AAMC Magazine

Summer 2007

The AAMC Difference

AAMC's Breast Program Years Ahead of New ACS Guidelines

Research shows that approximately 10 percent of women newly diagnosed with breast cancer in one breast have an undetected cancer in the other breast. New guidelines recommend that women who fall into this category undergo a breast Magnetic Resonance Imaging (MRI) of both breasts. In the case illustrated above, a patient whose cancer in the left breast previously had been detected by a physical exam had an MRI, which showed an undetected cancer in the right breast.

When the American Cancer Society earlier this year released new guidelines recommending that women who recently had been diagnosed with breast cancer have a magnetic resonance imaging (MRI) in addition to a mammogram, the reaction at Anne Arundel Medical Center's Breast Center was one of quiet pride.

This was no news for the AAMC team, which four years ago began implementing this same guideline for women newly diagnosed with breast cancer.

“The ACS recommendations simply validated our own findings,” said Zandra Cheng, M.D., a surgeon at AAMC's Breast Center. “We find bilateral cancer, meaning cancer in a second breast, nine percent of the time in women who recently have been diagnosed.”

And, two years ago, this AAMC program was expanded to recommend breast MRI in addition to mammogram for select women who are at high risk for breast cancer, but had not been diagnosed with it.

Lorraine Tafra, M.D., medical director of the Breast Center, notes that the team “reviews new data, our own data, and international data monthly. If information on any technology indicates there is a chance to find tumors earlier, provide for better or longer cures, or decrease the toll our treatments take on our patients, we are committed to bringing that technology here—and that is frequently, as in this case, long before there is widespread acceptance.”

They both credit AAMC’s dedicated breast radiologists, technologists, and the diagnostic capabilities of Anne Arundel Diagnostics (AAD), an on-site radiology center and the diagnostic arm of Anne Arundel Health System, as well as a strong spirit of collaboration with the referring physicians as reasons for the Breast Center’s high rate of early cancer detection.

“As a breast surgeon, I find that our radiologists identifying the scope of breast disease up front is of great benefit to our patients.”
-Dr. Zandra Cheng, AAMC Breast Center

“Breast MRI is particularly helpful in finding small cancers in patients with dense, nodular breast tissue;” says Dr. Radowich. “In identifying these small cancers you’re seeing another benefit to having dedicated breast radiologists read the films.”

AAD offers patients the latest in technology, including two digital mammography machines—the only ones in the area—and an experienced breast radiologist team that correlates all of a patient’s exams and reviews them in context so they make sense and provide a clearer diagnosis.

“Our team of breast radiologists has every tool we need for successful patient outcomes,”said Mark Radowich, M.D., a dedicated breast radiologist and medical director of Anne Arundel Diagnostics. “Combining advanced technology and the experience that comes from reading thousands of breast imaging studies translates into quality patient care.”

MRI, Mammogram—What’s the Difference?

“Breast MRIs image breast tissue differently than mammograms,” said Daina Pack, M.D.,a breast radiologist at AAMC. “Mammograms are X-rays of the breast. MRIs create images with strong magnets and capitalize on tumor blood flow and contrast enhancement. Tumors draw increased blood flow and are often accompanied by abnormal blood vessels. MRIs can detect abnormalities even if the tumor itself is extremely small and invisible on a mammogram.”

Years ago AAMC began relying on the skills of dedicated breast radiologists over computer-aided detection systems (CAD), which have been under scrutiny because they often generate false-positives, requiring often-needless follow-up exams. “In CAD, you have an example of humans finally beating the computers;” said Dr. Radowich, noting that the trained eyes of dedicated breast radiologists do a better job identifying abnormalities than the computer programs.

One constant in all recent recommendations is the message that imaging and exams be done at comprehensive centers with the ability to perform follow-up breast biopsies in the event of positive findings. Having imaging and biopsies done at the same center allows for streamlined and efficient surgical planning, which AAMC’s Breast Center prides itself on providing. Likewise, at AAMC,the radiologists who are looking at breast MRIs are the same ones who read the mammograms and ultrasounds, unlike some institutions where MRIs and mammograms are read by different imaging departments.

“As a breast surgeon, I find that our radiologists identifying the scope of breast disease up front is of great benefit to our patients, and to our surgical management,” said Dr. Cheng. “The patients of this region are fortunate to have a comprehensive breast center at AAMC. Our patient care is a great source of pride for us.”

Making Sense of New Breast Cancer Screening Guidelines—What Does It Mean For You?

The recent spate of news about who should get what kind of breast cancer screening is enough to confuse even the savviest of patients. AAMC magazine takes a look at the guidelines recently updated by the American Cancer Society (ACS):

What does “high risk“ mean?

Women who are considered at high risk for breast cancer fall into certain categories:

They have a family history of breast disease cancer (mother or father’s side) or they previously have had breast cancer.
They have a mutation on their BRCA1 and BRCA2 genes or they have a first-degree relative (parent, sibling, or child) with a mutation on those genes. The BRCA1 or BRCA2 genes are “tumor suppressors.“ When there is a mutation on these genes, they lose that characteristic and no longer suppress abnormal cell growth, which can lead to the development of cancer.
They have had radiation to the chest between the ages of 10 and 30.

What should “high risk“ women do?

Women at high risk should:

Conduct a month breast self exam.
Have an annual clinical exam.
Have a mammogram when they are 10 years younger than their first-degree relative at the time of diagnosis. (For example, if a woman’s mother was diagnosed with breast cancer at age 45, that woman should begin having annual mammograms at age 35).
Consider enrollment in a high-risk screening program to assess whether more frequent exams are necessary. Genetic testing may also be discussed.

“It is vital for women to discuss risk factors with their physician;’ advises Dr. Zandra Cheng, a breast surgeon at AAMC.

ACS guidelines for the “average“ risk woman

At age 20 women should conduct a breast self exam monthly and have a clinical breast exam every three years until age 39.
At age 40 women should have annual mammograms, an annual clinical breast exam, and continue to conduct a monthly breast self exam.
Women who have dense breast tissue and who are advised to have a breast MRI should not panic. A breast MRI simply may provide the radiologist with a clearer picture of the breast.

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