Dr. Anna Chen and Maureen Connors, a certified breast imaging patient navigator, are on the front lines when it comes to breast cancer – in both women and men.
Chen – a radiologist and In the Field feature subject today in WNY Refresh – is director of Women’s Imaging at Windsong Radiology Group, headquartered at 55 Spindrift Drive in Williamsville.
Connors is a veteran employee there who helped lead the movement toward certified health workers who focus on bridging the gap between a breast cancer diagnosis and the first appointment with a breast surgeon.
That two-week or so timetable can weigh on someone.
“We try to make the transition as seamless as possible for the patient,” Connors said.
As part of the process, Windsong runs a question-and-answer session with a panel of experts every other week for anyone who has been newly diagnosed – whether they are working with Windsong-related medical staff or not.
“We take the patients through the generalization about what’s going to happen and who they’re going to meet,” Connors said. “It gives patients a blueprint of what they can expect. We encourage them to bring a friend or family member.”
The next panel will gather at 5:30 p.m. Monday at the Williamsville headquarters. It’s free but you must register by calling 631-2500, Ext. 2115.
Connors job shares her position with Patricia Smith, and both check their voicemails regularly to give broad access to their patients.
“We usually discourage googling when they’re first diagnosed,” Connors said, “because one little click can take them somewhere that has nothing to do with them. It’s human nature to look at the worst thing and say, ‘Yup, that’s me.’ There’s way more good stories out there than not. Our goal basically is to guide the patient right up to the appointment with their surgeon.”
Windsong also tries to make sure women feel as comfortable as possible before diagnosis, even though it’s common for the local company’s women’s services staff – made up of 16 fellowship-trained imagers, as well as several technologists, mammography managers and three breast patient navigators – to hear complaints about the discomfort of mammograms.
“I tell them that everybody has their own pain tolerance but, yes, a mammogram is a little uncomfortable,” Chen said. “We’re part of a research study that’s trying to improve the comfort. We tell our technologists, ‘You may think you’re doing women a favor by not compressing them, but you’re really not. You’re doing them a disservice.’ If you don’t compress, you’re sometimes not going to be able to see the cancer in the breast, plus the compression decreases radiation to the patient. By physics, if you have less tissue, you’re decreasing the scatter radiation.”
Chen and her husband, Kelvin Chen, live in Williamsville with their daughter, Payton, 11, and son, Jordan, 14.
I asked the doctor to walk me through the mammography process in the spa-like setting of the Williamsville office, one of five Windsong locations. Four of those locations, excluding West Seneca, conduct mammograms.
“Patients get a prescription from their doctor and call us to schedule their screening mammogram,” she said. “It does not take a long time to get an appointment. They register when they come in, the technologist meets and greets them, and tells them what to expect. They fill out a questionnaire and the technologist proceeds with the mammogram. It’s usually two views of each breast. The mammogram takes five minutes or less. It probably takes longer to read it. You’re in compression for a few seconds. It may feel like it’s longer sometimes...
“I’m very honest with my patients. I let them know if I see something that’s concerning. It’s something we have to figure out what it is, but most of the time they end up being benign, so I don’t want people to think that if you have to have a biopsy, you have cancer. Two-thirds of biopsies come back benign.”
What does that mean? Is that something that bears watching or needs to be removed?
It depends on the result. It can get complicated after that. Sometimes we follow them six months after the imaging. We certainly follow patients closely for a full two years.
So the big thing is that you encourage women not to get ahead of themselves.
Do you have any male patients, how rare is that and how does the diagnostic process differ?
It’s pretty rare. The problem with male breast cancer is that men tend to get diagnosed at a later stage because a lot of people don’t think about breast cancer in men. They go through the same imaging as a woman does.
(Connors said the center scheduled two men for biopsies during the same week earlier this month.)
In most cases, survivability rates are pretty good, right?
Yes, depending on the size and the individual tumor. Breast cancer is all different types of cancer that happen in the breast. They’re treated differently, depending on the type.
Whose input should women consider when deciding on when to get a mammogram?
They should talk to their primary doctor or OB/GYN. Those are the doctors who see them all the time and know their history. Most know what the general recommendations are. (Despite conflicting recommendations, mammogram screenings for high-risk women should start by age 35, if not earlier; and all women age 40 and over should get annual screenings, Chen said.) Women 40 to 50 are the least likely to come for annual breast cancer screenings, and those are the years that more aggressive cancers tend to form.
