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Breast Cancer Diagnosis: The Latest Technology

Even though lung cancer and heart disease kill more women each year, surveys show that women view breast cancer as their biggest health threat. But women can take steps to lower their risk. Screening and diagnosis for Breast Cancer have come a long way from your mothers mammogram.

Maria E. Nelson, MD is here to talk about imaging modalities to make a breast cancer diagnosis, and current surgical strategies for better cosmetic outcomes.
Breast Cancer Diagnosis: The Latest Technology
Featured Speaker:
Maria E. Nelson, MD
Maria E. Nelson, MD is Assistant Professor of Clinical Surgery at the Keck School of Medicine at USC. After receiving her undergraduate degree from Carleton College, she completed her masters and medical degrees at the University of South Dakota. Maria E. Nelson, MD is a member of the medical staff at Palmdale Regional Medical Center and at Keck Medicine of USC.

Learn more about Maria E. Nelson, MD

Melanie Cole (Host):  Regular clinical breast exams and routine mammography are important tools in the early detection of breast cancer. However, there are other modalities for women that can help detect breast cancer even more specifically. My guest today is Dr. Maria Nelson. She is a breast surgeon and a member of the medical staff at Palmdale Regional Medical Center as well as a member of the medical staff at Keck Medicine - USC. Welcome to the show, Dr. Nelson. Tell us about what’s going on in the world of mammography and diagnosing breast cancer.

Dr. Maria Nelson (Guest):  Thanks, Melanie. It’s a pleasure to be on your show this morning. The world of breast imaging has included mammography as the staple, or backbone, of our breast screening. The most recent guidelines from the American Cancer Society has kind of made a ripple with the announcement that women should start at 45, consider having their annual screening twice a year after the age 55. I deviate from this and would recommend that patients consider individualizing this recommendation based on their own person risks and their own personal history of breast issues. I still advise my patients to start at age 40 if they’re of average risk. The standard 2-D mammogram is what most radiology facilities have. There is a newer mammogram called 3-D, or tomosynthesis. This is being done in women who have high risk or dense breasts, particularly 50% or greater density to their breasts, which would be defined by their prior imaging. This provides a bit more compression to the breast, a bit more radiation. So, it’s not for everyone but in selective cases or in challenging breast imaging, this is a very nice tool to add.  Ultrasound has also been used selectively for cases of breast masses or distortions or just needing to further evaluate, say, a cyst from a solid mass. The final modality is breast MRI which is being used in high risk women, particularly those with genetic mutations that confer a higher risk of breast cancer in a woman’s lifetime.  

Melanie:  I’d like to talk for a minute about the tomosynthesis and 3-D technology. How does that help you with dense breasts? We’re hearing more and more, Dr. Nelson, that certain states are requiring that if a woman does have hard to detect or dense breasts that they get a letter about it and then they can get further testing without it being called diagnostic. Tell us a little bit about tomosynthesis. How does that help with dense breasts?

Dr. Nelson:  Tomosynthesis is a software program that’s added to a digital mammogram machine. The radiologist gets a sequence or series of images rather than just the static one, two or three as the previous two dimensional mammography would do. This allows them to see in more detail areas of distortion or early areas of abnormal calcifications that may suggest a small, early forming cancer. In a woman with dense breasts where most of the tissue can appear white against a black background, having some more pictures and sensitivity to kind of weed out what is the dense breast tissue versus what is a concerning area just facilitates that process and ability to detect it earlier when it’s smaller. That’s the real advantage.

Melanie:  Every woman dreads that mammogram even though they’re just not a big deal and then we dread that waiting to hear if we have to come back or if something’s suspicious. Once it becomes diagnostic, what is the next step in diagnosing breast cancer?

Dr. Nelson:  Good question. There are three ways to make the diagnosis and they all hinge on a core needle biopsy. The method of doing that biopsy is by image guidance. The image guidance that is most commonly done is ultrasound needle biopsy. The alternative to that might be a stereotactic or a mammogram guided biopsy. That would be in cases where this wasn’t a mass but a distortion or abnormal calcification. That’s where a stereo or mammography guided biopsy would be indicated. The third modality would be an MRI guided biopsy. That is probably the least common and used in cases where the lesion is not seen readily by ultrasound or mammogram.

Melanie:  If you do these biopsies, you determine it is breast cancer, women are worried not only for their lives but also there’s that – it’s not vanity necessarily--self-esteem and our feeling as a woman. What do you tell patients, Dr. Nelson, about the surgical intervention that you would need to do and what they can expect afterward for a better outcome cosmetically?

Dr. Nelson:  Our hope for all women with early stage breast cancer is that we can do breast conservation, meaning we can preserve their breast and we can leave them with the best cosmetic outcome where it’s hardly noticeable that they’ve undergone a surgery. We do this by making smaller incisions, placing those incisions in a way that can be as discreet as possible or as hidden as possible. We also have new approaches to doing mastectomy so the decades old mastectomy that was quite deforming has really transformed. We’re now doing skin sparing or nipple areolar sparing which just creates a much nicer aesthetic that’s more natural and less deforming for the women. For those women that have the unfortunate case of being diagnosed with breast cancer, I think there’s a multitude of new procedures that can be done that can both save their breasts and/or make the cosmetic outcomes much better and more natural looking.

Melanie:  What about breast reconstruction when you’re doing mastectomy because women are hearing more and more that they can get this done at the same time?

Dr. Nelson:  That’s correct. When we are planning for a mastectomy, we partner right along with our plastic surgeon colleagues and we do the mastectomy followed by the reconstruction in one anesthetic. The woman goes in, she gets both procedures done and when she wakes up she has the reconstruction done. The possibility of having this all done in one stage is the goal. Sometimes, there needs to be a second stage to the reconstruction maybe for a temporary implant to be exchanged to a permanent implant. There are other ways to doing the reconstruction with using their own tissues so that they don’t have to have a second stage. They immediately have new breast mounds and look as natural as possible in the one surgery. This really helps to keep the aesthetic more natural and also, hopefully, take away that waiting period of feeling as though they don’t have their breasts physically there.

Melanie:  In just the last few minutes, Dr. Nelson, what should people diagnosed with breast cancer think about when seeking care?

Dr. Nelson:  They need to find a good surgeon who focuses on breast cancer care so they can insure that they are getting all of the standards of breast cancer care, including surgery, but also access to see additional treatment such as anti-hormonal treatment, chemotherapy treatment. Going to a center or a doctor who specializes in breast care, I think, is the most important first step in choosing their care.

Melanie:  Why should they come to Palmdale Regional Center for their care?

Dr. Nelson:  Palmdale has brought in a team of people that are focused on providing expert care and breast care in a multi-disciplinary fashion where we’re including the breast surgeon who is focused on surgical oncologic care, the medical oncologist, the radiation oncologist, the radiologist, are all working together to individualize care to the breast cancer patient. This is a unique and excellent opportunity for patients to have a coordinated approach that’s individualized to them.

Melanie:  Thank you so much. What wonderful information, Dr. Nelson. Thank you so much for being with us.  You’re listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information you can go to That’s Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.