YOUNGSTOWN, Ohio – Advanced technology, improved treatment techniques and more public awareness mean earlier breast cancer diagnoses and better patient outcomes, according to physicians who specialize in the disease.
“There’s definitely significant advancements in breast imaging …,” says Dr. Nicole Reyes, a breast surgeon at Mercy Health. “We have 3D mammograms, we have breast MRIs. There’s now something that is called contrast enhanced mammography, which is becoming more popular.”
A 3D mammogram gives a better picture, enabling a doctor to scan through the whole breast, she explains.
“Specifically with breast MRIs, we use IV contrast so the contrast is really good because it goes in the breast, and it can light up different breast lesions,” Reyes says.
The technology itself has also improved, and many radiologists use artificial intelligence to help better characterize breast lesions, she adds.
Mercy Health’s Joanie Abdu Comprehensive Breast Care Center has been recognized by the American College of Surgeons National Accreditation Program for Breast Centers, American College of Surgeons Commission on Cancer as an Integrated Network Cancer Program, the American College of Radiology and the American Society for Radiation Oncology.
October is Breast Cancer Awareness Month, and the American Cancer Society reports the disease is the second deadliest cancer for women behind lung cancer. Breast cancer death rates are declining though, and decreased 44% between 1989 and 2022, according to the society.
Technological Advancement
Dr. Peter Apicella, a board-certified radiologist and chairman of the Department of Medical Imaging at Salem Regional Medical Center, who’s been practicing for 32 years, says the technology has changed tremendously.
In 1994, the Mammography Quality Standards took effect, establishing a minimum baseline quality for mammography.
“And within five years, the quality was tremendous,” he says…,” Apicella says. “We were finding much, much smaller cancers. And then in the early 2000s they created something called tomography… That lets us see through the breast tissue, and now it’s a 3D tomography along with digital mammography. We have MRI, we have PET scans, we have all of this new technology that’s all based on breast cancer… and it’s made a huge difference.”
Detecting tumors when they’re smaller means better survival rates.
The 3D wide-angled mammography, also known as tomosynthesis, provides more detailed images than standard mammography.
“It’s better at detecting smaller and hidden cancers and reducing false-positive results in dense breast tissue, avoiding unnecessary biopsies and unnecessary concern,” Apicella says.
High-definition ultrasound helps find small masses and distinguishes cancers from cysts and other non-cancers, the doctor explains. A 3D stereotactic biopsy allows minimally invasive outpatient sampling of abnormalities to detect breast cancer at the earliest stage. SRMC also has 3T MRI, which Apicella describes as the most sensitive test for breast cancer detection.
“3T MRI provides twice the resolution and twice the speed of older scanners,” he says. “MRI is used for newly diagnosed patients to find the extent of cancer and for annual screening of women at high risk for breast cancer.”
National Accreditation
SRMC is accredited by the National Accreditation Program for Breast Centers. It’s also accredited by the Commission on Cancer and is a designated breast imaging center through the American College of Radiology.
Dr. Linda Camp, the center’s breast program director, is a plastic and reconstructive surgeon who provides surgical treatment of breast cancer and breast reconstruction. She joined the medical center staff in April 2021 and oversaw the breast center’s accreditation process.
Camp says Dr. Anita Hackstedde, SRMC’s president and CEO, had a vision of developing a breast program. Camp joined the staff to help with that initiative.
“We started to explore what we currently offer and where the gap is to where we need to be,” she says, adding that they didn’t want to only improve – they wanted to be nationally recognized and accredited.
Securing that accreditation involved a whole team that works with patients, Camp explains. It includes surgery, medical or radiation oncology, radiology, nursing staff, a social worker and treatment, medication, therapy and nutrition personnel. A nurse navigator, who is also part of the team, helps patients through the challenges of diagnosis, treatment and follow-up.
“Everyone here that has a touch point with any breast cancer patient is part of our breast care team,” Camp says.
