Keep Up On What's New
The world of medicine is constantly changing. Here, we will provide you with a selection of interesting news items from the medical world and regarding our practice. Also, we provide many current intersting articles for you to read on Facebook. Please follow us there.
Osteoporosis drugs should still be considered more than they are currently June 2016
Osteoporosis is a dangerous disease, which often leads to pain and disfigurement due to fractures of bones. Many people are now afraid of the common medications used to treat this disorder, bisphosphonates. With any illness, one needs to weigh the pros verses the cons. Many people would benefit from these medications, but are so worried about rare potential side effects, that they do not take them. Only 1-4 people per 10,000 will develop a thigh bone fracture due to the medicine and only 1 person in 100,000 will develop a jawbone problem from the medicine. Without treatment, many people will have fractures due to osteoporosis. http://www.nytimes.com/…/hea…/osteoporosis-drugs-bones.html…
Mammograms can help detect women at risk for Coronary artey disease March 2016
Mammograms can help detect women who have an elevated risk for coronary artery disease. There is a good correlation between breast arterial calcification and coronary artery calcification. Since most women have mammograms, this may be any easy and inexpensive way to see who may be at a higher risk for having a heart attack.
The real debate about mammography is money: How much should we spend to save lives?
The debate over at what age mammograms should begin, or how often mammograms should be done, is all about money. At what cost is it worth saving lives?
Supplemental Breast ultrasound is more sensitive finding hidden breast cancers than 3D mammography. March 2016
Breast ultrasound has a higher detection rate than 3D in finding breast cancer in women with dense tissue. In women with dense breasts, additional breast ultrasound finds 7.1 breast cancers per 1,000 women, whereas additional 3D (tomosynthesis) finds fewer, 4/1,000 women.
Dr. Marcus and Dr Camerino, at Westchester Imaging, do not agree with the US Task Force new recommendations. The Task Force suggests mammograms at age 50 rather than at age 40. They also suggest mammograms every other year rather than yearly from 50-74. They are trying to reduce false positive mammograms, at a cost of missing curable cancers.
For women in the USA, breast cancer is the 2nd leading cause of cancer death after lung cancer. For every 10,000 women screened ...
between 40-49, 4 lives are saved
between 50-59, 8 lives are saved
between 60-69, 21 lives are saved
between 70-74, 13 lives are saved
At Westchester Imaging, we feel that every life counts. The younger women, 40-49, have more potential years to live and need to be screened. In our practice 20% of the breast cancers that we find are in women 75 and older. Their lives also count.
The choice is still yours. So far insurance companies will pay for yearly screening. You need to tell your doctor, that you want a yearly mammogram.
For women with dense breasts, ultrasound finds as many cancers as mammography. At Westchester Imaging we do both studies for women with dense breasts.
Breast ultrasounds find additional cancers in women with dense breasts: Nov 2015
More research shows that by adding breast ultrasound exams to mammograms for women with dense breasts, more breast cancers are found and at an early stage. At Westchester Imaging, we have been strong advocates for breast ultrasound exams for women with dense breasts for many years.
Computer Aided Detection, CAD, for breast cancer is No better than without it! Sept 2015
Many radiologists use computer-aided detection (CAD) to help evaluate mammograms. The theory is that if a radiologist does not see an abnormality, the computer will. We tried it out a few years ago and found that the computer pointed out many areas that were normal and often missed other areas of concern. Westchester Imaging chose not to use CAD, even though we could charge extra if we used it. Now a new study states that radiologists do just as well without CAD as with it. No surprise to us!
Who needs chemo in early breast cancer? Sept 2015
In early stage breast cancer, some people benefit from chemo, while other people do not. A gene test can help predict who may benefit and those who will not can skip it!
Women with triple negative breast cancer are at high risk for having a BRCA gene mutation and should get tested, if under age 60: Sept 2015
Women who develop a type of breast cancer called triple negative are at a higher risk for carrying a mutation in a BRCA gene. All women under age 60 who develop this type of cancer should get genetic testing.
Mammogram 101: What to expect on your first visit Sept 2015
Getting your first mammogram can be stressful. Even women who have had mammograms for years may get nervous.
Learning how to prepare for and what to expect from this important cancer screening exam can lesson some of the guesswork. ...
Here’s what you should know.
Don’t put off your mammogram. For most women, a mammogram is the best way to find breast cancer as early as possible, using a low dose x-ray, often before a lump can be felt.
We believe that a baseline mammogram should begin at 35 -40 for average risk women, or earlier for those with high risk factors.
