screening mammography - up health system health system...screening mammography became widespread...
TRANSCRIPT
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Screening Mammography Heidi K Henry, MD
UP Health System Marquette
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Screening mammogram
Asymptomatic patients
Standard 4 images--CC and MLO views of each breast
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What does breast cancer look like Examples
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Signs of malignancy Spiculated mass
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Signs of malignancy Focal asymmetric density
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Signs of malignancy Architectural distortion
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Signs of malignancy Clustered micro calcifications
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Malignant calcifications Regional
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Signs of malignancy Asymmetric density
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Diagnostic mammogram
Patient is symptomatic ( lump, nipple discharge, focal pain or swelling)
Includes necessary additional views ( magnification views or compression views)
Follow up an abnormality
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Patient with lump
Ordered correctly as a diagnostic
mammogram reveals invasive lesion
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Call backs
Finding seen on screening mammogram that requires additional views
May need spot compression views, mag views or ultrasound
Approximately 1o% of patients
Patient stress and anxiety
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Call back for modular density Simple cyst
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Call back for small mass Spot compression views help assess borders
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Small invasive carcinoma Small solid mass
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Ultrasound often used to assess densities, distortion and masses Performed same day as additional views
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Screening mammography Sorting through the chaos
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Risk vs benefit Balancing act
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Risks
Patient anxiety/stress
Cost
Over diagnosis
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Overdiagnosis
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Benefits
Early detection saves lives
1/3 reduction in breast cancer deaths since screening mammography became widespread since 1990
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Beginning annual
mammography at 40 saves the
most lives All groups agree on
this. Disagreement is on balance of harm vs
benefits.
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Percentage of new breast cancer by age
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Size matters Mammography finds lumps 1/8 the size than
occasional self exams
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Benefits of starting screening at 40 ACR, SBI, ACCG, NCCN
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Screening high risk patients Guidelines
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34 year old. BRCA 1 Example screening
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34 year old screening MRI
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Allows for targeted ultrasound biopsy If not seen by ultrasound, then do MRI biopsy
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38 year old screening Mother breast cancer at 42
Previous biopsy of ADH
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Screening MRI
38 year old High risk patient
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Targeted ultrasound Reveals suspicious mass
Ultrasound guided biopsy
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Michigan's new breast density law Patients informed of their breast density, it's
limitations, and increased risk
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Dense breasts relative risk .
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Familiar scene UP winter
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Guidelines for women with dense breasts
Case by case
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What else is new in mammography? Breast tomosynthesis
3D mammography
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Tomosynthesis Reduces call back rate
Improved detection in dense breasts
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Cancer detection rates And recall rates
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One size does not fit all Mammography is becoming more tailored
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Breast imaging team UP Health System Marquette
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Thank You!