Barbara Smith knows firsthand how new developments in diagnosing and treating breast cancer can help her patients get on with their lives.
As a breast health nurse navigator at Albany Medical Center, she guides people as they prepare for biopsies and face the uncertainty ahead.
Smith, 53, of Clifton Park, went through the same procedure herself earlier this year after being scanned in January on Albany Medical Center’s new breast tomosynthesis machine, a three-dimensional scanner that takes more images of the breast from different angles than the typical digital mammogram.
The 3-D breast scan revealed a 7-millimeter tumor the regular digital mammogram, done simultaneously, failed to detect. Smith had a lumpectomy, had a lymph node removed and then received seven weeks of radiation while she continued to report to work daily.
“I have a little teeny scar,” she said. “I’m perfectly fine. I never lost a pound; I never lost a hair.”
And Smith believes that without the scan by the breast tomosynthesis equipment, which Albany Med started using shortly after the U.S. Food and Drug Administration approved it in February 2011, her tumor would have gone unnoticed for another year, when it would have gotten large enough for her to feel or for the mammogram to pick it up.
“Either scenario, it would have been a much bigger tumor,” Smith said, adding the cancer may have spread by then, requiring chemotherapy.
“I knew this [machine] was going to save a lot of lives,” she said. “I just never thought it was going to be my life.”
Other women have found themselves in situations similar to Smith’s, said Dr. Beth Whiteside, a radiologist at Albany Medical Center. Whiteside conducted clinical trials with the tomosynthesis machine before it was approved by the FDA and now uses it on patients who request the scan.
“There have definitely been cases where we just can’t see the tumor in the regular mammogram and you can see it on the tomosynthesis,” Whiteside said.
Few clinics in the region have the new machine. Research has shown it’s good at detecting tumors in women who have dense breast tissue that may obscure abnormal lumps on a regular mammogram, which take two flat images of the breast, one from the top and one from the side, Whiteside said.
The 3-D machine spends four more seconds taking a series of images from different angles, increasing the chance of spotting a small tumor, she said.
“We believe that it decreases the number of false positives,” Whiteside said, so fewer women have to come back for a second look. “It helps us that we’re not having to do extra tests on people that don’t need it.”
Most insurance programs won’t cover the three-dimensional diagnostic procedure, something Whiteside hopes will change soon.
“It is a technology that could probably benefit almost every woman,” Whiteside said.
Like Smith, many breast cancer patients have fewer lymph nodes removed than they did several decades ago, when a radical mastectomy and removal of all the lymph nodes under the arm was standard treatment.
Now, when women are diagnosed with smaller tumors, doctors do a sentinel lymph node biopsy to determine which nodes near the breast have developed cancer, reducing the number that need to be removed, said Dr. Arvind Mahatme, a breast surgeon at Ellis Medicine.
In the past year and a half, if the breast tumor is small and the cancer has spread to only a few lymph nodes, doctors remove those and treat the rest of the underarm area with radiation.
“There’s been a push toward doing less and less intervention,” Mahatme said, adding that less invasive surgeries have improved patients’ lives.
Removing fewer lymph nodes reduces the risk of developing lymphedema, a painful condition that causes swelling and decreased arm movement, often for life, in about 20 percent of women who have all their underarm lymph nodes removed, he said.
Doctors now usually recommend women with smaller tumors have a lumpectomy and radiation, Mahatme said. Depending on a slew of factors, some women also get chemotherapy, and those with tumors that are sensitive to female hormones receive drugs that block estrogen or progesterone receptors or prevent the body from producing those hormones, Mahatme said.
“It’s a very dynamic process,” he said of changes and advances in breast cancer treatment. “I think every year, ultimately the goal is to cause the least harm to the patient while providing the best prognostic outcome.”
There haven’t been any major changes in chemotherapy and radiation treatments for breast cancer in the past few years, and those therapies are well-honed to treat the cancer, said Dr. Todd Doyle, a radiation oncologist at New York Oncology Hematology in Albany. Only 10 percent of patients who receive radiation see a recurrence, he said.
Today’s radiation also targets the area better than 10 years ago, reducing potential damage to the heart and lungs. So researchers now are studying ways to make radiation more convenient for breast cancer patients — who typically report for radiation for 15 minutes five days a week for six weeks — while preserving that low recurrence rate.
“The big thing is trying to do this in three weeks instead of six,” Doyle said.
Despite the advances in treating breast cancer, Smith has seen in her work at Albany Med how some women’s fear causes them to avoid mammograms, sometimes with tragic results.
Thanks to well-honed treatments and new technology that allows for early detection, women don’t need to fear a breast cancer diagnosis as they did in the past, Smith said.
“It’s a very curable cancer if it’s caught early,” she said.
For her part, she’s glad she got the 3-D mammogram that allowed her to treat the cancer early and get back to living her life.
“I feel very fortunate to be in a place, in a geographical area, that has this technology,” she said.
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