There are an increasing number of reports in the media lately about a new relationship between breast implants and an extremely rare form of cancer showing up in the breasts. Notice that I did not say breast cancer. That is because although this cancer is found in the breast, it does not appear to arise from breast tissue.
This cancer, known as Anaplastic Large Cell Lymphoma and commonly…
Ryan Polselli's Social Stream:
This is a great idea. I hope it takes off during breast cancer awareness month coming up this year. Men should always support their women and their support makes an incredible difference whether they realize it or not. #ImOnYourTeam
Breast Tomosynthesis is better known by most patients and physicians as 3D mammography. However, the use of the term “3D” is a bit misleading. There are no 3D glasses to wear as one would typically expect when viewing a 3D image or movie and nothing “pops” out of the screen in the traditional “stereoscopic” sense.* The images actually appear as “flat” 2D images but are taken at multiple angles…
Fluoridation of water exists to mask bad dental care to the poor. Vaccinations cause autism but the proof has been suppressed by a massive pharmaceutical company cover-up. HIV is an artifical disease created by the CIA. Condensation trails from aircraft represent the emission of biological and chemical agents into the atmosphere.
If you believe in any of the above or similar conspiracy theories,…
For those unfamiliar, preoperative needle localization is the procedure performed on the overwhelming majority of patients undergoing lumpectomy or excisional biopsy prior to surgery. The general idea is that one or more needles and wires are inserted into the area in question before surgery with imaging guidance to assist the surgeon in removing the correct area of the breast that could not…
In 2009 the United States Preventative Services Task Force (USPSTF) updated their now infamous breast cancer screening recommendations. In their report, the so-called experts (many of whom had no direct affiliation with patient breast cancer screening) voted that a total of 12 mammograms throughout a woman’s lifetime should be enough to effectively screen women for a disease that is the second…
This is one of the most important questions in the field of breast imaging today.
It is important to keep in mind that there are widely varied opinions about this question depending who you ask. As a breast imaging radiologist, my opinion may differ from physicians in other specialties. My opinion, however, is formed from all prior studies and current research, as well as personally interpreting…
For all practical purposes, there is no significant relationship between a “true” fibroadenoma and breast cancer.
However, there is slight overlap in the mammographic and sonographic appearance of some fibroadenomas and some uncommon forms of breast cancer. For this reason, care should be taken when attempting to make the diagnosis of a breast fibroadenoma without a biopsy.
Usually this means if biopsy is not performed, at a minimum the potential “fibroadenoma” should be followed over an extended period of time (usually a minimum of two years) to be sure it’s not a slow growing breast cancer masquerading as a “fibroadenoma.”
Also, even if a biopsy is performed, there is some overlap between a fibroadenoma and other tumors. Fibroadenomas belong to a class of tumors in the breast known as fibroepithelial lesions. Rarely (exceedingly rare), the tissue obtained from the tumor during the biopsy can be difficult to differentiate from a “relative” of the fibroadenomas in the same class of tumors known as a Phyllodes tumor (of which a small percent can be malignant).
For this reason, even after a biopsy, at least one follow up visit may still be indicated for a fibroadenoma diagnosed by biopsy, but it’s usually just due to an over abundance of caution because no-one wants to miss a sneaky form of breast cancer.
Ryan Polselli, M.D., Breast Imaging Radiologist
The New England Journal of Medicine just published a study that showed MammaPrint may effectively predict which breast cancers may be cured without the need for chemotherapy.
Although we tend to think of breast cancer as a single entity, breast cancers are a lot like fingerprints…no two breast cancers are exactly alike.
MammaPrint is a test performed on samples of the breast cancer (such as those obtained from a biopsy) that tells us about the behavior of the cancer based on several important genes.
It looks at the genomics of the cancer, the genes operating behind the scenes that give us an idea of how aggressive (or in this case), how likely the cancer is to be effectively treated without chemotherapy.
Ryan Polselli, M.D.
Fellowship Trained, Breast Imaging Radiologist
I have written about this before, but I receive so many questions about this on a daily basis that I want to revisit the question.
There are organizations that advocate both.
