American College of Radiology, the governing body that oversees radiology services at St. Luke Hospital, recommends women begin annual breast cancer screening at age 40.
“That’s our recommendation along with talking to your doctor about your risk factors,” said Keri Helmer, registered radiology technologist and mammography technician at St. Luke. “It’s a good idea to get (your doctor’s) opinion on it.”
Mammography, which X-rays images of the breast, is a basic tool to diagnose cancer.
“Out of all the different modalities, it is the most cost effective,” Helmer said. “It gives the doctor a really good roadmap as where to aim toward for a more specific test. It’s a low dose of radiation, so there’s not a lot of interaction with the body.”
Lone local provider
Helmer, who has been giving mammograms for 10 years, screens her patients using digital imaging at St. Luke, a unit installed in 2014 that replaced film screening.
“We are the only hospital in the county that offers that, and out of the surrounding counties, we probably have one of the newest machines,” she said.
The digital equipment works similarly to the film screening machine, using compression and taking four standard views of the breasts.
“But with the digital unit we can see through the breast tissue a lot better than we could with the film screen,” Helmer said. “A lot of times if you had denser breast tissue that you’re to image through or penetrate through, you were losing a lot of that other tissue in the breast that wasn’t as dense.”
The digital machine adjusts for that denser and less dense tissue.
“It’s able to get a good picture of both simultaneously, so you’re not having to do extra images to try to get through that denser tissue,” she said. “There’s a lot more adjusting that we can do on the (computer) work station, too, so if we do want to zoom in on an area, we can adjust for that also.”
Fewer callbacks
Since using the new machine, Helmer said they’ve had fewer callbacks for patients who come in for regular screening because of better imaging.
Images are read by a radiologist who is trained and licensed to interpret mammograms.
“They have to keep up their license for that,” she said. “They also have to keep up continuing education specifically for mammograms. They have to read so many (mammograms) a year to be considered qualified, and that’s something we all keep track of. The state comes in once a year and overlooks our program to make sure everything is in compliance.”
Radiology and Nuclear Medicine in Topeka is the group that reads mammograms for St. Luke.
“They have two doctors that mainly come to see us—they’re from Emporia,” Helmer said. “They come in once a week to read for us.”
The doctors come every Wednesday morning.
“We do mammograms throughout the week, Monday through Friday,” she said. “But anytime we have a patient that’s been called back for a suspicious mammogram or a patient that has felt a lump and is needing imaging done, we schedule those for Wednesday mornings when the doctors are here so (the patients) can get results when they leave.”
Indicators
When reading mammograms, the radiologist looks for microcalcifications, Helmer said.
“They’re little, small calcification deposits in the breast, and if there’s kind of a cluster of them, that’s something that they look for,” she said.
“It depends on the shape of the calcifications and how they’re clustered together. As the cancer grows, it can develop these calcifications, and that’s what starts showing up on the mammogram or it starts pulling these calcifications into it.”
The radiologist also looks for masses in the breast.
“A lot of times they can be cysts, benign things like that,” Helmer said. “If they see a cluster of dense tissue, that’s something they’ll want to do more investigating on.
“We’ll do additional views from that to separate out the breast tissue. If that still doesn’t give them a clear idea what is going on, we’ll go to ultrasound.”
On Wednesdays, when Helmer, the radiologist and ultrasound technician are all present, patients can receive a mammogram and ultrasound to come up with the diagnosis, she said.
“After we’ve done the mammogram and we’ve done the basic picture that gives an area to focus in on,” she said, “the ultrasound can go in and take a real good look at what that tissue is made of—if it’s a cyst or fibrous tissue, the size of it, the shape and get all those measurements off of the ultrasound.”
The ultrasound can also detect whether a mass has any vascular flow to it, when there’s blood vessels being fed into it that are feeding the cancer, she added.
When to stop
One question Helmer said she often receives is when to stop getting mammograms.
“There’s really not a set age to that—it’s just between you and your doctor when you want to stop,” she said. “We always say as long as the patient is in good health, can come in and we can get pretty good pictures, then I wouldn’t see any (reason to) necessarily stop. If we can catch something early, there’s a lot less follow up that needs to be done to take care of the issue.”
Another factor to consider, she added, is decisions about treatment if cancer is diagnosed.
Helmer said the most typical warning sign of breast cancer is “changes in the skin where you notice the skin is getting thicker or it seems like it is pulling or retracting.”
Women should pay attention to the nipples, as well.
“If your nipple starts to retract or pull in and it hasn’t been like that before, that’s something to keep an eye out for,” she said. “Another thing is nipple discharge if that’s not something that’s not common for you.”
Primary risk factors
The two primary risk factors for breast cancer, Helmer said, are being a woman and getting older.
Contrary to what many think, having a family history of breast cancer doesn’t increase one’s risk of breast cancer.
“In the majority of breast cancers that are found, there no family history,” Helmer said. “That’s a really big myth that’s out there.”
Though rare, men also can have breast cancer.
“In my years of doing mammograms, I have come across men with breast cancer,” she said. “It happens. With them, a major sign could be a lump, if they notice a lump. A lot of times breast cancer in men tends to be worse off once it’s found because they don’t realize until it is way more progressed.”
Helmer advises regular mammograms.
“As best you can, try to maintain a yearly mammogram,” she said. “Try to keep track of where you have your mammograms done. If you move, keep track of the facility where you had them.”
St. Luke has access to a national database.
“If a patient can just give me the town they had it in and some kind of ID of the facility, and about how long ago they thought they had it done, we track those down from there,” she said. “It’s so very helpful to have prior images.”
Helmer also recommends maintaining a healthy weight and good diet, exercising, reducing alcohol intake and eliminating smoking to reduce risks of breast cancer.
“Those are things a person can do,” she said.
