Symptoms

Some warning signs of breast cancer include:

• New lump in the breast or underarm (armpit)
• Thickening or swelling of part of the breast
• Irritation or dimpling of breast skin
• Redness or flaky skin in the nipple area or the breast
• Pulling in of the nipple or pain in the nipple area
• Nipple discharge other than breast milk, including blood
• Any change in the size or the shape of the breast
• Pain in any area of the breast

If symptoms occur contact your doctor immediately and work with them to implement appropriate treatment and monitoring.

For years, the gold standard in breast cancer screening has been 2D mammography. Unfortunately, it doesn’t always deliver clear results. Traditional 2D mammograms suffer from decreasing sensitivity as the density of a woman’s breast tissue increases, or when breast tissue overlaps. This can result in unclear images that leave health providers unsure of what they see, and can lead to cancers being missed.

IPMC Medical Center now offers MAMMOMAT Revelation with wide-angle breast tomosynthesis. It’s state-of-the-art 3D mammogram technology that is proven to detect breast cancer better than traditional 2D mammography alone. We’re using it in our practice to give our patients new confidence in their breast health.

Unlike 2D mammography, 3D wide-angle breast tomosynthesis takes many x-ray pictures of each breast from many angles that are not available in traditional mammography. The x-ray tube moves in a 50-degree arc around the breast, taking 25 images during the exam. Those images are then sent to a computer, where they are assembled into a 3D picture of the breast. The result is a clearer image that helps health providers detect malignant tumors better than standard 2D mammography alone, with fewer recalls.

We introduced wide-angle tomosynthesis as an adjunct to 2D mammography because we want you and your family to be sure. We love its wide-angle imaging and the clarity it offers our doctors. We think it will save lives because it leaves breast cancer no place to hide.

According to statistics, women have a 35% chance of getting wrong results. More often, women get false positive results—they are told to have heart disease while they don’t. But sometimes, the test fails to detect a problem—clogged arteries that significantly raise the risk of a heart attack. Now that’s scary.

Fortunately, cardiologists nowadays have access to advanced technologies that give a much more accurate assessment of heart issues and can predict a possibility of a heart attack or a stroke 20-30 years in advance.

Every year, over one million of Americans suffer from heart attacks, and over half of them are lethal. Men are leading in these numbers, but women are starting to close the gap.

Here are the heart tests that can give more accurate results in your heart health evaluation, and if your physician does not request them for you, demand the ones that are recommended for your age group or risk category.

Cardiac Calcium Scoring

HOW IT WORKS: A CT scanner checks for atherosclerotic plaque in your heart’s arteries. After electrodes are attached to your chest and to an EKG machine that monitors your heartbeat, you lie on an exam table that slides into a short, doughnut-shaped tunnel and hold your breath for 10 to 20 seconds.

COST: $99 to $399

DURATION: 10 minutes

WHY IT’S HEART SMART: Calcified plaque—a major warning sign of coronary artery disease, the leading cause of heart attacks—shows up at least 10 years before a heart attack or stroke hits. By catching the problem early, you can treat it before the buildup narrows arteries so severely that it triggers a heart attack.

GET IT IF: You’re 50 or older with risk factors—or you’re younger with a family history and several risk factors. Since the test involves x-rays, women shouldn’t have it if there’s any chance they might be pregnant.

WHAT THE RESULTS MEAN: You’ll get an Agatston Score, which indicates the total amount of hard and soft plaque in your heart’s arteries. A score of zero means you have no calcium deposits and a low risk of heart attack in the next 5 years. A score of 400 or more puts you at high risk of a heart attack within 10 years; a score of 1,000+ means you have up to a 25% chance of having a heart attack within a year without medical treatment.

NEXT STEPS: If your score is 200 or higher, your doctor may advise lifestyle changes, a statin to lower cholesterol, or a diabetes drug to lower blood sugar—all of which will also reduce plaque.

Carotid Intimal Medial Thickness Test

HOW IT WORKS: This “ultrasound of the neck” takes a picture of the left and right carotid arteries, which supply blood to your head and brain. After putting a gel on your neck, a technician glides an ultrasound transducer over your carotids to measure the thickness of the arteries’ lining.

COST: $150 to $500

DURATION: 15 minutes

WHY IT’S HEART SMART: Studies show a link between an abnormal thickness of the carotid lining and coronary artery disease. This test can detect even the earliest stages before blood flow is blocked. Because it’s not an x-ray, it’s also helpful for women who are or may be pregnant.

GET IT IF: You’re 40 or older—or you’re under 40 and a close relative (parents or siblings) had a heart attack or stroke before age 55.