Make your experience more comfortable with these tips:
If your breasts get painful before your menstrual period, then schedule your mammogram for the week after your menstrual period, when they are less tender. Don't wear deodorant, or powder, as they may show up on the mammogram and could look like an abnormality. Each breast gets compressed in 2 views. Each compression is only for about 5 seconds, which may be mildly uncomfortable. Afterwards, a report will be sent to your doctor. You will get a report too. At our office, a doctor will give you the results before you leave the office.
Sometimes extra views may be needed to get a better look. This is not unusual. Sometimes a sonogram may also be needed.
One in eight women will develop breast cancer during her life, so it is a very important test to do yearly. Most women say that the fear of the test is worse than the actual exam. If needed, bring a friend or family member along with you to help you relax. Don't put it off.
Personalized Care: Sept 2015
Are you tired of the direction medicine is going? Does your doctor look at a computer screen
and not at you? We practice medicine the old fashioned way. Even though we are radiologists, we take the time to discuss your mammogram with you. We offer you a breast exam, which many clinical doctors do not. We go over your ultrasound/ sonogram results with you. We answer your questions. Remember the choice of where you go is up to You!
Mammographers practice what they Preach: June 2015
A new study published in AJR concludes that 98% of radiologists recommend mammography for average risk women 40 years old and older and were consistent in that they "practice what they preach." Their personal convictions should influence providers, patients and the public.
Some families test negative for the BRCA 1 and 2 genes but likely have a gene since many members have developed breast cancer. Now many more genes have been discovered that are associated with breast cancer:
Many more genes are being found that increase the risk of breast cancer, beyond the BRCA 1 and 2 genes.
Osteoporosis Treatment may help prevent Breast cancer spreading to Bones: May 2015
Breast cancers often spread to bones. The medications used to help osteoporosis, bisphosphonates- like Fosamax, Actonel and Reclast, may help prevent the cancers from spreading to the bones.
BRCA genes increase the risk of cancers beyond breast, including prostate cancer in men
We often discuss that women who carry a BRCA gene mutation are at an increased risk for breast and ovarian cancer. Men may carry the same gene and are at an increased risk for prostate cancer.
How Often Should Women Have Mammograms? APRIL 2015
An excellent response to the government suggesting that women need not be screened as often for breast cancer. Please read.
Women 75 and over should continue to have mammograms: APRIL 2015
The government would like women over 75 to stop having mammograms, as a means to save money, not because it isn't helpful in detecting breast cancer. Age is a risk factor for breast cancer. In our office, 20% of the breast cancers we detect are in women 75 and older.
Fatty liver disease can harm the liver and may lead to liver cancer: APRIL 2015
Fatty liver disease is now found in 25% of the US population. It can lead to cirrhosis and liver cancer. More liver cancer is now due to fatty liver disease than alcoholic liver disease.
Removing ovaries can lower the risk of dying from breast cancer: APRIL 2015
Women who develop breast cancer and carry the BRCA 1 mutation can lower the risk of dying from breast cancer by having their ovaries removed. This also lowers the already increased risk of ovarian cancer.
It looks like inexpensive breast cancer gene testing may soon become available.
Research suggests how much exercise we really need to live longer:
There will be an increase by 50% of breast cancer by 2030 APRIL 2015
If this is true, then for sure we need to continue to screen women beyond age 74.
The Choice is yours Feb 2015 Are you happy where you get your mammogram? Do you know that where you go is up to you?
At Westchester Imaging in White Plains you get treated as a person, not a random number. Either Dr. Marcus or Dr. Camerino will personally speak with you about your results, while you are in the office. If you need any extra pictures, the policy at Westchester Imaging is to do them while you are at the office, so you can leave in a relaxed manor, with your results in hand. The choice is yours.
Should women over 75 have mammograms? Aug 2014
OSTEOPOROSIS: July 2014
1. 1/2 of women and 1/4 of men will have an osteoporosis related fracture in their lifetime.
2. You can't feel your bones getting thinner.
3. A Bone Mineral Density (BMD) test is the only way to accurately find out if you have osteoporosis before a bone breaks.
4. A BMD is generally recommended for all women 65 or older and all men 70 or older.
5. A BMD is also advised for women under 65 and men under 70 if there are other risk factors such as a family history of osteoporosis, being small and thin, and / or smoking. Some diseases or medications may also increase the risk for osteoporosis. Having lost 1.5 inches in height is also an indication to be tested.
6. Osteoporosis and broken bones does not need to be a normal part of aging.
We are so pleased that breast ultrasound is finally getting recognized as a very helpful tool in detecting breast cancer!!