It’s treating the patient as a whole person who has a life outside of cancer, she explains.
And at SRMC, when a patient is diagnosed with breast cancer, the hospital is committed to see them within seven days.
“We know that timing is critical,” Camp says. “It creates such extreme anxiety for the patient and family. We want to mitigate that anxiety as quickly as we can and education and knowledge is the way to help with it. It doesn’t cure it, but it helps with it.”
While much progress has been made with diagnosis and treatment, not all types of breast cancer respond to treatment, Camp acknowledges.
“We still have triple negative cancers that don’t respond to anything that we hit it with, and patients still can die of breast cancer,” Camp says. “Maybe in the future, we’ll be able to say that’s not true, but in the present time, we’re narrowing that window. So, if you have breast cancer today, you have a much greater chance of surviving and becoming cancer free than that same patient 15 years ago.”
Research Underway
Reyes at Mercy Health points to research that may lead to even better results for people with breast cancer.
“There’s definitely a lot of research with systemic therapy,” she says. “I know a lot of what they are looking at right now is personalized and targeted therapies, so directed at very specific types of breast cancer.”
Studies underway are looking into the best way to combine modalities to provide the best outcomes for patients, Reyes adds. It’s targeted based on the breast cancer biology.
“Some different things that we look at with breast cancer is, do they contain hormone receptors?” Reyes says. “If they do, then people have an option of taking antihormone therapy. There’s also certain proteins that some breast cancers have specifically.”
One of those is HER2, or Human Epidermal Growth Receptor 2. “And there’s targeted therapies specifically against HER2 positive breast cancers,” she says.
Reyes recognizes a breast cancer diagnosis is frightening for a patient and when a breast cancer patient meets with her before surgery, she offers reassurance.
“I start by telling them breast cancer treatment has come a long way in the past few decades, and we have become very advanced in how we treat breast cancer,” she says. “But essentially, I tell them treatment is going to be very individualized. There are a lot of options. And each individual is treated in a multidisciplinary team.”
The team includes the surgeon, the medical oncologist, the radiation oncologist and others. “Essentially, we come together, and we develop a treatment plan that is hopefully going to give the patient the best outcome,” Reyes says.
Both Reyes and Camp say maintaining a healthy lifestyle such as eating healthy, exercising regularly, avoiding smoking and avoiding or limiting alcohol can reduce breast cancer risk.
The Risk
And many factors contribute to a woman’s breast cancer risk. Apicella points to what’s known as the Tyrer-Cuzick score which is designed to assess a woman’s lifetime risk of developing the disease. It’s used to help create a personalized screening and health care plan.
The TC score considers age, family history and genetics, personal history, hormonal factors, breast density and factors such as height, weight, ancestry, race and ethnicity.
Those whose risk assessment is higher may be advised to have more frequent or intensive screening such as a breast MRI in addition to an annual mammogram, Apicella says,
“Salem Regional Medical Center offers the latest version of the Tyrer-Cuzick score with every mammogram performed,” Apicella says. “We have a high-risk clinic for patients wishing to receive counseling, genetic testing and the latest screening tests and allow self-referrals.”
For a woman with an average risk, for example, the American College of Radiology and the Society of Breast Imaging recommend annual mammography screening beginning at age 40.
For a woman with high risk, the recommendation is to begin MRI imaging at age 25. Beginning at 30, 3D mammograms and MRIs alternate at six-month intervals, per the recommendation.
SRMC, which has locations in Salem, Columbiana and Canfield, is affiliated with the Seidman Cancer Center of University Hospital. It’s part of a consortium that’s a specialty center for breast cancer.
“What it’s done is it’s allowed the hospital to focus on finding early cancers and to really make a difference,” Apicella says.
Pictured at top: Dr. Linda Camp, a plastic and reconstructive surgeon at Salem Regional Medical Center, in a treatment area of the hospital. Camp also leads SRMC’s breast cancer initiative for certifications and new accreditations.