WHAT THE RESULTS MEAN: You’ll get two numbers: the thickness of your carotid lining (normal is less than 1.06 mm) and your “arterial age,” an estimate of how that thickness compares to that of healthy women your age. If your arteries are more than 8 years “older” than you are, your doctor can tailor treatment to reduce your risk.

NEXT STEPS: A diet and exercise plan, stress reduction, and, if necessary, drugs to lower your cholesterol, blood pressure, and blood sugar and reduce your intimal medial thickness.

High-Sensitivity C-Reactive Protein Test

HOW IT WORKS: A blood test measures CRP, a protein in your blood that’s a strong indicator of inflammation throughout your body.

COST: $8 to $43

DURATION: 5 minutes

WHY IT’S HEART SMART: Cholesterol plaque injures blood vessels, triggering inflammation and raising CRP levels in your blood. That’s dangerous because women with high levels of CRP may be up to four times more likely to suffer a heart attack or stroke. A high CRP is most dangerous if you also have a waist circumference of more than 35 inches, indicating the presence of belly fat.

GET IT IF: You’re 40 or older.

WHAT THE RESULTS MEAN: If your score is under 1.0 mg per liter, your risk of developing heart disease is low. A score between 1.0 and 3.0 mg/l equals average risk. Above 3.0 mg/l, you’re at high risk. It’s possible to have high CRP without heart disease, though, because infections and injuries can also trigger a spike in levels.

NEXT STEPS: A statin, along with weight loss and exercise, can cut the risk of heart problems in women with high CRP.

Advanced Lipid Profile and Lipoprotein(a) Test

HOW THEY WORK: Unlike the traditional cholesterol blood test, which measures total cholesterol, HDL, LDL, and triglycerides, the advanced test also looks at particle size. This is important because some particles are big and fluffy, so they tend to bounce off artery walls as they travel through the body. Others are small and dense, meaning they can penetrate the artery lining and form clumps of plaque. (Think beach balls versus bullets.) The Lp(a) blood test analyzes a specific type of cholesterol that can triple heart risk.

COST: $19 each

DURATION: 5 minutes

WHY THEY’RE HEART SMART: Sizing up your particles gives a clearer picture of heart risk than the conventional test: Having a lot of large particles cuts risk, while small ones raise it. The more Lp(a) you have, the worse it is too—it makes LDL particles extra sticky, so they cling to the lining of blood vessels, causing plaque and clots.

GET THEM IF: You have a family history of heart disease.

WHAT THE RESULTS MEAN: For Lp(a), levels above 30 mg/dl put you at increased risk.

NEXT STEPS: If you have small particles, your doctor may prescribe a drug to increase their size, most likely a fenofibrate (such as TriCor or Trilipix) or niacin (vitamin B3), along with a healthy diet and exercise. Niacin is also among the best treatments for high Lp(a).

A1C Blood Glucose Test

HOW IT WORKS: A blood test indicates your average level of blood sugar over the prior three months. Unlike other glucose tests that require fasting or drinking a sugary beverage, this test requires neither.

COST: $50

DURATION: 5 minutes

WHY IT’S HEART SMART: This is the simplest way to detect your future risk of diabetes. This disease puts you at 5 times higher risk of developing heart disease—yet 5.7 million Americans have undiagnosed diabetes (on top of the 17.9 million who are diagnosed) because they haven’t had their blood sugar checked.

Get It If: You’re 45 or older—or earlier if you’re overweight and have one or more diabetes risk factors, such as family history, high triglycerides, or low HDL.

WHAT THE RESULTS MEAN: An A1C level between 4.5 and 6% is normal; between 6 and 6.4 indicates prediabetes; 6.5 or higher on two separate tests means you have diabetes.

NEXT STEPS: The disease can often be reversed with weight loss, exercise, and dietary changes. If that’s not enough, you may need oral medication or insulin injections.

Genetic Tests

HOW THEY WORK: A blood sample is tested at a lab for mutations of the KIF6 and APOE genes.

COST: $130 each

DURATION: 5 minutes

WHY THEY’RE HEART SMART: A common variation in the KIF6 gene and two mutations in the APOE gene raise your heart disease risk. You cannot control your genes, but these tests can help your doctor better tailor your treatment to head off a heart attack.

GET THEM IF: You’re 40 or older.

WHAT THE RESULTS MEAN: The KIF6 gene test predicts how effective statins are likely to be at heading off a future heart attack. A recent study found that people with a certain variant of KIF6 had a better response to statin treatment, with a 41% drop in heart attack risk, while people without this mutation didn’t respond as well, with a 6% drop. As for the APOE gene, certain people with those variants have a much greater response to a low-saturated-fat diet and may not even need medications.

