UT Health health and wellness

by Brandon Ashton, MD, DABR

October is Breast Cancer Awareness month. Here is a Q&A with one of the physicians from UT Health:

1. What is a breast imaging radiologist and what is your role.

I interpret breast imaging including 2D and 3D mammograms, ultrasound, and breast MRI. Many patients who have no symptoms or abnormalities will only see my name on their result notification letter. When there is an imaging finding or clinical symptom, patients are scheduled at the breast center for additional diagnostic images and if necessary image guided biopsy. If patients present for this so called diagnostic imaging, I am able to interact with them. Often the interaction is to show the patient what we have found and provide reassurance. Occasionally I am tasked with preparing the patient for the reality that they may have cancer and telling them we will perform a biopsy to confirm this.

2. What is one of the biggest misconceptions people have about mammograms/screenings?
Some women believe that if they do not have a family history of breast cancer, they do not need to be screened/checked. However only 5-10% of breast cancer cases are due to a known inherited mutation. Additionally 8 out of 10 women diagnosed with breast cancer do not have a known family history of the disease. On average 1 in 8 women will have breast cancer in their lifetime.

3. How often should I have testing for breast cancer and what test should I get? Can I do regular self-breast exams instead of come in for imaging checks?

In general an average risk woman, someone without significant family history or inherited genetic disease, should be screened with a mammogram yearly starting at age 40. This has been proven to save the most lives. As the world of "personalized medicine" advances we are discovering that certain individuals with higher risk due to personal or family history benefit from earlier (before 40) and supplemental screening. As such we recommend all women have a risk assessment at age 30 to see if they fit in this category. Women in certain groups such as those with dense breast tissue or other risk factors should also consider supplementary imaging in addition to mammograms with breast ultrasound or MRI.

While self-breast exams are useful and encouraged, sometimes by the time a breast cancer is felt it has grown relatively large. With imaging we have the ability to see many cancers before they would be noticed physically. When cancers are found at an early stage there are more treatment options including less aggressive treatment and the chance for cure is better. Chemotherapy is not needed for some cancers if they are discovered early enough.

4. What is meant by dense breast tissue? How do I know if I have this?

Dense breasts are a natural occurrence in 40 % of women. In these women the breast contains less fat with more glandular and connective tissue. After a mammogram your notification letter will notify you if you have dense breast tissue. Women with dense breasts should consider yearly evaluation with imaging in addition to mammograms. The dense breast tissue makes it possible for small cancers to be hidden on a mammogram. Also having dense breast tissue increases the likelihood of developing cancer. Ultrasound and MRI are tests that can help us see though those dense tissues and find cancer earlier in women with dense breast tissue. Depending on your other risks your doctor may recommend ultrasound or MRI in addition to mammography.

5. If I am asked to return for more imaging after my screening exam, does that mean I have cancer?

There is no cancer in the majority of patients who return for additional imaging. Sometimes these images show that the abnormality questioned on their screening exam represents overlapping normal structures in the breast or non-cancerous masses such as cysts and fibroadenomas. We are aware that being called back for additional images can still cause anxiety so we make every effort to schedule returning patients as soon as possible.

6. What is something you wish everyone knew about mammograms?

Mammography is unique because no two breasts look exactly the same. Much like a fingerprint, each person has a different pattern. So a woman’s first mammogram helps establish what is normal for them. Being asked to return for additional images is more common after your first mammogram. It is also very important to compare prior mammograms to the current exam. If you change facilities or move make sure you bring your old records including mammography images. Occasionally a subtle change in an otherwise normal appearing tissue pattern is the earliest hint a cancer is present.
7. What are the latest advances in breast imaging?

Digital Breast Tomosynthesis, also known as 3D mammography, is the latest advancement in mammography. It is quickly becoming the standard of care for screening exams in the US. Thankfully, in Texas private insurers who insure women over 35 are required to cover this exam. Medicare also covers this exam.

8. What are the advantages of UT Health’s 3D mammography unit? How is better than a standard mammogram?

One of the limitations of mammography is that tissue in one part of the breast can lie on top of tissue in another part of the breast and hide abnormalities. Digital breast tomosynthesis or “3D” mammography electronically divides up the breast, showing breast tissue in individual thin “slices” that partially overcomes this problem allowing for improved detection. In other words, we can see smaller cancers that may have been hidden in the tissue otherwise.

9. Does Tomosynthesis use more radiation?

There will be a slight increase in radiation but the amount is so small that it is not felt to be significant. It remains below the recommended levels set by the FDA through MQSA (Mammography Quality Standards Act). Radiation from a mammogram is approximately the same as the background radiation we receive every 3 months from unavoidable sources like soil and the cosmos. The benefit far outweighs the theoretical risks of a low dose of radiation.
10. Who should have Tomosynthesis?

There is a potential benefit for all women. If you are at increased risk for breast cancer due to family or personal history, you should consider Tomosynthesis. If you have dense breast tissue, you should consider Tomosynthesis.

Brandon Ashton, MD, DABR, is a board-certified radiologist who specializes in breast imaging at the UT Health East Texas Breast Care Center.