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36 WWW.UNWLA.ORG “НАШЕ ЖИТТЯ”, ВЕРЕСЕНЬ 2017 New Mammography Imaging by Ihor Magun, M.D., F.A.C.P. Breast cancer is the second leading cause of death in women, and screeing remains the best me- chanism for reducing this statistic. Despite all the contoversy surrounding the time guidelines for breast cancer screenings, there has been an encouraging decline in mortality, a decline that can be directly tied to early detection and treatment. This can be attributed in large part to the growing awareness and use of new screening technology. Regular mammograms have been the cornerstone in detecting breast abnormalities, but have proved inconclusive or inaccurate in women who have dense breast tissue. Tissue density does not depend on breast size, and there are a significant number of women who typically fall in this category. Dense breast tissue can make it more difficult to detect breast cancer because both dense breast tissue and cancer appear "white" on a mam- mogram. To improve visualization, digital tomosynthesis or 3-D mammography, when coupl- ed with standard 2-D mammography imaging, provides a forty percent boost in detection of invasive breast cancer. The 3-D mammogram is very similar to the 2-D mammogram; it requires only several additonal seconds to perform and no additonal breast compression. There is obviously more ra- diation, but it falls within acceptable limits set by national standards. The 2-D mammogram takes images from two angles of the breast; the 3-D scan takes multiple images from various angles with the image seen as a series of thin slices. Each “slice” can be viewed one layer at a time, increasing the sensitivity of the study. The American Cancer Society recommends breast MRI screening as an adjunct to mammo- graphy in women wtth the following risk factors: the BRACA gene mutation (found by genetic testing), first degree relative of BRACA carrier but untested, and radiation to the chest between the ages of ten and thirty years. There are additional syndromes that require MRI examinations, but these are well beyond the scope of this article. Obviouslly you need to schedule an appointment at a facility that provides this type of imaging. You should also be aware that although many in- surance companies are beginning to cover the costs of this new and improved procedure, some require an additonal fee. To prevent confusion, your physician’s prescription should clearly state: Mammogram with tomosynthesis. It is worth the extra fee. Molecular Breast Imaging (MBI) is yet another new screening option for women with dense breast tissue. This is also an option for in- dividuals who cannot be accurately screened using the MRI approach and need furher testing. MBI is highly sensitive and specifically good for patients who have dense breasts and who may have a suspicious mammogram lesion, women who have breast implants, and women who test negative in mammogram and/or sonogram but have some ab- normality that suggests a lesion. The technique requires an injection of a radioactive tracer. This tracer clearly shows the “hot spot” in the area of concern. No “hot spot” lighting up during screen- ing mean no visible abnormality; the presence of a "hot spot" that lights up indicates a potential can- cer lesion. The imaging is safe, fast, and easy, and is associated with a fifty percent reduction in biopies compared to other testing methods. The equip- ment offers high resolution, provides a digital functional image with approxiately four hundred percent increase in invasive cancer detection when compared to mammography alone. The American Cancer Society, the US Preventive Services Task Force and the American College of Obstetrics and Gynecology do not have a unified aggreement on screening mammograms. My recommendation is to speak to your gyne- cologist and/or personal physician, taking into account your personal history, your family history, and other factors affecting your individual pre- sentation. I sincerly hope you have kept up with your personal mammograms, in whatever method is the best for your individual needs. Not everyone needs all the new technology, but it’s good to know that it exists for those who do need it. Please share this information with your family and friends. We all need to be proactive about our health; wishful thinking that “this will not happen to me” or “technology will be in my favor, if I need it” are not a wise approach.
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