NEXT STEPS: A drug to lower cholesterol, changes in diet, or both.

Stress Echocardiography

HOW IT WORKS: This test is an improvement over the standard stress test because it adds an ultrasound both before and after exercise to evaluate blood flow to your heart’s pumping chambers and check for blockages in the arteries that supply the heart.

COST: $850 to $1,600

DURATION: 45 minutes

WHY IT’S HEART SMART: Adding echocardiography to the standard stress test raises accuracy by as much as 85% for women. This is an excellent way to tell if your heart disease is severe enough that you could require treatments like a stent or a bypass.

GET IT IF: You have signs of heart disease, regardless of your age. If you experience shortness of breath, chest pain, neck pain, or any other symptom, you might need this test.

WHAT THE RESULTS MEAN: If the test detects reduced blood flow, one or more of your coronary arteries may be blocked.

NEXT STEPS: Your doctor may recommend a cardiac catheterization to check for blockages. If your vessels are clogged, they can be reopened with angioplasty, a stent, or bypass surgery.

Will Your Insurance Pay?

Compared with the $760,000 it costs to treat a single heart attack patient, these tests are cheap—but some insurers won’t pay for them. Most will pay for the stress EKG, blood glucose, and advanced cholesterol tests. Some will cover the gene tests and CIMT. Cardiac calcium scoring usually isn’t covered. Call your carrier beforehand to find out what it will pay for and what your co-payment will be.

What Are MRIs?

MRIs use magnets and radio waves that bounce off water and fat molecules within the body. Gathered information is then transmitted to a machine that “decodes” the message and creates pictures of internal body tissues.

MRIs are a common choice for diagnosing issues related to joints, brain, heart and blood vessels, wrists and ankles, and breasts. Here MRIs have a certain edge over CT scans in the quality of details. Unlike CT scans, MRIs do not use radiation, but they are somewhat noisy, slower, and claustrophobic, which may cause anxiety. Besides, because of their strong magnets MRIs may not be safe for some candidates including those with aneurysm clips (unless the clips are MRI-safe), cardiac pacemakers or defibrillators, any metal parts or shaving inside the body (strong magnets will pull them out). Apart from those limitations, MRI scans are safe, painless and have no ill effects on the body.

What Are CT Scans?

Computer tomography scans combine a series of X-ray images taken at a variety of angles to produce a more detailed picture than a regular X-ray. CT scans are preferred for diagnosing internal injuries of bones, blood vessels and soft tissues. They are especially useful for diagnosing the area and extent of damage that came from car accidents, sport traumas and similar high-impact physical events. CT scans are also used for detecting traumas and tumors within bones and muscles, blood clots, cancer, internal bleedings, as well as for guiding during surgeries, biopsies, etc.

Even though CT scans are less detailed than MRIs, they are quicker, cheaper, more comfortable for patients (not as noisy and feel less “confined”) and don’t have so many safety limitations, although CT scans should be avoided by pregnant women.

The Takeaway

Although it will be up to your doctor to choose an imaging technique for you, you should ask questions and share any concerns you might have to make sure their choice is right for you.

The test aims to find out whether any areas of the heart muscle are not receiving enough blood flow during exercise. It is also known at the thallium stress test, a myocardial perfusion scan, or a radionuclide test. The test can be done while the patient is resting or doing exercise. Although the patient is exposed to a small amount of radiation, the test is safe and takes about 3 to 4 hours.

Benefits

The nuclear stress test can help to diagnose a heart condition by giving vital information. This data includes:

• the size of the heart chambers
  how well the heart is pumping blood
• whether there is any damage to the heart
• if there is any blockage or narrowing of the coronary arteries that provide blood to the heart
• the effectiveness of any current treatment.

The test can also help determine whether the patient is suitable for a cardiac rehabilitation program, and if so, how hard they should exercise.

Nuclear stress test with exercise

In the nuclear stress test with exercise, a radionuclide, such as thallium or technetium, is injected into a vein in the hand or arm. When the radionuclide has circulated through the bloodstream, a gamma camera takes pictures of the heart while the patient is lying down. This is known as the “rest scan” of the heart.

The patient then moves onto a treadmill. The treadmill starts slowly and gradually picks up speed and incline, to simulate walking or running uphill. At peak exercise, more radionuclide is injected into the patient. When the radionuclide has passed through the bloodstream, the gamma camera takes more pictures of the heart. This is known as the “stress scan” of the heart.

