Doctor's Corner

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This section will be intermittently changed to give research updates, clinical perspectives, or useful “pearls of practice”.

I would like to address two topics with this edition. One is something that should be well known by patients, doctor staff and physicians, but often slips by. It can make a huge difference in finding a cancer that may otherwise “fall through the cracks”. An early cancer diagnosis can be delayed, and a more difficult to treat cancer can result if we forget to think like this. It is a simple concept. It is the difference between screening and diagnostic imaging. If a patient has an area of concern by physical exam by her own self check or her primary doctor’s exam, she should be referred for DIAGNOSTIC mammograms. She should not be referred for ordinary or screening mammograms. A screening mammogram is appropriate for a woman who does not have any questionable findings. Do not think that a mammography center, no matter how good, can be a mind reader. If you are concerned about an area, express that to your doctor and to the mammography staff so that the proper work up can be done.

A screening mammogram consists of updating your history with regard to prior breast surgeries and results, family history and hormone use, and two views of each breast. A busy center should have a physician reading about 60 or more exams per day. Scheduling for screening can take several weeks to a month or so.

SCREENING IS FOR ROUTINE CHECKS OF PATIENTS WITH NO AREAS OF CONCERN. THEY ARE ELECTIVELY SCHEDULED.

A diagnostic mammogram will include the same detailed history, a physical exam by the radiology MD, and marking on the skin over the area of concern. Additional mammographic views over the area of concern, and often, an ultrasound are done. A patient who is scheduled for diagnostic imaging is scheduled into the “fast track” for appointment time. Extra time is allotted so that the work up and findings are done quickly, and you and your doctor are informed promptly. Sometimes the scheduling doctor’s office is not aware of this distinction, and a woman with an area of concern is sent for “mammograms” without any other distinction. Please inquire and make sure that you are scheduled for diagnostic imaging if there is a questionable finding. A diagnostic exam that shows benign or probably benign findings should give you an immense sigh of relief in short order. Those results really help the clinician like me who double checks the physical findings and correlates them with the imaging. If a woman who has a problem comes to the breast surgeon’s office with screening mammograms, she will need to go back and complete the imaging studies. So, for the best evaluation of any area of concern to physical examination, double-check that you are in the mode of “diagnostic” imaging at an experienced center.

DIAGNOSTIC MAMMOGRAMS ARE FOR THE TIMELY AND COMPREHENSIVE EVALUATION OF AN AREA OF CONCERN TO PATIENT OR DOCTOR. THEY ARE FAST TRACKED IN SCHEDULING AND REPORTING OF RESULTS. THEY INCLUDE HANDS ON EVALUATION BY THE SUPERVISING MAMMOGRAPHY MD.

I will write more on how to assess your imaging center in another edition.

The second topic for this edition introduces the availability of the L-Dex machine to help us minimize the occurrence and impact of lymphedema after cancer therapies. Lymphedema can occur early or late after surgery involving lymph node removal for cancer treatment. Its likelihood is influenced by how extensive the surgery is, the patient’s own anatomy and body fat, and other treatments like chemotherapy and radiation and further traumas to the arm (bites, cuts, burns, excessive pressure).

Lymphedema results in a swollen arm from fingertips to axilla, and is permanent, although it can be lessened and managed with treatment. Until now, we did not have a reliable way to diagnose it before the onset of swelling. Now, with the L-Dex machine we can detect lymphedema BEFORE visible swelling starts. We can start therapy with less intensity and greater success. The machine measures the volume of the operated side to the other limbs. It is much like having an electrocardiogram with simple leads for a few minutes.

We would like to measure patients at high risk for lymphedema pre- operatively and at intervals following surgery. It will be wonderful to reassure patients that their arm is doing well and ease a concern. As well, if we find those patients with lymphedema earlier, their results of treatment will be expected to be much better. Studies were done at the National Institute of Health, and this is an FDA approved device. Ask us more about it as you visit us.