From routine screenings to treatment and followup, imaging technology has a vital role in the fight against breast cancer.

Regular screening mammograms, beginning around age 40, remain part of the best-known strategy for early detection, radiologist Dr. Kristy Wolfel said at Conemaugh Advanced Imaging, 1450 Scalp Ave.

“Mammography is pretty much the gold standard for early detection of breast cancer,” Wolfel said. “It sees masses and calcifications very well.”

An annual screening mammogram, along with clinical breast exam by a medical professional, represents the best defense, Johnstown breast surgeon Dr. Gerard Garguilo said from Conemaugh Physicians Group – Johnstown Breast Center, 1111 Franklin St.

“They should have a mammogram and a good clinical exam yearly,” Garguilo said. "I still say from age 40 on for your mammogram."

While he acknowledges that some organizations have suggested yearly mammograms from age 50, Garguilo says he's concerned about breast cancer's lack of early symptoms.

“Part of the issue is, by the time there are warning signs, the horse is out of the barn,” he said. “A good screening program is the way to go.”

Chan Soon-Shiong Medical Center at Windber breast surgeon Dr. Debra Sims agrees.

Sims noted that some charities can provide vouchers for those without insurance for screenings.

“There is no excuse anymore not to get a mammogram, from a medical standpoint,” Sims said in Joyce Murtha Breast Care Center at the Windber hospital. 

When to have an MRI?

Mammography uses X-ray images to detect abnormalities in the breast. If the radiologist reading the image spots a suspected lesion, doctors can order additional imaging with 3D mammography, magnetic resonance imaging or ultrasound, said Bill Smithtro, Conemaugh Advanced Imaging operations manager.

Ultrasound imaging uses sound waves to help diagnose breast lumps or other abnormalities found during a physical exam or mammogram.

“If there are additional questions, the radiologist might request a breast MRI,” Smithtro said. “It can be done the same day.”

The MRI technology can distinguish different types of tissue and track circulation, Wolfel said.

“MRI is higher sensitivity,” she said “We can use it for diagnostics and problem solving.”

While the mammogram displays images in shades of white and gray, an MRI can show various aspects in different colors, Wolfel continued.

Cancer tumors direct more blood vessels to feed the malignancy, so blood flow enhanced on the MRI display shows possible tumor sites, she said.

But MRI is not effective for routine screening because of its high sensitivity.

“We see more benign things,” Wolfel said. “They could be hormonal changes.”

Pinpointing the problem

Johnstown breast surgeon Dr. Patti Ann Stefanick said the MRI technology has helped her be sure she is recommending the correct surgery.

“They are really, really important when you think you have one lesion, and you might have three or four in that breast,” Stefanick said at her 939 Menoher Blvd. office in Southmont.

“You won't find that with a mammogram or ultrasound.”

The Conemaugh Advanced Imaging program recently received a three-year renewal of accreditation for breast MRI by the American College of Radiology.

The accreditation involves a peer-review process that considers staff qualifications, imaging equipment and quality control. The center must consistently deliver image quality and maintain accepted staff qualifications.

“The accreditation reaffirms our commitment to providing high quality breast care to the women in our community,” said Dr. Michelle Casek, director of women’s imaging services.

Casek and Wolfel are among a handful of Conemaugh radiologists who specialize in breast imaging and image-guided biopsies.

All three imaging modalities – mammography, MRI and ultrasound – can be used to direct a thin metal tube used to extract suspected cancer specimens. The image-guided needle biopsies have become standard of care in most breast cancer diagnosis, greatly reducing the number of open biopsies performed with scalpels, Stefanick said.

'Targeted therapy'

All three imaging systems are in use at the Joyce Murtha Breast Care Center in Windber, where Sims performs the diagnostic biopsies.

Stefanick performs needle-guided biopsies at her office, and an increasing number of Johnstown's breast biopsies are done by the diagnostic radiologists at Conemaugh Advanced Imaging.

Sometimes, the biopsy can be done the same day a suspected cancer is first identified on a mammogram, Smithtro said, explaining the patient's referring physician and insurance payer would have to approve the test.

Once the specimen is removed, it is sent to the pathology lab to determine not only if it is cancer, but analyze what type of cancer it is. That information allows the surgeon and medical oncologists to decide a course of treatment, breast surgeon Dr. Diana Craig said from UPMC Altoona.

"It is targeted therapy," Craig said. "It narrows in on the cells themselves. I think there are going to be a lot of leaps and bounds in that area."

Different cancers respond differently to drugs, so it is possible to shrink some tumors before surgery, she said. The molecular information can also prepare the patient and medical oncologist for followup care.

After cancer surgery the same imaging technology is used to evaluate success of treatment and see if the cancer returns. 

Randy Griffith is a multimedia reporter for The Tribune-Democrat. He can be reached at 532-5057. Follow him on Twitter @PhotoGriffer57.

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