Size Matters: Detecting breast cancers when they are small and treatable is proven to reduce deaths from breast cancer

It is important because the smaller the tumour, the less likely it is to have spread beyond the breast and the better the chance for successful treatment. Small tumours are generally classified as two centimetres (20mm) or less.

The goal of screening is to identify cancers when they are at curable stage. The prospect for cure depends in turn on the extent to which the cancer has spread at diagnosis. It is well established that the highest cure rates are achieved in women with small, lymph node-negative breast cancers . A negative lymph node biopsy means the cancer has not spread.

Given the relationship between tumour size and survival, and given the conventional model of breast cancer spread, it is logical that the principal goal of early detection should be to identify cancers when they are small and node-negative.

3D mammography can help find breast cancer at an early stage, when treatment is most likely to be successful. A mammogram can often find breast changes that could be cancer years before physical symptoms develop.

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3D mammography/tomosynthesis: Imaging with more clarity for better cancer detection

It’s a piece of equipment that gives women a significantly better chance of detecting breast cancer: the 3D mammogram or digital breast tomosynthesis.

According to a large Swedish study, the Malmo study involving 15000 women screened over a 5 year period, and using the same tomosynthesis machines as those at Mercy Radiology, it was found that breast tomosynthesis detected over a third more breast cancers (34%) than traditional 2D mammography.

The difference between the 2D technology and the 3D mammography is compelling, says Dr Sugania Reddy, lead radiologist for breast imaging at Mercy Radiology. The 2D mammogram typically produces four images (two for each breast). Tomosynthesis produces multiple images of the breast depending on the size of the breast(somewhere between 60-80 images), scanning at a much more detailed level to build up 3D representations. While 2D mammograms still find many breast cancers, using tomosynthesis over the last few years at Mercy Radiology has allowed us to detect some breast cancers that could only be seen only 3D tomosynthesis. 
 
 

A breast cancer clearly detected on tomosynthesis (3D) and poorly on the 2D mammogram

“There’s another big difference,” says Reddy, “in that the 2D images are prone to overlapping of a breast cancer by normal breast tissue. On a 2D mammogram, the fatty tissue of the breast appears dark and fibro-glandular tissue appears as white. Unfortunately, most cancers are also white and occur in the white fibro-glandular tissue – meaning they are much harder to detect. Tomosynthesis prevents this overlap so that the cancer can be seen separately from the normal breast tissue.

A further benefit is that 3D technology also reduces patients’ recall rates. 2D technology can sometimes cause overlapping normal breast tissue on the mammogram to look like a cancer. This is reduced with tomosynthesis and therefore simply causes much less anxiety by preventing recalling a patient for extra views to confirm overlap of normal breast tissue.

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For more information, please visit website of Breast Cancer Foundation.

Why does it matter if my breasts are dense?

Breast contains fibrous glandular, and fatty tissue.  Some women have more fat than breast tissue, while other have more breast tissue than fat.  Breast that have higher proportion of the glandular tissue are described as “dense”.

Only a mammogram can show if a woman has dense breast.  The radiologist who looks at your mammogram classifies breast composition into one of four categories of increasing density: predominantly fatty, scattered fibroglandular tissue, heterogeneously dense or extremely dense.  If you were told that you have dense breast, it means that you have either “heterogeneously dense” (C) or extremely dense” (D) breast.

The presence of dense tissue may make it more difficult to detect abnormalities in the breast and may also be associated with an increase risk of breast cancer.  Dense tissue appears white on a mammogram.  Since lumps, cancerous and non-cancerous, also appear white, they can be obscured on the mammogram.

If you have dense breasts, please talk to your doctor.  Together you can decide if supplemental screening exams can benefit you, like using tomosynthesis (as known as 3D mammogram), breast ultrasound, and MRI.

For more information, please visit website of Breast Cancer Foundation.

