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Benefits and uses of 3D Tomosynthesis and Breast MRI


Vilert Loving, MD, is a radiologist for Banner MD Anderson Cancer Center.

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Banner Health: Benefits and uses of 3D Tomosynthesis and Breast MRI - Full Transcription

Audio: Music over opening titles and introduction.

Text:   Banner MD Anderson Cancer Center presents

Text:  The Benefits and Uses of 3D Tomosynthesis and Breast MRI
Vilert Loving, M.D.
Banner MD Anderson Cancer Center

Text:  Andrew Schorr
Founder and Host, Patient Power
Author, The Web-Savvy Patient

Image:  Andrew Schorr on camera

Audio:  “Hello. I’m Andrew Schorr from Patient Power for MD Anderson Cancer Center. Women wonder, of course, about mammography. How often should they have it? How reliable is it? When should they perhaps have something they may have heard about, a breast MRI? And, is there anything new that’s come along to make things better so they can be more confident in the health of their breasts or, should cancer be detected, that it’s detected accurately? Well, there is a new development. We’re going to hear about that and also, certainly, more about the guidelines in where breast MRI fits in. To help us understand this is a Breast Radiologist, a subspecialist in that area of radiology, and that’s Dr. Vilert Loving from the Banner MD Anderson Cancer Center. Dr. Loving, thank you for being with us.”

Image:  Dr. Loving on camera

Audio:  “Of course.”

Image:  Andrew Schorr on camera

Audio:  “Dr Loving, is there something now that is more useful than mammography that we’ve had for many years?”

Text:   Vilert Loving, M.D.
Banner MD Anderson Cancer Center

Images: Dr. Loving and Andrew Schorr on camera as each speak.

Dr. Loving Audio:  “Yes. With mammography, there’s been kind of a step-wise advance in terms of our technology. So the wide-spread use of mammography started back in the 80s and, since then, it’s progressed with better imagining. Now we use what’s called digital mammography to improve the imaging in the majority of women. But recently there’s been another jump in technology and with something called tomosynthesis. You may also it called 3D mammography. But it’s been a significant advance in terms of our breast imaging because it helps to improve our cancer detection.”

Andrew Schorr Audio:  “So, for you as a radiologist, does 3D tomosynthesis give you a more complete view of the breast?”

Dr. Loving Audio:  “Yes. An easy way to think of it is a traditional mammogram, a 2D mammogram, is basically taking a picture of the breast. And so it’s like when you have a camera and you’re taking a picture of something and it prints out a photo, which is a two dimensional photo, but there’s no depth to it. There’s no third dimension. With tomosynthesis, we’re adding that third dimension. And how that works is, instead of taking a normal, two dimensional picture, the tomosynthesis machine is actually moving kind of like an arc over the breast. And as it’s moving over that arc, it’s taking multiple additional pictures. And so, with those additional pictures, it’s giving us more information about the breast.

One analogy that I use for patients when I try to describe tomosynthesis and explain how it works: imagine if you’re standing in the middle of a forest. At the edge of the forest of trees, there’s a person waving at you. If you had a camera in your hand, you’re taking a picture of that person, you get a two dimensional picture. So sometimes you can see the person easily. Sometimes that person is obscured by trees and you can’t see them at all. Sometimes you may see an arm sticking out waving at you but oftentimes you may or may not get a good picture of that person just with that single photo. And that’s the analogy to traditional mammograms, which just takes a traditional two dimensional picture.

With tomosynthesis, the difference being, when you’re going back to that tree analogy, it’s as if you’re moving—taking a picture from one angle, moving to a different spot, taking another picture, move to a third spot, take another picture. And when you compile the data from all those pictures together, you get a better view. You get to see around the trees. You get the better view of that person that’s standing there. And so that’s the same idea with tomosynthesis. We’re taking these multiple views and we’re looking around the breast tissue and looking through it and more around it on the edges to see the potential for breast cancer behind things.”

Andrew Schorr Audio:  “So does that give you more confidence that you’re getting a clear picture?”