The radionuclide helps to identify blocked or partially blocked arteries on the scans because blocked arteries do not absorb the radionuclide into the heart. They are known as “cold spots.”

Without exercise

Patients with severe arthritis may be unable to do the physical activity required in a test with exercise. These patients may do the chemical nuclear stress test. In a chemical stress test, the patient receives medications that either speed up the heart rate or dilate the arteries. The body responds in a similar way it would to exercise. A radionuclide is injected into the patient’s arm or hand while resting. When it has circulated through the bloodstream, a gamma camera takes pictures of the heart, while the patient is lying down motionless. As in the test with exercise, this is also known as the “rest scan” of the heart.

The doctor then administers medication to either speed up the heart rate or dilate the arteries. When the peak heart rate is reached, the patient is injected again with a radionuclide. When it has circulated throughout the bloodstream, the gamma camera takes more pictures. This phase of the procedure is called the “stress scan” of the heart.

As in the stress test with exercise, blocked or partly blocked arteries will show up as “cold spots.”

SenoClaire, which was approved by the FDA in 2014, uses a low-dose short X-ray sweep around the positioned breast with nine exposures acquired with a “step-and-shoot” method, removing the potential motion from the tube helping to reduce blur and increase image sharpness.

We are committed to offering the community a complete suite of solutions – from screening and diagnosis through treatment and monitoring. SenoClaire will offer our patients a new solution to help clinicians detect breast cancer with low dose radiation and high image quality.

A key challenge when performing screening mammography is keeping the radiation levels as low as possible. With GE’s SenoClaire, there is no increase in dose from a 2D standard mammogram to a 3D view, which means there is no increased radiation to patients during a SenoClaire breast exam. ­­

SenoClaire marks a significant step forward in helping our clinicians detect breast cancer. At IPMC, our goal is to provide our patients with the most effective ways to battle cancer from every possible angle, with innovative procedures, medicines, and technology.

What is Tomosynthesis

Tomosynthesis is an exciting technology that offers a new way of looking at breast cancer detection with 3-dimensional imaging. It allows a radiologist to take multiple pictures of each breast from various angles, which differentiates it from a traditional mammogram, which takes a single image in two directions. Tomosynthesis has the potential to revolutionize mammography and breast cancer screening because it offers improved sensitivity and specificity at dose levels equivalent to those with 2D mammography.

Mammograms are:

• One of the best ways to identify breast cancer early, when it is most responsive to treatment.
• A low-dose x-ray that uses a small level of radiation to produce high-quality images of breast tissue.
• A 20–30-minute procedure, from checking in to leaving the facility.
• The screening procedure itself tends to run about 10 minutes for most patients.

Mammograms aren’t:

• Dangerous
• Time consuming
• Overly painful

Everyone’s pain threshold is different, but the compression involved in a mammogram is more often described as discomfort, and typically lasts for just a few seconds at a time.

Tips for preparing for your mammogram

• Schedule your mammogram for when your breasts aren’t likely to be tender or swollen, to help reduce discomfort and get good pictures. Avoid the week before your period if possible.
• On the day of the exam, don’t apply deodorant, antiperspirant, powders, lotions, creams, or perfumes under your arms or under your breasts.These can affect the imaging results.
• Instead of a dress, you might find it easier to wear a skirt or pants.

Comfort and confidence await

Because IPMC Medical Center uses Siemens Healthineers mammography solutions, you have access to systems that offer:

• Images captured from more angles in a single exam, giving your doctor a better view of the breast to help detect more abnormalities sooner
• Customized breast compression for each patient
• Comfortable, rounded paddles that warm up quickly
• A unique imaging process so you don’t need to hold your breath during exams
• Calming lighting to help create a more comfortable exam environment

About 60,000 women worldwide die as a result of preeclampsia, which causes severely high blood pressure. Potential complications include stroke, bleeding, and pulmonary edema, which can lead to respiratory failure. The study suggests a lung ultrasound can help physicians easily learn whether a woman with preeclampsia is suffering from pulmonary edema and ensure she receives the correct treatment.

“Lung ultrasound is fast, safe, noninvasive, and easy to use,” says Marc Leone, MD, PhD, lead study author and vice chair of the department of anesthesiology and critical care medicine at Hôpital Nord in Marseille, France. “We found it allowed us to quickly assess whether a woman with preeclampsia had pulmonary edema and confirm the severity of the condition.”

Physicians often measure urine output to determine whether a woman needs fluid administration, but the results are wrong about one-half of the time. “Lung ultrasound enables the medical team to identify which women really need the fluid treatment,” notes Laurent Zieleskiewicz, MD, the study’s first author.

