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Self-exams, professional screenings urged

October is Breast Cancer Awareness Month

Breast cancer is the second most common cancer among women in the United States, according to the National Cancer Institute. One in eight women in the U.S. will develop breast cancer over the course of their lifetime.

Increased awareness and use of annual mammography screenings, improved screening technology and treatment options are reasons for hope, according to area physicians. October is Breast Cancer Awareness Month, when health care providers remind women ages 40 and older to schedule an annual mammogram, a screening that can help detect breast cancer early before signs or symptoms appear and the odds of successful treatment are highest.

“Mammography saves lives,” said UPMC Altoona radiologist Lauren Deur. “Early detection saves lives — the earlier we find it the better.”

A mammogram takes about 20 minutes, she said, so she encourages friends to remind each other or schedule appointments together and then treat themselves to a lunch out. Too often, women forget or postpone their own health checkups because they are the family caretakers.

The use of 3D mammography or tomosynthesis has improved cancer detection and reduced call backs in women who have “dense” breast tissue, experts said.

A 3D mammogram (breast tomosynthesis) combines multiple breast X-rays to create a three-dimensional picture of the breast and is used to look for cancer in people who have no signs or symptoms of disease.

“It is particularly good with dense breast tissue — tissue that overlaps and is hard to see through. Those extra 23 slides are a very helpful supplemental tool,” Deur said. “I advocate that women get a mammogram at age 40 and get one every year.”

Penn Highlands Radiologist Maria Pettinger said women should know the density of their breasts, and it is required to be listed on mammogram results. Density is determined by heredity and can only be determined through a mammogram, not by how the breast feels or appears.

“Fatty breast tissue appears as a darkish gray on a mammogram,” she said. “Dense tissue is white. Guess what color cancerous tissue shows as? Cancer is white. So it’s like playing golf in the snow. More white dense tissue makes it harder to see cancer.”

Penn Highlands Huntingdon, then called J.C. Blair hospital, was the first hospital in the region to offer tomosynthesis. It came about through a conversation radiologist Maria Pettinger had with her mother, Peg Pettinger, who lives in South Carolina.

“I had just started here in 2002 with the goal of improving health care to women and my mother asked me what I needed. I told her the FDA had just approved 3D mammography. She asked me what it cost and I told her $120,000,” recalled Maria Pettinger. “A week later the head of development came to me and asked if I knew Margaret Pettinger — she’d donated the money.”

The radiologist said her mother’s donation enabled the rural hospital to be the first in the state to obtain the latest technology. Additional funds raised, such as through the Penn State Pink Zone, paid for her and other staff members to speak to women in the rural communities so they understood the need for annual screenings and the technology. The dual approach worked — screening mammograms have doubled.

Such funding helps women remember to schedule annual screening mammograms — the hospital sends out a reminder letter one month before a woman’s exam is due.

Her staff calculates that 45 percent of women between the ages of 40 and 80 are getting annual mammograms at the Huntingdon hospital. “I think that’s a pretty dang good percentage,” she said, noting that the actual rate is probably higher as women at the county’s borders likely obtain their screenings at other facilities.

In addition to an annual screening mammogram, Pettinger recommends women perform breast self-exams monthly and know how their breasts feel and compares a breast change to a pimple on the face.

“If you look at your face and see a pimple, you know it’s there. If you’re not looking in the mirror, you won’t know it’s there. If you are not touching and looking at your breasts, you won’t know what it looks and feels like. If you do, you’ll be the first one to know if something has changed.”

What happens next

If a radiologist sees a suspicious area, additional testing such as a diagnostic mammogram, an ultrasound, or biopsy ensues. Once a conclusive diagnosis is made, breast cancer treatment becomes very individualized. Treatment may involve a team of experts from various specialties, including breast surgery, a radiation oncologist, a medical oncologist, a breast health patient navigator and others.

Conemaugh Health System surgeon Renee Arlow said, “The trend in general is that less is more these days.”

Decades ago, complete breast removal along with removal of many lymph nodes was common. As research has increased knowledge, such radical surgeries are less common and patient considerations and preferences are taken into consideration, Arlow said.

“We are doing a lot more lumpectomies (removal of cancerous tissues with a rim of normal tissue) and we are trying to do less (removal) of auxiliary nodes,” she said. “It’s more personalized medicine.”

Such personalized medicine is also available when chemotherapy is recommended. Historically, that hasn’t always been the case as first chemotherapy triggered severe vomiting, diarrhea and fatigue.

“There’s plenty of hope” for women diagnosed with breast cancer today, said medical oncologist Dr. John Ford, who practices at Penn Highlands Healthcare in Huntingdon.

The hope extends to even more aggressive breast cancers, such as hormone receptor positive, or Her2-positive breast cancer, as chemotherapy agents become more targeted and more easily tolerated by patients.

“Chemotherapy today has fewer side effects and what side effects occur are better managed so treatments are well-tolerated,” Ford said.

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