A comprehensive review of the relevant literature by researchers at the University of Washington in Seattle has found that ultrasound screening for women with dense breast tissue increases cancer detection and leads to fewer false positive biopsies compared to mammography alone. Researchers considered some 189 peer-reviewed studies about c...ancer screening of women with dense breast tissue between January 2000 and April 2013, finding 12 that fit their criteria. They found that ultrasound used in addition to mammography led to the discovery of 0.3 to 7.7 additional cancers per 1,000 exams than mammography performed alone. It also yielded an additional 11.7 to 106.6 biopsies per 1,000. The researchers say most of the additional cancers identified by ultrasound were small and node-negative stage. Such cancers are curable through less aggressive treatment with early detection, though the researchers concede some of the detected tumors may have remained stable until the patient's next regular screening mammography. They suggest physicians discuss the use of ultrasound in addition to mammography with patients who have dense breast tissue. The review was published in the American Journal of Obstetrics & Gynecology.
From "In Dense Breasts, Screening Ultrasounds Find More Cancers" Diagnostic Imaging (07/01/14) | Back to Top
3D mammograms-Are they Necessary? July 2014
We have been asked if 3D mammograms are better than regular digital mammograms. A new
study published in JAMA reported that radiologists found 2.9 cancers per 1,000 digital mammograms and 4.1 cancers per 1,000 mammograms for 3D digital mammograms.
In our office we do digital mammography and add on breast ultrasounds for women with dense breasts. The average number of cancers we have detected over the past 10 years is 6.9 per 1,000 mammograms.
We believe that a digital mammogram plus a breast ultrasound when needed is better that a 3D mammogram alone.
Please note that a 3D mammogram has twice the radiation dose as a regular digital mammogram.
We are often asked about the Canadian study which suggested that mammograms are not helpful. Dr. Kopans, a leading expert on mammography helps explains why the study was flawed and therefore incorrect.
Dense Breasts- What does that mean?
A person who has very dense breast tissue, has a 5x increase risk of breast cancer over someone who has a clear, fatty breast.
Remember also that very dense breasts can hide an abnormality on a mammogram. So it is very helpful to add an ultrasound to the mammogram for those individuals. Mammography plus breast ultrasound is better at finding breast cancers than even the 3D mammography.
Having dense breasts is very common. Half of women less than age 50 and 1/3 of women over age 50 have dense breast tissue. The only way for you to know if your breasts are dense is to ask when you have a mammogram. If you live in NY or CT it is now a law to be given that information.
Great article on Breast Density:
VITAMIN D: Not only does it help the bones absorb calcium, but it helps lower the risk of breast cancer by 50% for those who have a blood level greater than 40 over those who have a blood level of less than 20. (Above 30 is considered normal.) It is thought to lower the inflammation in the body. Also, in women who develop breast cancer, the cancer tends to be smaller and less likely to metastasize than in women who have low vitamin D levels. In women who have breast cancer, when their blood levels for vitamin D are checked, premenopausal women are low 75% of the time and postmenopausal women are low 90% of the time. So, be sure you take enough vitamin D!
There are different genetic types of breast cancer, which need to be treated differently:
Dense breast tissue needs additional imaging
We tell our patients if they have dense breat tissue on their mammogram and suggest an ultraound of the breasts for all women with dense breasts.
The AMA agrees that women should have mammograms annually beginning at age 40!
ATA Advises Thyroid Collars Not Needed for Mammography
Thyroid collars are not needed for mammograms, according to new guidelines on minimizing radiation dose issued on June 13 by the American Thyroid Association (ATA). However, the association advised a number of other steps to minimize unnecessary exposure to radiation from medical and dental imaging procedures, such as the use of collars for dental x-rays and advising patients of the potential risks and benefits of radiation in a manner that is understandable to them.
From "ATA Advises Thyroid Collars Not Needed for Mammography"
The long term benefits of cacium and vitamin D.
Radiation received by the thyroid gland from mammography:
There have been emails going around that scare women into believing that they are putting their thyroid gland at risk by having mammograms. The radiation dose to the thyroid gland from a mammogram is extremely low. The thyroid gland is not exposed to the direct X-ray beam used to image the breast and receives only a tiny amount of scattered X-rays, equilivant to only 30 minutes of natural background radiation received by all Americans from natural sources. Thyroid shield usage can interfere with optimal positioning and can result in artifacts that could reduce the quality of the image and interfere with diagnosis. Therefore, a thyroid shield during mammography is NOT recommended.
