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MarinHealth
MarinHealth on the importance of breast health and screening for breast cancer
As October is Breast Cancer Awareness Month, I had the opportunity to sit down with Natalya Lvoff, MD, from MarinHealth to discuss the importance of focusing on breast health.
According to Breastcancer.org:
- In 2022 in the United States, it’s estimated that 43,780 people — 43,250 women and 530 men — are going to die from breast cancer
- According to the CDC, about 9% of all new cases of breast cancer in the U.S. are found in women younger than 45; breast cancer risk increases as women get older
- Black women are less likely to be diagnosed with breast cancer than white women, but are 41% more likely to die from the disease
- About 170,000 people in the United States are living with metastatic breast cancer
In response to these sobering statistics, Dr. Lvoff pioneered the use of MRI-guided breast biopsy at MarinHealth (formerly Marin General Hospital). She is involved in research, has published multiple articles, presented at numerous national radiology conferences, and has served as a representative of the Mammography Education Task Force for the American College of Radiology.
Screening guidelines seem to vary depending on the source. What is MarinHealth’s official position on when to start mammography and how often to screen?
Dr. Lvoff: There has been lot of confusion about the optimal regimen for screening mammography. There is a lot of misinformation out there about waiting to start screening at a later age or waiting longer intervals between mammograms.
The MarinHealth Multidisciplinary Breast Team recommends annual screening mammography starting at age 40, because this is the regimen that saves the most lives. This recommendation is supported by The American Congress of Obstetricians and Gynecologists, the American College of Surgeons, the American College of Radiology, the National Comprehensive Cancer Network, and the Society of Breast Imaging.
Mammography is the only test proven to reduce mortality from breast cancer. According to the National Cancer Institute, since screening mammograms became widespread in the mid 1980’s, the death rate from breast cancer in the US decreased by over 30%. Prior to screening mammography, the death rate had been unchanged.
What type of screening equipment does the Breast Health Center have?
Dr. Lvoff: Our breast center is on the cutting edge of technology. We were the first program in Marin County to offer tomosynthesis, the most sensitive type of mammogram for detecting breast cancer.
Tomosynthesis is a 3-dimensional mammogram that acquires multiple images of the breast at different angles. Images are reconstructed into thin slices, allowing the radiologist to see through overlapping structures - like reading the pages of a book, rather than just looking at the cover. This provides increased cancer detection, less additional imaging, fewer biopsies, and less anxiety.
Our breast center has four brand new state of the art tomosynthesis machines, so that all of our patients benefit from this technology.
We are the first community hospital in the Bay Area to use 3D Quorum technology for processing mammograms. The technology produces the clearest images of the breast while using the lowest amount of radiation.
One of the biggest complaints we get at the breast health center is that mammograms are uncomfortable. All of our mammography machines are now equipped with curved compression paddles - paddles that are curved to mimic the contour of a breast, making the mammogram as comfortable as possible.
I have received so much positive feedback about these paddles. Patients have said that this was the most comfortable mammogram they have ever had. They have said that they will tell their friends, some of whom have been reluctant to get a mammogram, how much better it is now.
We also have a state-of-the-art breast MRI center, specializing is screening and diagnostic breast MRI. We were the first hospital to Marin to be performing breast MRI and MRI guided biopsies.
We were the first to offer a high-risk program, so that each woman can learn about her own risk factors. Patients at higher risk for breast cancer receive a tailored approach for increased breast cancer screening.
We are the first Bay Area center with a prone 3D stereotactic biopsy table, which allows for greater patient comfort and optimized accuracy. And we are one of the first programs doing pre-operative seed localization for increased patient comfort.
What makes MarinHealth’s Breast Health Center stand out compared to other facilities?
Dr. Lvoff: The dedication of our breast care team is what stands out the most compared to other facilities. We are a team of physicians, nurses, navigators, counselors, therapists, technologists, schedulers, and staff with one common goal: providing the best possible patient care. It is a privilege and an honor to be part of this team. It is thanks to our team and to our patients that I look forward to coming to work each morning.
Patients appreciate the personalized and compassionate care that they receive here. Getting a screening mammogram can lead to a lot of anxiety. Our staff, starting from the front desk, to the technologists, nurses, and physicians, are here to guide the patient through this anxiety and to make each visit to the BHC a positive experience.
Do you also do bone density screenings?
Dr. Lvoff: Yes. For the patient’s convenience, we do breast density screening at the breast health center.
What are the most common barriers to screening?
Dr. Lvoff: Some patients fear the discomfort of mammography. The new curved paddle, designed to mimic the shape of a woman's breast, reduces this fear. The curved paddle provides the most comfortable mammogram.
Some patients fear radiation, but in reality, the radiation associated with mammography is minimal. Our BHC uses the minimal amount of radiation possible, well below the established national guideline. The new image processing equipment allows us to lower the amount of radiation even further.
Our patient's main fear is breast cancer. The best way to combat this fear is to get annual screening mammograms beginning at age 40. This is the approach that saves the most lives. Our team is here to help each patient through the screening process: To hold a hand, to offer guidance and reassurance, and to provide fast and accurate mammography results.
Are the new curved paddles for screening on ALL the Breast Health Center’s mammography equipment? If not, are they available upon request?
Dr. Lvoff: Yes, they are available on all of our machines. But note, they shouldn’t be used in patients with small breasts because it doesn’t provide uniform compression in these patients - the technologist determines the best paddle for each individual patient.
Take us through the Breast Health Center’s process if a routine mammogram turns up a suspicious area. What should a woman expect?
Dr. Lvoff: Screening mammograms can be associated with a lot of anxiety. Our breast care team is here to make the process as easy and stress free as possible.
Screening mammograms are interpreted within several days of being performed, often on the same day of the study. Thanks to our new electronic medical record, the result is available immediately to the patient. A small group of patients will be called back for additional pictures or ultrasound to get a closer look at an area. The patient receives the result of this additional imaging at the end of the exam.
Less than 2% of patients will need a biopsy. A nurse and Radiologist guide the patient through every step of the process. Pathology is processed accurately and efficiently at our pathology department at MarinHealth. We call the patient directly with the results as soon as they are available. Our patients never go through this process alone.
The MarinHealth Multidisciplinary Tumor Board meets weekly and is made up of a team of specialists in breast health, including Breast Surgeons, Oncologists, Radiation Oncologists, Radiologists, Plastic Surgeons, nurses, navigators, and therapists. We discuss each new breast cancer diagnosis to come up with a treatment plan that is individually tailored to each patient.
Marin was in the news a few years back for having a higher number of breast cancer cases compared to the national average. Is this still true? If so, do we have any idea why?
Dr. Lvoff: Breast CA rates in Marin County were considered among the highest in the country. The reason for this is likely multi factorial, including a combination of risk factors, such as waiting to have children at a later age and taking hormone replacement therapy to manage symptoms of menopause. Thanks to close collaboration with primary care physicians and gynecologists, the breast cancer rate in Marin is now at the state average.
Researchers from the Cancer Prevention Institute of California say the county has seen a 31 percent drop in new breast cancer cases since 2001, when the disease was at its peak. Deaths from breast cancer in the county have decreased by 65 percent since 1988.
Are you doing any sort of outreach or discounts to get underserved women to come in for their mammograms?
Dr. Lvoff: We have several funding programs available to our patients. Patients should contact the Breast Health Center for more info.
Are screenings read in-house at the Breast Health Center, or do they get read at the hospital? Are there staff radiologists? If so, do they specialize in breast imaging?
Dr. Lvoff: All breast imaging studies are read at the Breast Health Center by a subspecialized fellowship trained breast imager.