Pulmonary edema typically is caused by heart failure but also can be caused by lung inflammation. Researchers analyzed the use of lung ultrasounds, which can assess lung edema, are easier to use than cardiac ultrasound, and can be performed with devices commonly found in maternity wards. Lung ultrasound highlights white lines mimicking comet tails, irradiating from the border of the lungs. These lines are the reflection of water in the lungs. The detection of three or more lines strongly suggests the diagnosis of pulmonary edema.

Researchers performed both cardiac and lung ultrasounds before and after delivery in 20 women with severe preeclampsia. Five of the 20 women had pulmonary edema prior to delivery, according to lung ultrasound, while four had the condition according to the cardiac ultrasound. The lung ultrasound identified a patient with non-cardiac pulmonary edema, which the cardiac ultrasound did not detect.

The test results could help ensure that pregnant women with pulmonary edema will not be given IV or excess fluids, which worsens the condition and can lead to respiratory failure. Typically, women with pulmonary edema are treated with oxygen and medication to lower blood pressure or rid the body of excess fluid. In real time, lung ultrasound also serves to observe improvement or worsening of pulmonary edema.

Source: American Society of Anesthesiologists

Screening women aged 40 to 49 for breast cancer has additional benefits beyond the proven decrease in mortality rate, according to researchers at Case Western Reserve University. Patients screened with mammography are statistically less likely to undergo chemotherapy, avoiding the associated toxic morbidities. Screening mammography also helps identify a subset of patients at increased risk of breast cancer by diagnosing high- risk lesions.

The majority of high-risk lesions identified in a retrospective chart review were found in screened patients. Identifying patients at high risk may allow for the administration of chemoprevention, decreasing the risk of subsequent breast cancer development. The identification of high-risk lesions also may lead to supplemental screening MRI, which has the added benefit of detecting future mammographically occult malignancies in high-risk patients.

“When the US Preventive Services Task Force guidelines were published in 2009, confusion was created among patients and primary care providers on when and if 40- to 49-year-old women should be screened,” said Nelly Salem, MD, of University Hospitals–Case Western Reserve. “Without screening mammography, these asymptomatic high-risk women would be unaware of their risk and the opportunity to decrease their risk of subsequent breast cancer development with use of chemoprevention.”

Tomosynthesis After Screening Mammography Reduces Need for Ultrasound, Biopsies

Breast tomosynthesis in the diagnostic workup for one- or two- view focal asymmetry detected at screening mammography resulted in less ultrasound use, fewer biopsies, and higher positive predictive value for cancer than when diagnostic exams involved only 2D mammography, according to a study conducted at the University of Virginia.

“Tomosynthesis has been evaluated in screening populations and been shown to decrease recall rates,” said researcher Brandi Nicholson, MD, “but studies in the diagnostic setting are lacking.” The 532 patients who were recalled for a focal asymmetric density discovered at screening were analyzed across three categories: women recalled prior to the availability of tomosynthesis in the practice (PT), those who did not have tomosynthesis at diagnostic evaluation after it was available (NT), and those who had diagnostic tomosynthesis (YT). There were 238 patients in the PT group, 145 in the NT group, and 149 in the YT group.

The researchers found that additional full views and ultra- sound were performed significantly less frequently in the YT group than in both the PT and NT groups. They also found that the positive predictive value was increased for the YT group com- pared with both the PT and NT groups.

Overestimation of Radiation Exposure May Keep Women From Screening

Misinformation and misunderstanding about the risks associated with ionizing radiation create heightened public concern and fear, and may result in avoidance of screening mammography that can detect early cancers.

In a study to determine the baseline understanding of the radiation associated with mammography among patients presenting for initial or follow-up imaging, women were asked to rate the amount of radiation received in a single mammogram as being significantly less, slightly less, about the same, slightly more, or significantly more compared with a series of radiation benchmarks. None of the subjects correctly ordered all six of the benchmarks; on average, they significantly overestimated the amount of radiation associated with a mammogram in comparison with other radiation benchmarks.

“Our findings indicate a need to educate patients about the amount of radiation they are exposed to during a single screening mammogram,” said Jacqueline Hollada, a member of the UCLA research team. “Using everyday sources of radiation exposure as benchmarks can help add perspective and improve patients’ understanding of radiation levels associated with mammography, thereby reducing anxiety related to the examination.”

The authors concluded that medical personnel should make concerted efforts to accurately inform women of the risks and benefits of mammography, specifically highlighting the low dose of mammographic ionizing radiation, and provide objective facts to ensure that women make informed decisions about screening.

Source: Radiology Today