If it appears someone may have breast cancer, what happens next?
Once someone has been diagnosed with cancer, I’ll give them a call to give them their biopsy results and right away we plug them in with Maureen or Pat, and one of them will give them a call shortly after.
For every patient that has cancer, we recommend a breast MRI, as well. That’s a presurgical assessment, even before they see the surgeon. What we have found is that up to 8 percent of the time you can find a cancer in the other breast, or a different type of cancer in that same breast, and you want to make sure you evaluate them with everything that you can, so once they go in for that surgery, they’re going in for one surgery and you don’t catch another cancer six months later.
Describe what it's like to read a mammogram.
Dense breast tissue is the whiteness and fatty tissue is the darkness. The problem is with women, breast density is important and women who have dense breast tissue are now being told they have it. The reason it’s important is that one of the things we look for in a mammogram are masses, and those will be white. You can understand how it would be difficult to find a white mass inside a white tissue. Some women have all white tissue, their breasts are extremely dense, so you understand how it would be extremely difficult. Some people say it’s like finding a snowman in a snowstorm.
You can still see a mass and spiculation, but it’s harder to see than with a 3-D, mammogram, where it’s easy to see the mass and the tendrils and the spiculation. When you have a 3-D image, you’re even more able to pick up cancer that’s hiding in that dense breast tissue.
Talk about your 3-D mammography equipment, the Selenia Dimensions machine, by Hologic.
Right now, we’re really focusing more on people who have dense breast tissue or are at high risk, telling them about the additional screening benefits of tomosynthesis. Patients usually don’t notice a difference because it’s done at the same time as their regular compression. Images last maybe 4 seconds longer. How it helps us is the machine takes a little sweep – an arc 15 degrees forward and 15 degrees back – and the computer generates 1-millimeter slices through the breast for us to look at. When you see a 2-D image, everything’s kind of superimposed on top of one another. With the 3-D image, it’s kind of like the pages of a book that you can flip through layer by layer and look at the tissue that way, in the hope of seeing something that might be hiding in the dense breast tissue.
What percentage of women have dense breast tissue?
There are four categories:
- People who have all fatty tissue. Their mammogram’s all dark. That’s 10 percent of the population.
- People who have scattered fibro-glandular tissue, which means that they have these little patches of whiteness in probably 25 or 50 percent of their breasts. That’s 40 percent of the population.
- The people we call heterogeneously, or extremely, dense, have 50 percent of the whiteness compared to the darkness. Those are the people we consider as having dense breasts. That’s another 40 percent.
- The extremely dense is about 10 percent.
So 50 percent of the population has dense breasts.
(A 3-D mammogram screening costs $50 more out of pocket for most women with insurance, Chen and Connors said.)
Talk about false positives. Can 3-D imaging help with those?
False positives are when patients have a screening study, you question something and after you do the workup you actually don’t find anything. When people have the 2-D mammogram and you end up doing an ultrasound to see if it’s real, and you find nothing, that’s what we call a false positive.
At most places, if you’re reading the screening study and the patient’s not there, and you see something, you’re recalling the patient. The recall is when they come back and have additional imaging. In some facilities you come back at a different time, but we do it right then and there.
The tomosynthesis helps reduce that recall rate. So if a radiologist questions something and there is 3-D imaging on the screening study, you can look through it and say, ‘Oh, that’s just tissue,’ then they don’t need a workup. That saved that patient from having more mammogram pictures and, maybe, an ultrasound.
Nationwide, it’s reduced recall rates by about 30 percent.
Are there any disadvantages to 3-D?
Right now, I’d say the only limitation is that there’s more radiation than in a regular mammogram. It’s almost double the dose but the total dose is under the FDA limit.
Is that something companies are working on?
So if you’re diagnosed, the bottom line is don’t get too far ahead yourself?
“Absolutely,” Connors said. “We tell them not to google. Everyone knows someone with breast cancer, but there’s so many different types of breast cancer today that everyone’s story is different. Someone may know somebody who had a horrible time with breast cancer, or who didn’t make it, but most patients do make it today.”