A medication that can lower the risk of developing breast cancer in high risk women may harm the bones:
Study Finds Breast Self-Exams, Annual Screening Key
Annual mammography and breast self-exams are still valuable tools for detecting breast cancer even among women ages 40 to 49, according to a study carried out by researchers from St. Mary's Comprehensive Breast Center and presented at the American Society of Clinical Oncology's Breast Cancer Symposium. The researchers determined that women younger than 50 with breast cancer were more likely to be diagnosed based on a palpable mass than via mammography, and they also were more likely to have advanced-stage cancer requiring mastectomy. The study involved analysis of diagnosis data compiled from a statewide registry from 14 institutions through the Michigan Breast Oncology Quality Initiative, and it included data from 5,903 women between 2006 and 2009. Nearly 66 percent of breast cancers evaluated in the study were spotted by mammography, 29.8 percent by palpation, and 4.76 percent by other techniques. Eighty-one percent of women with tumors identified by mammography were older than 50, while 40 percent of women with tumors detected by palpation were younger than 50. Yearly mammography and breast self-exam were comparable in women younger than 50, with the former identifying 48.3 percent of cancers and the latter finding 46.1 percent. More advanced cancers were found in women with palpable tumors, and they were more likely to undergo mastectomy and chemotherapy than those whose tumors were diagnosed through mammography. "Results of this study validate the importance of annual screening mammography in women older than 50 years, and [in] women aged 40 to 49 years recently omitted from screening guidelines," the researchers wrote. "If screening mammography is omitted in this group [of younger women], cancers when detected may be of a more advanced stage and result in more mastectomies."
From "Study Finds Breast Self-Exams, Annual Screening Key"
AuntMinnie.com (09/07/11) Yee, Kate Madden
Many women are concerned about the radiation exposure to having a mammogram and may put off having the study out of fear. The amount of radiation for all types of x-ray studies is not the same. Mammography and bone desitometry are very low.
Natural occurring background radiation at sea level: 3mSv/year
Natural occurring background radiation in Colorado: 4.5mSv/year (1.5 higher than at sea level)
Bone Density (DEXA): 0.001 mSv, which is equal to 3 hours of natural radiation
Mammogram: 0.4 mSv, which is equal to 7 weeks of natural radiation
CT scan of abdomen and pelvis: 15mSv, which is equal to 5 years of natural radiation
Mammography saves lives! We already knew that, but here is an article that goes into more detail based on a research study.
Avastin: Should it be kept on the market to treat breat cancer? The FDA says no, while Genentech says yes.
The FDA has just put together some very helpful information on breats implants.
Many women develop swelling of the arm after having lymph nodes removed as part of the treatment for breast cancer. There now may be a surgical way to correct this problem.
The drug Aromasin, which is commonly used to treat breast cancer in post menapausal women, has now been shown to reduce the risk of breast cancer in women at high risk by 65%!
Breast Cancer Survival May Be Hurt by Guidelines on Mammograms, Data Show
Three radiologist-led studies imply that women younger than 50 who follow the U.S. Preventive Services Task Force's advice to skip yearly mammograms risk more severe forms of breast cancer. Research at hospitals in Ohio and Missouri found that women who failed to get regular breast screenings were more likely to discover advanced-stage cancer, including larger tumors and a bleaker prognosis once the cancer was revealed. A Colorado study suggests 62 percent of doctors changed their advice to suit the task force's guidelines and 16 percent fewer women received the test. The studies were presented at separate medical conferences held on May 2 and May 6 by the American Society of Breast Surgeons and the American Roentgen Ray Society, respectively. In releasing its recommendations, the task force said women in their 40s had a greater likelihood of getting false-positive tests that lead to unnecessary biopsies and worry than to find cancer via mammogram. The American Cancer Society challenged the guideline and called on physicians to advise women of that age to continue routine yearly testing. "Despite significant objections to the new guidelines, few researchers have specifically looked at mammography and its long-term impact on outcomes in younger women," notes Paul Dale, chief of surgical oncology at the Ellis Fischel Cancer Center at the University of Missouri School of Medicine. He and his colleagues studied breast cancer cases in women under 50 from 1998 to 2008, and the study demonstrated that 94 percent of the women ages 40 to 49 diagnosed through a mammogram were considered disease-free after five years, versus 78 percent of those who were not screened.
From "Breast Cancer Survival May Be Hurt by Guidelines on Mammograms, Data Show"
Bloomberg (05/02/11) Wechsler, Pat
Women in their 40s benefit from screening mammograms:
Here is an interesting article which describes that for women in their 40s, screening mammograms can find smaller and more easily treatable breast cancers than physical exams.
