I wish u knew… about breast cancer screening

Tim Hampshire

Welcome to the first in a series of interviews where oncology professionals talk about what they wish their patients and the public knew. These interviews were conducted by Tim, a third-year student at NYU. His interest in oncology comes from his family, which includes two cancer nurses, a radiation oncologist, and multiple relatives who have fought the disease. He is not a medical expert, or even in the field of medicine. Too often, we only learn about medical professionals through media that make it difficult to really understand what they do, why they do it, and what they want us to know. This blog is an attempt to tap into those stories– the ones with tangible human value. It’s about time we knew what they wish we knew.

With all that in mind, I was particularly lucky to have an interview with breast crusader Dr. Jennifer Tobey, a radiologist who specializes in breast imaging technology.

Screening with Mammography: Looking at the Controversy”

3D Mammography: What is it?

The ABCs of Mammography with Dr. Jennifer Toby, Radiologist at Penn Medicine

Layman’s question #1: What is breast imaging technology?

Breast imaging technology is the set of mammogram strategies that includes film screen mammography, digital mammography, and tomosynthesis. The first is a bit of a dinosaur (like film cameras), the second is the modern standard (like digital cameras,) and the third is a super cool new weapon in the radiologist’s arsenal. The thing that makes tomosynthesis so exciting is that it takes a standard digital image and places it alongside individual 3D segments that are pictures of sectors throughout the entire breast. The resulting model is much more comprehensive and makes it easier to determine what lesions are potentially harmful ones.

So why do we need something like this? Dr. Tobey, a woman all too familiar with the mystique and danger of the breast, put it better than I ever could: “Standard mammography is just a composite image of the entire breast smushed together. There are so many structures in there…”

As it turns out, a big problem with breast imaging is the occurrence of false positives. It often happens that standard mammography images give radiologists an idea that, you know, some stuff looks like it could be bad. Tomosynthesis allows for a greater degree of accuracy, especially for younger women, who tend to have denser breasts.

Layman’s question #2: Denser breasts?

That’s right. In the wide world of breasts, there’s fatty and dense, and the spectrum in between them. Dense breasts are a result of more fibroglandular tissue than adipose tissue. Fibroglandular tissue includes the milk ducts and connective fibers supporting the breast. Fatty breasts are just the opposite, composed of mostly fat cells, which allow radiation to penetrate them more easily. From a radiographic standpoint, dense breasts are more problematic (for the same reason it’s harder to see into a dense forest than a sparse orchard.) This is why it helps to use tomosynthesis. It’s a good way to make sure the radiologist is getting everything.

Dr. Tobey had more to say on the issue of screening.

Oh boy. Ask any cancer professional about screening, and you’ll get a long answer. It boils down to this: a research trend in recent years has shown that testing large swathes of the population for detectable cancers like breast and prostate might not actually decrease mortality rates for those cancers. The thrust is that the medical community might be wasting time and resources trying to find cancers that aren’t there, or might not become very bad. Many doctors have pushed back with, “Well, what the hell are we supposed to do? Not test people?”

And there’s the point of clash. The United States Preventive Services Task Force has a lot of correlative data and fancy charts, while doctors like Jen Tobey have a waiting room full of people scared to death, and a world full of women with breasts. To them, that’s reason enough to keep screening.

“Without any definitive evidence that mammography is not working, we’re gonna not fix what ain’t broken,” said Dr. Tobey.

Sounds good to me.

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