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Why regular breast exam is important

Dr Benson-Cooper, an expert radiologist in breast imaging at Mercy Radiology / Mercy Breast Clinic, says mammography screening contributes to a 35 per cent reduction in breast cancer death rates, making check-ups all the more important.

Breast cancer is the leading form of cancer among women – and it kills. Every year over 3000 are diagnosed with breast cancer – primarily women over 45. Over 600 die from the disease every year.

But, when diagnosed early as part of a regular mammogram programme, the 10-year survival rate is 92 per cent.

“Breast cancer is a very serious problem in our community and can lead onto devastating outcomes. In New Zealand, 90-95 per cent of women diagnosed with breast cancer have no family history. So booking in for an annual screening mammogram is essential from the age of 40. ​After 55, if there are no risk factors, a two-yearly mammogram can be done,” Dr Benson-Cooper says. “We also recommend annual breast examinations by a GP.”

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For more information, please visit website of Breast Cancer Foundation.

Your 1^st mammogram: It will be a lot easier than you thought it would be.

Sonya Smyth, is a lead technician in Mercy Radiology with a wealth of knowledge and experience in mammography acquired over 30 years.

“If it’s your first time, you should know that it is a pretty straight forward procedure, and it’s probably not what you expect it to be.  You've heard stories about how a painful mammograms can be, and I would say that everyone who has had a first mammogram at Mercy Radiology has gone away saying “that wasn't as bad as I thought it would be”, Sonya says.   

If you are unsure of what happens, here’s a quick run-through:

1. You need to book your appointment.  An online booking facility is available at www.radiology.co.nz or you can call our Customer Care Centre to make a phone booking.

2. When you present for your appointment, the mammographer will explain  the procedure to you and ask you a few questions about your family history, personal breast history, if you are on HRT(Hormone Replacement Therapy), and other relevant information

3. As for the actual mammogram, the mammographer will take 4 views of your breasts, 2 of each side, with images taken from the top and side.

4. If you decide to have the tomosynthesis/3D mammography, the only difference you will notice is that we compress the breast a little bit longer while we do an additional scan of the breasts. This produces a more comprehensive set of images that our radiologists can scroll through to give them more information of your breast tissue.

5. Once the mammogram is done, we ask you to wait for a few minutes while our radiologist views your images.  Sometimes we may come back to you for additional views or ultrasound and finally you will receive the radiologist's report.

6. Your doctor will receive the report and we will add you to our recall system to inform you when your next mammogram is due.

Here’s another resource that will give you more information on what to expect in a mammogram https://radiology.co.nz/services/breast-imaging 

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My imaging story

Marissa has a cancer history in her family and that’s why she carries out an active and preventive care of herself.  At mid 40's, she started getting annual mammograms. 

"This is something simple, something I owe to myself, my family and friends, and something that gives me peace of mind.  I also  know that getting regular screening tests can catch some cancers early, when they’re small, have not spread, and/so easier to treat.”

Whilst the real causes of many cancer may be unknown, she believes that there are ways within our hands to lower the risks of dying from it at an early stage or at a prime stage of your life.  “In my case, it’s about being good to yourself with healthy food choices, not missing my annual medical exams, and keeping away from unnecessary stresses”, says Marissa.

Marissa also added that she still gets a level of wariness each year that she does her mammogram because it still involves breast compression, but she found the latest technology called tomosynthesis more comfortable than the traditional mammogram.  It also helps when the technologist assisting you have gentle hands and makes you feel at ease all throughout the process.  “I had my latest exam with Mercy Radiology, and I immediately felt comforted that a radiologist was on site to read my report straight away, and within 10 minutes, I was cleared of potential cancer.  That gave me immediate peace of mind.”

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Volpara: Providing the best quality image for dense breast

By adopting Volpara, it enables our radiologists to perform breast density assessment much quicker, and decide on what supplementary screening a patient may require. Using this tool gives reassurance both for us and our patients the deliver top quality image, better interpretation, and better outcome for the patients.