so that they could consider additional screening with ultrasound. As a result more than 30 early invasive breast cancers have been detected, just at my small facility, that were not seen with mammography.
Until recently detection rested almost entirely on mammography, but we are now aware that for women with dense breast tissue mammography alone is inadequate. Dense breast tissue appears white on a mammogram. So does cancer, making it harder to discern cancerous tumors, especially in the early, smaller stages of their development. A recent study found that in women with dense breast tissue, 75 percent of cancers are missed by mammography alone.
We have the tools to compensate for this, but the affected women do not know to ask for them.
Further, dense breast tissue, especially in women of middle-age or older, is associated with a higher risk of cancer. For women with extremely dense breast tissue, the risk is five times greater than for those with low density.
"Are You Dense? Day" is a day to encourage women to learn more about their breast health. Forty percent of women tested by mammograms have dense breast tissue, but surveys show that more than 90 percent of women are unaware of their breast density.
Women with dense breast tissue should talk to their doctors about the potential benefits of screening tools beyond mammograms. Ideally every woman should have a breast cancer screening plan that takes into account her individual risk factors - her age, family history, breast density and her own health history.
Legislation introduced by Simitian would require that the mammogram reports sent to women include information about breast density, and for those women with dense breasts, suggest that they might benefit from supplemental screening. Simitian's Senate Bill 1538 has 32 co-authors in the Senate and 52 in the Assembly.
The message of "Are You Dense? Day" is not just that the law should require patients to be informed if they have dense breasts, but that women should take the initiative to ask for this information as part of their mammography report. Under federal law, an assessment of breast density already is included in mammography reports to referring physicians. This is information that a woman has a need and a right to know.
Late-stage diagnosis of breast cancer causes immeasurable personal and societal costs in grief, suffering, and money. These costs have a ripple effect and result in increased health care costs, lost productivity and earnings, and the premature deaths of mothers, sisters, wives, co-workers, and friends.
Notification of the vital information about breast density is essential for women to make informed health choices. In my own practice it has also facilitated needed discussion with primary care physicians about individual assessment of breast cancer risk, and strategies to improve prevention and early detection. "Are You Dense? Day" sends a message to all women that they need to be informed if they are to be effective advocates for their own health. One of the most important facts to know is "Am I dense?"
Women, ask your doctor. And insist that doctors share what I and my fellow radiologists already know.
Dense Breast Tissue Notification (DBT)
For women with dbt, the rate of tumor detection is as low as 25% by mammography. Currently, most doctors do NOT inform their patients (more than 40% of all women have dbt) if they have dbt, instead, these women receive a report with "normal" results.
In the U.S., 45,000 women per year receive this "false negative" result, when they actually have invasive cancer! To make matters even worse, dbt is among the strongest risk factors for developing cancer. This is a double whammy of the worst kind; the women who are most at risk for developing cancer are the very ones for whom mammography fails. There are other imaging methods that when used as a supplement to mammography, raise the rate of tumor detection to 97%.
SB1538 simply gives the >40% of women with dense breast tissue the information they need so that in the event they do develop breast cancer, it can be detected at an earlier stage. We all know that the key to breast cancer survival is EARLY detection. It is every woman's right to know information about her own physiology that could save her life.
THIS IS WHERE KNOWLEDGE = SURVIVAL
Dr. Dean Testifies in Washington DC Regarding the Benefits of Whole Breast for Women with Dense Breasts - April 2012.
Ultrasound screening for breast cancer achieved a major step forward with the unanimous approval of the first automated breast ultrasound device for screening at the FDA Radiologic Devices Panel in Washington DC on April 11. I am proud to have been one of two physicians to testify in support of this new technology. The approval process will now move on to the full FDA panel, and their ruling is anticipated in 60 to 90 days.
Dr. Dean began working with automated breast ultrasound in 2005, and in 2010 co-authored the largest published prospective trial of this technology. (EJR Study Article) She has been a study radiologist and consultant for both companies currently pursuing FDA approval, and now has the world’s largest experience with automated breast ultrasound with over 9000 cases. The milestone reached with the FDA is extremely gratifying for the thousands of local women who have supported research efforts with their participation.
At the panel hearing there were several painful moments when women from around the country testified about their personal experiences with breast cancer, and how this technology did or could have affected them. Women with dense breast tissue face both a 4 to 6 fold increased risk of developing cancer, and a hugely increased risk of a cancer being missed by mammography. The women who spoke had cancers that were missed by mammography because of dense breast tissue; one now has metastatic disease.
The goal in using ultrasound to screen for breast cancer is to reduce or eliminate late-stage cancers that are currently missed on imaging because of over reliance on mammography alone; this will ultimately reduce deaths from breast cancer. There is every reason to expect this to happen because of the fundamental difference in the types and stage of cancers found with mammography, and cancers found with ultrasound. Breast cancers found with ultrasound are almost entirely small invasive tumors, significantly smaller than those imaged with mammography, and more often node negative than those found with mammography. These early invasive tumors are where screening will have its greatest impact.
