breast

Recent Questions About the Usefulness of Mammography

by Columbia Surgery on March 7, 2014

mammogramMany patients have inquired about a recent study in the British Medical Journal by Canadian researchers who found that mammography did not reduce death rates from breast cancer and may even have harmed some women by leading to unnecessary surgery, radiation, and chemotherapy. A vast majority of physicians, researchers, and breast radiologists have criticized the study sharply and cited massive evidence to discredit it.

It is important to keep in mind that the study is based on data from mammographic screening performed 30 years ago. At that time, two-view analog film-screening mammography was the standard of care. Unfortunately, the results from the study shed no light on the benefit of screening with current digital mammographic technique.

Differences in sensitivity between mammograms from the 1980s and now

Almost a third (30.6 percent) of the mammographically detected breast cancers in the Canadian study had already spread to lymph nodes and the vast majority were palpable (could be felt) by physical exam. Thus, it is no surprise that there was no survival benefit from mammography performed with the primitive technique of the 1980s. Results from contemporary studies1 show that with modern digital mammography, 18 percent of screening-detected cancers involve the lymph nodes; they are also more likely to be closer to 1 cm at diagnosis, compared with the mean size of 1.91 cm found by mammography in the Canadian study. The improved accuracy of digital mammography vs. analog film is well established for women under age 50 with dense breast tissue.2

Quality-of-Life Advantages to Earlier Detection

The Canadian study fails to acknowledge the many benefits associated with detecting tumors at smaller sizes. When tumors are detected earlier, patients are more likely to avoid mastectomy and to take advantage of breast-conserving options such as lumpectomy. They are also less likely to be prescribed radiation and chemotherapy.

Breast-Cancer Screening of the Future

Scientists at NewYork-Presbyterian/Columbia are involved in research to improve methods for early detection of breast cancer, including a PAP smear-type method to analyze nipple fluid to detect pre-cancerous changes. Another promising approach in development is 3D mammography. According to Sheldon M. Feldman, MD, Chief of the Breast Surgery Division, “Though digital mammography, the current ‘gold standard,’ performs reasonably well, we anticipate significant improvements in diagnostic capabilities in the near future.”

All patients should check with their physician before making any decisions about breast cancer screening or treatment.

      Sheldon M. Feldman, MD
      Chief of the Breast Surgery Division
      NewYork-Presbyterian/Columbia University Medical Center

Learn more about diagnosis and treatment of breast cancer at breastmd.org

    1. Nederend J, Duijm LEM, Louwman MWJ, Groenewoud JH, Donkers-van Rossum AB, Voogd AC. Impact of transition from analog screening mammography to digital screening mammography on screening outcome in the Netherlands: a population-based study. Ann Oncol 2012;23(12):3098–3103
    2. Pisano et al; DIMIST Trial: N ENGL J MED 10.1056/NEJMoa052911

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Dawn Hershman, MD

Dawn L. Hershman, MD

One of the main reasons that women have low quality of life while taking hormonal therapy is their side effects, says Dawn Hershman, MD, MS, Associate Professor of Medicine and Epidemiology and leader of the breast cancer program at the Herbert Irving Comprehensive Cancer Center.

While taking aromatase inhibitors (such as exemestane), the most common side effect is joint pain. Aromatase inhibitors block the natural production of estrogen in the body, reducing the amount of estrogen that is available to fuel the growth of estrogen receptor-positive breast cancers.  No medical therapies have been shown to relieve joint pain in women taking these medicines. Now, the HOPE study has found that exercise therapy improves joint pain by 30%.

Listen to Dr. Hershman explain the findings in a video available at OncLive.com.

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Innovations in Breast Cancer: Intraoperative Radiation Therapy Update

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TweetPrevious posts have informed our readers about an innovative breast cancer therapy, intraoperative radiation therapy (IORT), which became available at the Breast Center during the summer of 2013.  New York-Presbyterian/Columbia University Medical Center is one of the first institutions in the New York metropolitan area to offer IORT, which entails a single dose of radiation […]

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January 16, 2014

TweetOver the past several years there have been many important breakthroughs in the treatment and management of breast cancer. New screening methods, the advent of minimally invasive biopsy techniques, advances in oncoplastic surgical procedures, and new information on the ever-important role of genetic analysis are just a few of the many exciting recent developments in […]

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New Procedure to Prevent Lymphedema Gains Media Attention

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TweetA new protocol to help patients undergoing breast surgery is gaining widespread media attention as NewYork-Presbyterian/Columbia University Medical Center continues an important clinical trial of the LYMPHA protocol. The LYMPHA protocol combines microsurgery with advanced imaging in order to prevent, detect, and treat lymphedema. Lymphedema, painful swelling of the arm or hand, can be a […]

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Sneak Peak: Breast Cancer and Bridging the Gap

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TweetOn Saturday December 7th, Columbia University Department of Surgery is hosting its annual breast cancer awareness event, Bridging the Gap: Enhancing Breast Cancer Prevention, Screening and Wellness. We spoke with Preya Ananthakrishnan, MD, one of the key members of the planning committee, for a sneak preview about what we can expect at this year’s event. […]

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Treating Cardiovascular Disease in Breast Cancer Patients

November 21, 2013

TweetResearchers at Columbia University Medical Center have discovered that certain women undergoing radiation therapy for early-stage breast cancer may have an elevated risk of developing cardiovascular disease. David J. Brenner, PhD, DSc, of Columbia University, and his team studied treatment plans of 48 patients with stage 0 through IIA breast cancer in order to assess […]

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A Multicenter “Ablate and Resect” Study of Novilase Interstitial Laser Therapy for the Ablation of Small Breast Cancers

October 2, 2013

TweetColumbia University Medical Center is helping to lead a new clinical trial examining the effectiveness of using laser therapy to treat early-stage breast cancer. This new research involves a non-surgical treatment called, Novilase® Interstitial Laser Therapy (ILT). Novilase Breast Therapy is already cleared by the FDA for the treatment of breast fibroadenomas, which are the […]

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WABC-TV Breast Cancer Special features NYP/Columbia Breast Surgeons

September 28, 2013

TweetTune in October 5th for the WABC-TV Special “BREAST CANCER: ANSWERS, UPDATES & PROGRESS” features NYP/Columbia Breast Surgeons On Saturday, October 5th, WABC-TV will air a special program, “Breast Cancer: Answers, Updates & Progress” at 7:30PM, EDT (also to be re-run Sun. 10/6 at 5:30am).  Hosted by Eyewitness News Anchor Diana Williams, the program focuses […]

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Save the Date: BlogTalkRadio 9/23/13 with Raven Keyes, Reiki Master

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TweetTune in to the Dr. Carol Francis BlogTalkRadio show Monday, Sept. 23 to hear Raven Keyes talk about bringing the ancient art of reiki into mainstream medicine. In her award-winning book, “The Healing Power of Reiki,” Raven Keyes tells moving stories of trailblazing an ancient healing practice into the operating rooms of  Mehmet Oz, MD, […]

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