Dr. Loving Audio:  “Yes. So it definitely improves the images we’re looking at and we consider it to be a tool on top of traditional mammography. It just helps us to be much more confident and more sure of what we’re looking at in looking for abnormalities that could be hiding in the breast.”

Andrew Schorr Audio:  “Is this something you’re now using routinely at Banner MD Anderson Cancer Center?”

Dr. Loving Audio:  “We are. When women come in for their yearly screening mammograms every year, we do perform tomosynthesis on all of those patients. So it’s very helpful and we do offer it to everyone that comes in.”

Andrew Schorr Audio:  “Women have heard about breast MRIs. Some have had it. Where does breast MRI fit it?

Dr. Loving Audio:  “That’s a good question. MRI—there’s a lot of publicity and people may have heard about it. The studies have shown that MRIs are actually superior to mammography in detecting breast cancer. We can find it much more easily. The disadvantage that comes with that is that, with that sensitivity in finding breast cancer, we’re also finding a lot more benign or noncancerous things in the breast and, with the MRI pictures alone, sometimes we may not be able to tell easily, at least, if something is cancerous or something is noncancerous. What that leads us to in some people is with biopsies. So, a lot of people are going through with biopsies that are potentially unnecessary—things that turn out to be noncancerous. And so, for that reason, we don’t recommend it routinely for all people. We only recommend it for people that are considered to be at higher risk compared to the average population. The reason being is, because people who are at higher risk, it’s justifiable to potentially have to go through with more biopsies because of their increased chance of having breast cancer compared to the average population.”

Andrew Schorr Audio:  “So if a woman has a family history, maybe with a mom or her sister with breast cancer, where does breast MRI fit in? Is she considered high risk?”

Dr. Loving Audio:  “Yes. Definitely. So we encourage all women that have either a question or they know that higher risk, to discuss that with their primary care physicians. There’s a number of factors that contribute to women’s risk of breast cancer. The common ones, being family history, such as someone with their mother or their sister that had breast cancer, particularly at an early age or in some people, they have genetic conditions that they know of that predispose into developing breast cancer. And people like that, it’s important to talk to your doctor and discuss your risk factor and determine if MRI plays a role in your screening routine for breast cancer.”

Andrew Schorr Audio:  “It sounds like you’re now at the point with imaging techniques that you have a good chance of spotting the breast cancer early, where it can either be cured or the effects can be limited.”

Dr. Loving Audio:  “Yes. In the breast imaging world, there’s been a lot of research to improve our technology: tomosynthesis and MRI being two examples of those. We’re constantly researching and developing new techniques and the goal, ultimately, is to look at the breast and to be able to distinguish what’s normal and what’s abnormal. And of the things that are abnormal, to be able to find them earlier and smaller and at an earlier stage. We found that the earlier you find breast cancer, the better the chances of ultimately getting a cure.”

Andrew Schorr Audio:  “I know there have been federal panels that have made some recommendations. There’s been some controversy. What do you recommend as far as breast cancer screening guidelines?”

Dr. Loving Audio:  “At Banner MD Anderson Cancer Center, we are in agreement with the American Cancer Society that we recommend annual screening and mammography once a year, starting at age 40 and on from that point. We’ve found that that screening schedule is the optimal for minimizing breast cancer mortality. In other words, finding breast cancer at its earlier stage and improving chances for a cure.”

Andrew Schorr Audio:  “Dr. Vilert Loving, Breast Radiologist at Banner MD Anderson Cancer Center. Thank you for explaining this for us and our viewers.”

Dr. Loving Audio:  “You’re welcome. Thank you.”

Image:  Andrew Schorr addresses camera

Audio:  Closing music over conclusion and titles.

Andrew Schorr Audio:  “I’m Andrew Schorr for Patient Power. Remember, knowledge can be the best medicine of all.”

Text:   Banner MD Anderson Cancer Center presents

Text:  Banner MD Anderson Cancer Center
Making Cancer History
©  2012 Banner Health

Banner MD Anderson Cancer Center
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Gilbert, AZ 85234
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(855) 256-6444

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