Dr. Dean has cared for over 30 local patients whose cancers were found with automated breast ultrasound at her office after a normal mammogram.
The U-Systems team giving a thumbs-up in Washington DC. Dr. Dean is seated in the front row between Ron Ho, President and CEO of U-Systems, Inc., and Nancy Capello PhD, founder of the "Are You Dense" website as well as the grassroots movement for notifying women about breast density issues.
Dr. Dean's Published European Journal of Radiology Study on Automated Whole Breast Ultrasound
Breast Cancer Detection Bill Passes Legislature (9/12/11)
State Senator Joe Simitian's (D-Palo Alto) bill to improve breast cancer detection has passed the State Legislature and now goes to the Governor for consideration. Senate Bill 791 requires that following a mammogram, patients with dense breast tissue be informed that they have dense breast tissue, that dense breast tissue can obscure abnormalities (i.e., cancer) on a mammogram and that they may wish to discuss the potential value of additional screening(s) with their doctors.............Read More
Press Conference on SB 173
Dr. Dean testifies before California State Senate. This law would make it mandatory for Radiologists to inform their patients of their breast density. Mammograms are not as effective for women with dense breasts. Adjuncts such as ultrasound, clinical exam and/or MRI should also be utilized.....Watch
Nancy Cappello, Amy Colton, Dr. Dean
Judy Dean MD first in tri-county region to join the National Mammography Database
Launched in 2009 by the American College of Radiology, the National Mammography Database (NMD) is an information system that allows facilities to compare their mammography results and outcomes with national and regional data. The goal of NMD is to improve patient care through peer review and self-assessment using objective measures. The program is voluntary, and to date only a small fraction of eligible facilities have joined.............Read More
Study estimates consequences of revised mammography guidelines
In 2009 the US Preventive Health Task Force broke with recommendations by numerous medical societies and professional organizations and advocated no routine mammography screening before age 50, and then only every two years.
A newly published report estimates an excess of 100,000 breast cancer deaths if the 20 million US women currently 30 to 39 years old follow the Task Force recommendations, instead of having a mammogram yearly from age 40 to 84.
The American Cancer Society, American College of Radiology, and several other medical societies continue to recommend annual mammography starting at age 40.
"Are You Dense" Campaign gains momentum
In 2009 Connecticut passed legislation mandating that radiologists inform women if they have dense breast tissue demonstrated by mammography, and more states are now considering similar action.
The Connecticut lay is known as "Nancy's Law" for Nancy Capello, who received a diagnosis of advanced breast cancer after a normal mammogram when she was 51 years old. Capello founded ARE YOU DENSE, to promote information about the risk of missed cancer in women with dense breast tissue. Capello has also been instrumental in organizing the Density Education National Survivors' Effort (DENSE) which supports density notification legislation.
Other states considering proposals include California, New York, Florida, and Massachusetts.
Dr. Dean advocates additional screening with ultrasound for women with dense breasts. Notification of her recommendation has been included with every results letter since 2005............Read More
What You Need to Know About Mammography Screening Guidelines
The American Cancer Society and the American College of Radiology recommend annual screening mammography beginning at age 40. Women with higher risk due to family history of early, pre-menopausal breast cancer may need to start earlier. Since mammography became widely available in this country in the 1990's breast cancer deaths have decreased 30%............Read More
Dr. Dean’s AJR Article
Journal of Roentgenology (AJR) has published Dr. Dean’s research on Computer-Aided Detection
(CAD), Volume 187, No.1 in July, 2006. AJR is a peer-reviewed publication, and
one of the two major scientific journals in the
field of diagnostic radiology. Titled “Improved
Cancer Detection using Computer-Aided Detection
with Diagnostic and Screening Mammography; Prospective
study of 104 cancers”, the paper reports
on over 9500 mammograms. Of the cancers detected
during the study using mammography, ten were not
apparent to the radiologist without using CAD.
CAD was effective in detecting additional cancers
in both Screening (asymptomatic) and Diagnostic
(patients with lumps or other symptoms) populations.
During the study period two patients with breast
implants had cancers marked by CAD, and one of
these would not otherwise have been detected.
Two recurrences of cancer following lumpectomy
were also marked by CAD.
Significant numbers of cancers were not marked
by CAD, however, underscoring the importance of
using CAD markings only as a guide to additional
findings. Possible evidence of cancer noted by
the radiologist should never be dismissed because
it is not also marked by CAD, as not all cancers
are marked by currently available CAD systems.
The additional cancers detected using CAD were
significantly smaller than the cancers detected
by the radiologist regardless of CAD findings.