SalemNews.com, Salem, MA

October 16, 2012

A new era in breast cancer diagnoses and therapies

By Audrey Duva-Frissora
MD

---- — Breast cancer is the most commonly diagnosed malignancy in women in the Western world. Many of us know someone who has been touched by the disease: a friend, a neighbor, a colleague, a sister or mother. That “someone” may even be you.

It is estimated that one in nine women may at some time in their life be afflicted with breast cancer. But our future is not so grim, as advances in the science of breast medicine are making a significant difference. Diagnostic imaging technologies continue to evolve, improving in their ability to detect and diagnose breast cancer at earlier stages. Basic and applied science research in the field of molecular biology and genomics show promise in both treatment and prevention. The academic medical community is in constant quest for new therapies and treatment protocols, and with the help of the tens of thousands of women willing to participate in clinical trials, there is great hope in our battle against breast cancer.

We are transitioning to a new era of “personalized medicine,” which utilizes the information related to a person’s unique set of genes combined with relevant environmental factors in order to effectively prevent, diagnose and treat diseases, including cancers and non-cancer related medical disease. So called “risk assessment models” and sophisticated genetic testing are being developed to identify patients who may be unknowingly at high risk for developing a particular disease. A number of such risk assessment tools have been developed for breast cancer.

We have embraced innovation in the fight against breast cancer right here on the North Shore at Beverly Hospital. We have incorporated free breast cancer risk assessment at the time of an annual screening mammogram, utilizing one of the newly developed tools. The results are then incorporated into a mammogram report that is sent to the referring doctor. Women who are identified as high risk (currently defined as a 20 percent greater lifetime risk of developing breast cancer compared to their contemporaries), are notified by letter. It is recommended that these women consider consultation at The Breast Health Center at Beverly Hospital at Danvers for further counseling and screening recommendation. A breast health specialist will review a women’s mammogram with a radiologist specialized in breast imaging at the time of her visit to determine if additional imaging or preventative strategies may be beneficial. One factor considered is the overall breast density of her mammogram; the more dense, the more likely a potential cancer could be masked on a mammogram.

Studies have shown that with the selective addition of breast ultrasound, and at times breast MRI, additional early breast cancers will be identified in high risk women that would have otherwise been undetectable on routine mammography. This spring, we are excited to incorporate a new, cutting-edge generation of mammography called tomosynthesis or tomo-mammography. This technology is similar to a CT scan, in that images appear as cross sectional slices of breast tissue. Our radiologists may analyze “slices” of breast tissue, rather than the entire “loaf.” It will now be much easier to identify a “small marble” placed in the center of the “loaf,” particularly helpful in young women with very dense breasts.

Breast health specialists, surgeons and “breast navigators” (nurse practitioners who specialize in breast health) are available to counsel women on preventive measures that can further impact a women’s risk of developing breast cancer. These risks can be separated into those that can be modified, allowing a woman to better shape her destiny, versus those that are non-modifiable. Examples of modifiable risks include diet, weight management, exercise, alcohol intake, breast feeding and hormonal use. Non-modifiable risk factors include gynecological history, overall breast tissue density, genetics, family history of all cancers — to name a few. If appropriate, genetic testing for the BRCA gene may be recommended. These results can be valuable not only for the women being tested but for her family members and her children. Finally, some women may be candidates for preventive medications that have been shown to decrease the incidence of breast cancer. Most importantly, breast health professionals like those at The Breast Health Center at Beverly Hospital at Danvers are knowledgeable about new investigational studies and are able to offer leading edge care to women.

Our breast center is dedicated to the comprehensive care of our breast patients, from screening and diagnosis, to treatment and long term follow-up. We incorporate a team approach, with a dedicated staff of nurses and imaging technologists, radiologists and surgeons, medical and radiation oncologists, nurse navigators and genetic counselors. We gather weekly with our patients in our Multidisciplinary Conference, along with our pathologists, and (by video conferencing) a “second-opinion” medical oncologist from the Beth Israel Deaconess Hospital. As a team, we recommend the optimal, tailored treatment program for each patient with newly diagnosed breast cancer. We are committed to providing comprehensive care, looking out not only for your breast health, but for your emotional well-being throughout the process. And it is our goal to bring the promising advances in knowledge and technologies into our community.

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Audrey Duva-Frissora, MD, is board certified in diagnostic radiology and a member of Beverly Radiology Associates Inc. located in Beverly, where she serves as the medical director of breast imaging. She is an active member of the American College of Radiology and Society of Breast Imaging.