Mammography, sonogram, MRIs and tons of other very long words make the world of breast cancer screenings pretty tough for someone with no medical background to understand. And with new reports on the how’s, when’s and why’s of breast cancer screenings coming out daily, we tapped Englewood Hospital and Medical Center’s breast surgeon, Dr. Faith Goldman for the latest, most accurate information in the name of Breast Cancer Awareness Month.
Q. Can you brief us on the latest and greatest technology out there that Englewood Hospital and Medical Center has available?
A. The most up-to-date technology that we have here is the Tomosynthesis mammography for a significant portion of our screening and diagnostic mammography. This is definitely the state-of-the-art technique for a mammography. It involves a 3-dimensional image of the breast, rather than just a standard 2-dimensional image. This is great because it helps us see dense breast tissue in another way. It helps eliminate some of the effects of overlapping dense breast tissue which may give the appearance of a mass that may not truly be there or can help us see masses in areas with dense breast tissue that we may miss with conventional mammography. This is combined with our standard digital mammography that we were previously using. We’re not currently using the tomosynthesis mammography for every single patient that comes in for a screening or diagnostic mammography, it’s on a case by case basis for patients who have particularly dense breast tissue or have had prior breast surgery and have scar tissue which makes a mammography more difficult to read. We also use it for diagnostic imaging for patients who were already tested and had an abnormality on their screening view and we’re trying to get additional information to hopefully eliminate the extra number of pictures that may be necessary using the more traditional mammography.
Q. So will this then help eliminate the need for some MRIs?
A. Yes, absolutely. There are times when we may have been turning to either a breast ultrasound or a breast MRI for additional information in the effort to reduce the number of unnecessary biopsies. The 3D breast imaging has helped us eliminate those additional imaging or biopsy procedures for many patients.
Q. Many doctors say women should start getting screened at age 40. Is this still valid or has that changed?
A. There has been a lot of debate amongst societies around when the appropriate time to start annual screening mammography. Patients who are at average risk and are asymptomatic, we tend to follow the recommendations from the American Society of Breast Surgeons and the American Cancer Society which state that women should be getting an annual screening mammography at age 40. There are some doctors who will push for a baseline screening mammography at age 35 and if everything is normal, start again at age 40, but that’s not what most societies are recommending. For women who have either a strong family history of breast cancer or they’re known to carry genetic mutations either personally or in their family or for patients who had prior breast problems, we start screening earlier but that would be on a case by case basis.
Q. Are you seeing women taking advantage of genetics screening and working with a Geneticist? Do you offer this kind of testing? What are you doing to keep up with this trend?
A. We actually have a wonderful risk assessment program available through our breast center where it’s not specifically just for breast cancer but they see patients with a variety of familial cancer patterns. It’s actually a very accessible program. Patients can make appointments and sometimes those appointments can be on the same day. It’s a long face-to-face conversation with a nurse practitioner who has special training in genetic counseling and is certified for that genetic counseling. The provider in our breast surgery practice also has particular interests in counseling patients who have familial breast or ovarian cancer patterns and we also perform the testing through our office. It’s one of the biggest high risk programs in northern New Jersey.
Q. If someone is diagnosed with breast cancer and they want to be treated at Englewood Hospital, tell us a little bit about the process and the Infusion Center.
A. We have several clinical trials that are currently open in our new facility and every week we consider the introduction of new clinical trials. Patients no longer need to worry about getting driving hours from their home or crossing the bridge. Patients can get the same cancer treatment and the same availability for cancer trials in their own neighborhood. Our cancer center is dedicated to offering those options and increasing options to our patients here. We are trying to offer same day diagnosis for patients who present probable breast masses. We have a system in place to expedite care if a patient or doctor feels a probable mass. They are usually seen by a pathologist on the same day and the process for getting a biopsy begins that day. Most of our patients are leaving with at least a sense of a diagnosis and with appointments scheduled for additional imaging, breast surgery consultation, and medical oncology consultation which is a unique feature provided by Englewood Hospital. Our goal here in our breast surgery practice is to have breast cancer patients seen within a 48 hour period, in an effort to alleviate stress and ease anxiety for our patients.
Q. For those patients who go through treatment, how is the comfort level in the Infusion Center and how are they treated?
A. Patients are treated with respect and compassion. There are both private and public areas for patients. Not everyone wants to share their diagnosis or feelings with their neighbor and we have facilities that can accommodate patients who want more privacy and areas that cater to patients who are more comforted by others. We have public and private areas for being seen in the breast center as well. We have a patient navigator at our breast center and the patient navigator sees every newly diagnosed breast cancer patient on the day of diagnosis, before they leave the center. The patient navigator lets them know everything from support groups in the community to helping to organize scheduling of tests and consultations. It’s a wonderful resource for patients. When I have a patient who has a particular need on a social work level, I will contact the nurse navigator and she goes out of her way to make sure the problem is addressed that day. Whether it’s a patient who has been seen recently or someone who has been seen for several years, the nurse navigator is very invested to make sure that all of their needs are met.
Q. For people who don’t have a family history of cancer, what is the best thing they can do as a preventative measure?
A. Unfortunately, breast cancer goes beyond genetics. There are some things we can control such as what we are putting into our bodies. It’s important to eliminate smoking habits, have a healthy diet and exercise routine to help maintain a healthy body weight. Alcohol intake has also been associated with an increased risk of breast cancer, so women should really try to limit themselves to one alcoholic drink per day. All of these things promote a healthy lifestyle which in turn may help to reduce the risk of any type of cancer. For women who recently had a baby, breastfeeding has actually been associated with reducing the chance of getting breast cancer. Women who choose to breastfeed – ideally should do so for a year or more. Finally, women who have an elevated risk for breast cancer should have a discussion with their doctor about whether they should consider taking anti-estrogen medications to help reduce their risk. And women who are post-menopausal should also have a discussion with their doctor to see if hormonal replacement is really necessary, as that can sometimes increase the risk of breast cancer.
