I am Dr. Judy Song, and I am an attending radiologist and current section chief of
Breast Imaging at MedStar Georgetown University Hospital. My patients are both
symptomatic and asymptomatic women who come into the Betty Lou Ourisman Breast
Center and also at our satellite offices in the MedStar system in the Washington,
D.C., area. The asymptomatic women who are coming in
for their screening or routine mammograms are patients who are coming
in to have mammographic evaluations which are X-ray examinations utilizing
our most current technology which is our 3D mammograms to evaluate their breasts
to look for indolent or early disease before it is causing any symptoms or
before it's clinically manifest. In the field of breast imaging and breast
cancer diagnosis and treatment, we have made great advances in recent decades.
Some of the most relevant advances in my field have been the advent of 3D
mammography or breast tomosynthesis which was approved by the FDA in 2011 and
which allows us to take a more in-depth look at women's breasts by acquiring
scans over a arc and so we get a volume of images that we which we can then
reconstruct and therefore it allows us to flip the pages of a book rather than
looking at the six sides of a book. Other advances include the developments
involving breast ultrasound including potential automated systems that are out
there and breast MRI. At the Ourisman Breast Center, we are very fortunate to
not only physically be located at one site so patients can come in and see
their radiologist, their surgeon, their oncologist, and their plastic surgeon all
in one visit. But more importantly, we all work and collaborate so well together so
that we are often discussing patient cases and making sure we get input and
thoughts from one another and as we all know multiple heads are better than one
when it comes to coming up with solutions and treatments. We know that
screening mammography has been shown to decrease breast cancer deaths by up to
30 to 40 percent following those recent studies and I think that's fascinating
to be able to find disease in someone who's not having any symptoms of that
disease and to treat and cure them before it affects their lives in a
long-term and affects their lifespan. I think that's probably one the most
rewarding things out there.
A mammogram is a low-dose X-ray examination of the breast. In our modern
time today and at the Ourisman Breast Center, we use the most cutting-edge
technology. So we do what we call 3D mammograms which allow us to image the
breast in a very short period of time, and we obtain a great volume of data
which we then reconstruct into images and slices which allow us to look
through the breast almost like flipping through the pages of a book rather than
looking just at the six sides.
A 3D mammogram is a more accurate evaluation of your breasts and for the
patient takes just as much time or as little time rather has a 2D mammogram.
And now with our current technology offers is offered at the same radiation
dose so it's more bang for your buck and allows us to get more accurate imaging
of your breasts.
I think that is one of the fallacies about mammograms is that mammograms hurt.
Mammograms are not by any means comfortable, but they are tolerable and
they do not they should not cause active pain. They do not actively hurt.
When you prepare to come in for your mammogram, we ask that you wear a
two-piece outfit and that you do not wear any deodorant or any powder and
come in with a good attitude and understanding that you will be asked
your name and your birthday and a lot of your history questions such as your
family history and any medications multiple times. We want to make sure
we're imaging the right patient and giving you the right test.
We know that starting annual mammography at the age of 40 saves the most lives ,so
multiple organizations including the United States Preventive Task Force,
American College of Radiology, the American College of Obstetricians and
Gynecologists, American Cancer Society all advise that women be entitled to start their
mammogram at the age of 40. We do have some disparate recommendations about
when to definitively start your screening mammograms and how often to
have those examinations whether annually or biannually and that stems from each
organization's difference in judging the risk versus benefits and their
interpretation of the clinical data that's available today.
Women with dense breasts are women who have a higher percentage of fiber
glandular tissue in their breasts with respect to that. Historically, imaging
women with dense breasts was a little bit difficult. With the advent of 3D
mammography however, it's much easier to provide an accurate interpretation of these
women's breast because as I mentioned we're flipping through the pages and will
be able to look through their breast tissue. Women with dense breasts are
informed of their breast density because it is it an important individual risk
factor for developing breast cancer.
Women with dense breasts are women who are born that way. You can't necessarily
affect your breast density. Sometimes in patients once they approach menopause
and have a decrease in their hormone stimulus, their breasts can get
replaced by fat. We have found that that does not happen all the time. And having
dense breast wall in itself is an important thing to know because it is a
risk factor for breast cancer. There really is not much though any woman can
do to change their breast density.
We know that 3D mammography benefits women across the board regardless of
their breast density, but it has been found to be particularly helpful in
women with dense breasts. We are finding more cancers at earlier stages which is
particularly significant and impacting patient survival and patient lifestyle.
We use 3D mammography at our facilities because we know that 3D mammography is
the best mammography imaging tool out there in the detection of breast cancer.