Westchester Imaging is very excited that it has recently been awarded a three year term of accreditation in:
1. Breast Ultrasound
2. General Ultrasound (abdominal, pelvic, renal and thyroid)
3. Gynecological Ultrasound
as the result of a recent survey by the American College of Radiology (ACR). The ACR awards accreditation to facilities for the achievement of high practice standards after a peer-review evaluation of the practice. Evaluations assess the qualifications of the pesonnel and the adequacy of the equipment. Only the highest quality facilities are awarded this accreditation!
Focus on prevention: Early Detection
We recommend a baseline mammogram at 35 and then mammograms every one to two years, depending on risk factors. At age 40 we recommend annual mammograms. We are sometimes asked at what age mammograms are no longer necessary. Well, there is no set age. You should continue to have yearly mammograms until the point at which, if a cancer developed, you would not seek any treatment.
We do not agree with the recent suggestions by the fedarally funded US Govt. Task Force. We feel that the motivation of the Task Force is to save health care dollars at the expense of women's lives! The Task force was composed of many representatives from health care insurers, but not a single radiologist, oncologist, breast surgeon, or any other clinician with demonstrated expertise in breast cancer diagnosis or treatment.
New Guidelines Back Mammograms Starting at Age 40
Two joint recommendations by the American College of Radiology and the Society of Breast Imaging advise women with an average risk of breast cancer to begin undergoing regular mammograms at 40. According to Dr. Carol Lee of Memorial Sloan-Kettering Cancer Center in New York, these guidelines take into account the success of annual mammography screening at age 40. "The significant decrease in breast cancer mortality, which amounts to nearly 30 percent since 1990, is a major medical success and is due largely to earlier detection of breast cancer through mammography screening," Lee said. The recommendations also advise high-risk women to start screening at 30; however, they should not start before 25, when the risk of radiation from mammograms begin to outweigh the benefits of screening. Additionally, the recommendations say high-risk women should be screened using MRI as well as mammography because it provides improved sensitivity for tumor detection. For high-risk women who cannot undergo MRI because of claustrophobia or for other reasons, a breast ultrasound should be used. These recommendations contradict recent guidelines published by the U.S. Preventive Services Task Force, which recommend against routine breast mammograms for women in their 40s.
From "New Guidelines Back Mammograms Starting at Age 40"
Reuters (01/04/10) Steenhuysen, Julie
New Breast Screening Limits Face
Federal guidelines released last year stated that annual mammograms may no longer be necessary. However, the final healthcare overhaul bill is likely to require coverage for more mammograms than the new guidelines recommend, largely due to women's groups, doctors, and imaging-equipment makers putting pressure on lawmakers. For years, many doctors and patient groups have supported early, frequent screening for breast cancer, and in recent years have worked with mammography companies to hold joint events to promote breast-cancer awareness. In November 2009, the U.S. Preventive Services Task Force said routine mammograms were unnecessary for women in their 40s with a normal cancer risk, arguing that the downsides of mammograms, like false positive results and exposure to low-level radiation, could outweigh the benefits for many women in this age group. In the Senate, lawmakers approved an amendment to the healthcare overhaul bill from Sen. Barbara Mikulski (D-Md.) that effectively nullifies the new guidelines and promises mammogram coverage for women starting at age 40. Just before Christmas, the House voted unanimously in approving a resolution stating that task-force guidelines should not be used by insurers to deny coverage for routine mammograms.
From "New Breast Screening Limits Face Reversal"
Wall Street Journal (01/12/10) Mundy, Alicia
Digital Mammography Helps Lower Radiation
Researchers report that digital mammography delivers significantly less radiation than conventional mammography and that the reduction in radiation exposure may be greater for women with larger and denser breasts. The researchers analyzed data from 5,102 women who received both digital and standard film mammography. The study showed that the average breast radiation dose per view was 22 percent lower for digital mammography. A study published in 2005 showed that digital mammography detected up to 28 percent more cancers than film mammography in women under age 50, in women who were pre- or peri-menopausal, and women with dense breasts. Currently, more than 60 percent of breast imaging facilities in the United States offer digital mammography.
From "Comparison of Acquisition Parameters and Breast Dose in Digital Mammography and Screen-Film Mammography..."
American Journal of Roentgenology (02/10) Vol. 194, No. 2, P. 362; Hendrick, R. Edward; Pisano, Etta D.; Averbukh, Alice; et al.
Office Renovations Completed!
We recently finished renovating and redecorating our office to create a more comfortable and updated environment for our patients. We hope you like our new look!