Organizations such as the United States Preventative Services Task Force (USPSTF) advise mammograms every other year. They acknowledge that many cancers will be missed with this model, but they believe the number is “small” (it is estimated an additional 100,000 women will die as a result of the recommendations) but they believe this is outweighed by the anxiety, additional biopsies, and the potential for misdiagnosis that can occur by yearly mammograms.
Organizations such as the American College of Radiology (ACR), still recommend yearly mammograms because they believe the number of lives that will be saved by yearly screening far outweighs the anxiety, the extra biopsies, and the potential for misdiagnosis.
I personally want every important woman in my life to have a mammogram every year because I am more concerned that they could end up as one of the 100,000 women that will die from a missed cancer than I am that they could experience some anxiety, an extra biopsy, or misdiagnosis.
But this may not be the right decision for everyone and most importantly I believe in patients being given all the facts…and the freedom…to make their own choices.
There’s a lot of press about the importance of a 3-D mammogram (breast tomosynthesis) and how much better it is in terms of detecting cancer than the traditional 2-D (standard digital) mammogram.
Here’s a little known secret:
While it is true that there is a difference in the cancer detection rate between the two technologies, what I notice on a daily basis is that the most important consideration for a patient should actually be who interprets their study.
A mammogram is one of the most subjective radiological studies in the field of radiology and there are huge differences in the breast cancer detection rates between radiologists.
I often see breast cancers that were missed (on both 2-D and 3-D mammograms) that would have been detected if a different radiologist had interpreted the study.
Interestingly, most of these statistics are recorded and regularly reported for radiologists. However, they are rarely made public. In part, there is resistance to releasing data such as this because of the potential for misinterpretation by patients and the public in general.
However, today’s patients are increasingly sophisticated and it is my personal opinion that it may be time to bring awareness to this topic.
-Ryan Polselli, M.D.
Fellowship Trained, Breast Imaging Radiologist
Answer by Ryan Polselli:
How often should women get mammograms?
There is so much confusion about this question! I want to try to answer for both healthcare professionals AND patients in the simplest way that I know how (deep breath)…
In the past, the general answer was simple…“When you turn 40, get a mammogram every year until you die.”
In 2009, a group of healthcare professionals, the US Preventative Services Task Force (aka USPSTF), gave their best attempt at crunching some numbers to determine the value of the mammogram in terms of risks and benefits.
Their recommendation was…“Beginning at age 50, get a mammogram every other year until 74.”
Once they came out with their recommendation, all hell broke loose in the medical field and there has been confusion ever since.
So what happened? Why is there not agreement?
Both groups have argued back and forth about the science and statistics…the sensitivity, specificity, true and false positives, receiver operating characteristic curves, and various other concepts requiring an advanced degree to understand…
However, the essence of the difference between the two groups boils down to a difference in human values of what is actually harmful versus what is actually beneficial.
The USPSTF places more emphasis on the harm that arises from unnecessarily diagnosing and treating a suspicious area of the breast (the so called false positives) than the benefit that arises from diagnosing and treating a cancer. The result is a recommendation for fewer mammograms.
While this may not sound that bad, the problem is what follows as a result. The USPSTF acknowledges that with a decreased frequency of screening mammograms beginning later in life, more women will lose their life to breast cancer.
And so it goes…
In general, the opinion of those close to breast cancer will strongly favor the traditional recommendation.
This is why the official recommendation of the American Cancer Society remains…“When you turn 40, get a mammogram every year for as long as you are in good health.”
Ryan Polselli, M.D.
Breast Imaging Radiologist
**Please note, high risk patients should see their doctor and may have different recommendations than those with typical lifetime risk.
Answer by Ryan Polselli:
In general, most women should have a screening mammogram once a year beginning at the age of 40. If a woman is at a high risk for developing breast cancer then earlier screening may be advised.
High risk is typically defined as a known genetic defect (such as with Angelina Jolie), a family history of early (before menopause) breast cancer, prior breast cancer, and a few others. There are risk calculators available on the web if you think you may be at a higher risk.
Also, there are many mammography clinics which do not require a referral for screening mammograms and some will accept walk-ins. I hope this helps answer your question.