Advances in Mammography
with Judy Destouet, MD
How does digital mammography differ from film?
“Mammography is the best tool to detect breast cancer in its most treatable stages,” says Judy Destouet, MD, Chief of Mammography and Diagnostic Radiologist at GBMC and Chief of Mammography for Advanced Radiology. She has been named one of the top women’s imaging specialists in the country.
A mammogram is an x-ray of the breast and can be used as a routine screening tool, or as a diagnostic measure after a lump or other abnormality has been detected during a breast self-exam or a clinical breast exam. Women of all ages should examine their breasts for changes on a monthly basis and undergo a clinical breast exam each year.
During a mammogram, the breast is pressed between two plates in order to flatten and spread the tissue for the x-ray. Although uncomfortable, Dr. Destouet says this compression is absolutely necessary for obtaining a readable result. “If you have a mammogram and your breast is not properly compressed, it is not going to produce a good study of the breast tissue,” she says.
The current mammography technique has been used for more than 30 years. Modern mammogram equipment uses very low levels of radiation and is completely safe. In fact, according to the American Cancer Society, flying on a commercial jet from New York to California will expose a woman to approximately the same amount of radiation as one mammogram.
Over the years, there have been dramatic improvements in film quality and other technical factors that help enhance visualization of small masses and calcium deposits, which may be the earliest signs of cancer. “The most recent change in mammography is digital imaging,” says Dr. Destouet. Digital mammography employs the same technique as traditional mammography, except the results are displayed digitally rather than on black and white film. Both methods are equally effective for detecting breast cancer.
Nationwide, mammography has a 74 percent sensitivity or effectiveness in detecting breast cancer; Dr. Destouet and the other mammographers in her group are even more successful with a 95 percent sensitivity. “Don’t wait to have a mammogram. If something is detected, we can determine if it’s benign and you can rest easy. Or, if it is cancer, we can get you on the road to treatment right away,” says Dr. Destouet.
Mammograms are recommended on a yearly basis for women age 40 and older. Those who are at an increased risk due to a personal or family history of the disease should begin routine mammograms at an earlier age. Women over the age of 80 should undergo mammograms as recommended by their gynecologist.
Mammograms are read by radiologists, who look for several types of changes in the breast including calcifications (tiny mineral deposits), masses and cysts. To confirm cancer, a biopsy is required. In some cases, ultrasound, which uses sound waves instead of x-rays, or computer-guided imaging such as MRI will be used to help pinpoint the exact location of the suspicious cells that need to be sampled for the biopsy.
At GBMC, the breast ultrasound and biopsies are often performed at the same time as a mammogram.
“If we detect something, we perform a needle core biopsy right here in the radiology department,” says Dr. Destouet. “The tissues are then read by a pathologist and we have a diagnosis within 24 to 48 hours so patients don’t have to spend four or five sleepless nights wondering.”
A needle core biopsy is an image-guided procedure that involves removing small samples of breast tissue using a hollow needle. The samples are then examined under a microscope for the presence of cancer.
“One reason we can expedite the diagnosis is because the woman does not have to schedule a separate appointment for the procedure or go into an operating room for the biopsy. She leaves with a band aid as opposed to stitches,” says Dr. Destouet.
Although having a mammogram can be anxiety producing, it is necessary. “What women fear most about this procedure is the result. They worry that we are going to find cancer,” says Dr. Destouet. “But it’s so important for a woman to remember that when the tumor is still small, there is a greater likelihood that she can be treated with less radical surgery, she can keep her breast and most importantly, she can survive.”
