Not your mama's mammogram


WALLA WALLA — It’s a game changer, a “quantum leap forward,” nearly magical.

And may change the future for the one in nine women who will get breast cancer.

Diagnosing the disease will continue to be mostly done through mammography, but it’s not your mama’s mammogram, say the imaging experts at Providence St. Mary Medical Center.

Beginning in mid-February, all mammogram patients at St. Mary began being screened for breast cancer with three-dimensional mammography, also called tomosynthesis technology.

The machine moves around the breast, taking laser-sharp images in thin slices. The radiologist can then view the entire breast in 3-D, moving through each slice to find cancers that may be obscured. The machine also provides two dimensional views.

In conventional mammograms, views of the breasts are limited to a few two-dimensional angles. Cancer can hide from view behind breast components such as dense tissue or scarring, St. Mary officials said. In those cases the cancer has an entire year or more to grow until the woman comes in for her next mammogram, and continue to grow until it is large enough to be seen behind obscuring structures.

The opportunity to treat it at its earliest stages is missed.

The tomosynthesis system was approved for widescale use by the U.S. Drug and Food Administration just 19 months ago. The Walla Walla hospital is the first to have the machine in Eastern Washington and the fourth in the state, said Dr. Bradley Johnson, medical director of the imaging department. “We’re way ahead. But this will populate the country eventually. This will raise the standard.”

That’s because the new technology is apples to the oranges of what has been available up until now, Johnson said. While the digital technology that came along in recent years was a huge improvement over what had been available to see tumors in the breast, tomosynthesis offers much more.

“This picks up cancers otherwise obscured and maybe not seen until an inch in diameter,” the doctor said.

That is a big deal, because providers hope to find cancers by the time those are no larger than 5 millimeters, less than a quarter-inch. Earlier detection means better survival rates, perhaps as much as 20 percent better, Johnson said. “Women have a 98 percent survival rate when breast cancer is detected early and is still localized in the breast. But to treat the cancer, it must first be detected.”

As well, the new imaging will reduce the dreaded “call back,” Johnson said.

Statistics say tens of thousands of women go through that emotional storm every year, he added. “And that call back is not free of charge.”

The tomosynthesis machine still uses the oft-joked about and uncomfortable compression of breast tissue to get the best image of what’s under the skin. Women still stand in the same manner at the machine. Radiologists still read the images and report results to doctors. The new way adds only one second to the traditional mammogram. So how different is this new medicine?

Paul Conklin, director of radiology at St. Mary, summed it up this way. “The difference between old and new makes it almost unconscionable to send a loved one to the old style of mammogram.”

Images speak for themselves. In the older digital pictures Conklin puts up, a woman’s breast is a blur of milky white tissue, colored by intersecting and overlapping roadways of tissue and ligaments. In the tomosynthesis images, even the pores on the skin of the breast show up in the first of 74 one millimeter-thick images, that virtually slice the tissue “like a loaf of bread” for viewing, Johnson said.

In one particular case, a void left in tissue by surgery is as clearly outlined on two or three slices as if surgeons had marked the borders with a Sharpie.

Since implementation, doctors at St. Mary have already found a tumor that would not have been seen with the old style imaging, Johnson said.

Any woman can ask for the new style of mammogram, self- or physician-referred. It may add a lot of volume to the St. Mary imaging department, he conceded, “but it’s an interesting problem to have.”

Low income women may qualify for free screening mammograms through the Lifesaver Fund maintained through the Providence St. Mary Foundation.

“Early diagnosis is important, so you don’t die of breast cancer,” the director pointed out. “We don’t prevent breast cancer with mammograms. We prevent death from breast cancer because of mammograms.”

For more information call 522-5850.


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