3D mammography is more effective in not only picking up cancers earlier but also
in helping us call back the right patients so we minimize our false
positives, meaning that patients who do not have disease do not get called back
for further evaluation. And we do, therefore, we minimize the stress on
those patients who may previously have been called back for findings that were
not actually cancerous or precancerous.
We are very fortunate here at MedStar Georgetown University Hospital to
provide mammography interpretations by dedicated breast imaging radiologists.
All of our radiologists are fellowship-trained and all of us
specialize in mammography breast MRI and breast ultrasound, so that is an
important distinction to make. Not all radiologists are breast imaging
specialists. And for all women out there, I would say that wherever you go, make
sure your mammogram is read by a dedicated breast imager and a dedicated
breast imaging fellowship trained radiologist. And here at Georgetown, we
are fortunate to have eight of them.
Screening mammograms are examinations that are performed on women who are
asymptomatic. They have no clinical symptoms and they have no signs of
disease. Diagnostic mammograms are mammograms that are performed in
patients who have symptoms. And these symptoms can vary from pain to skin
changes to nipple discharge to palpable lumps and focal tenderness. We also do
diagnostic mammograms upon patients who have a history of breast cancer within
the past five years and patients who had screening mammograms who have findings
that we would like to work up further. For the patient, the difference between a
screening and diagnostic mammogram is that for a screening mammogram you come
in, you get your four views, and you get to go home, and you wait for a letter
from us or a phone call from us regarding findings that say you're fine
come back in a year or please return for additional imaging. Diagnostic mammogram
appointments involve a patient coming in, getting all of their imaging done, and
waiting while the radiologist looks at the images and makes a final
interpretation. The diagnostic appointment may entail additional
imaging, breast ultrasound, and at the end of the day with your diagnostic
mammogram, you get to go home with your result.
For patients who undergo screening mammogram, there is a small percentage
that may be asked to return, and this can range between twelve to fourteen percent.
Of those patients that return, the majority will be fine. In a thousand
patients, we will find about four to five breast cancers. So when you look at the
numbers, we are talking about less than one percent. Having said that, there's a
lot of anxiety and quite frankly fear when you're asked to return for for
additional imaging from a screening mammogram. At our institution, you will
receive a letter but more importantly you will also get a phone call from our
clinical coordinator.
One of the exciting new advances in breast cancer diagnosis and treatment is
the individualized, personalized medicine of one. We are now able to stratify each
woman's risk for breast cancer using a number of different modeling tools. And
once we can stratify your risk, we can provide additional supplemental
screening examinations that can help detect cancer earlier in those patients
that are at an elevated risk for developing breast cancer. Our imaging
technology is available for supplemental screening include whole breast
ultrasound and breast MRI. We have found that breast MRI is the most effective
additional screening tool with the greatest sensitivity and specificity. And
in patients who undergo supplemental screening who are at a higher risk for
developing breast cancer, meaning that their lifetime risk is greater than 20
to 25 percent, the addition of MRI has been found to detect 14.7 more cancers
in every thousand patients. And that is remarkable. If we can find cancers
earlier before they're clinically significant and when they're smaller, we
can treat them more effectively and help improve both the woman's quality of life
and their length of life.
When you come in for your mammogram, we will ask you a number of questions
including the medications you've been on, your prior surgical history, as well as
your family history. We ask about your family history because we have found
that women who have a positive family history of breast cancer, and we can
divide that into a strong family history when it affects a first-degree relative,
your mother, your sister, or your daughter, or a still significant but weaker family
history when it affects other family members, that family history is important
because that will help stratify your risk of developing breast cancer. It is
important to note, however, that in women diagnosed with breast cancer, less than
15% of women have a positive family history. So while it is an important
piece of information to have for us radiologists has we interpret your
mammogram, your ultrasound, and your breast MRI, it is by no means the only
risk factor and it does not necessarily predict that you will have breast cancer.
So that is important to know.
The Ourisman Breast Center and the breast cancer program at MedStar Georgetown
University Hospital is truly unique in the world class clinicians and
researchers you have here. Your doctors will all be experts in their field and
more importantly we are collaborative and compassionate. We all come to work
every day with the same goal in mind to make a difference in helping women who
are diagnosed with breast cancer, and we all work together to make sure that that
goal is achieved. Because we are all at one facility and on one campus, that
allows us to easily collaborate. And our research is also on one campus and that
allows us to bring new technology that's at the forefront of breast cancer
diagnosis and treatment into our clinical practice in a seamless manner.
So the benefit of being all on on campus allows us to have a quicker
bench-to-bedside approach.