It bothered Carol McFarlin when she was doing a routine self-exam and found a lump in her left breast in January 2008. She had just had a clean mammogram the previous September and it turned out her cancer was invasive and had already spread a little by the time she found it.
“That was just too quick,” said McFarlin, 57, of Augusta. She thought, “Something must be wrong with the machine.”
While radiologists acknowledge there are limitations with mammography, particularly in the past, newer technology is helping to overcome them. They like to give the analogy of looking into the breast as peering into clouds, with some breasts having relatively few fibrous or glandular tissue to obscure a tumor while denser breasts are much more difficult to spot tumors in.
“If it is hidden in there and it is pretty much the same density of the dense breast tissue, then you are not going to see it,” said Dr. Marion Weir of Brown & Radiology Associates.
Masses are also easier to find than the tiny “dots” that could be early lesions, said Dr. James Craft, the head of mammography for Medical College of Georgia Hospital and Clinics.
“We’re getting closer and closer and closer to the microscopic level of these areas,” he said.
Digital mammography over the last few years has given doctors a much clearer picture, Weir said.
“It has been better for women with dense breasts and it has also decreased the callbacks” but has not completely eliminated them, Weir said.
It is those callbacks that turn out to be nothing that wear on the patients, said Kellie Bedenbaugh, the lead mammographer for MCG Breast Health. She is hoping the health system can change that with a new 3-D mammography system that allows multiple views from different sides to be arranged in a “slice” 1-millimeter thick that allows the radiologist to peer down through dozens of slices to eliminate obscuring tissue and look at the relevant area.
“If there is a mass hiding in that thick, dense super-imposed tissue, they can actually get to the level of where it actually is,” Bedenbaugh said.
“It’s just stripping away the things that could be hiding the cancer,” Weir said.
If they find a spot and it is round and does not appear suspicious, the radiologist can also use other technology, such as ultrasound, to gauge the blood flow to get a better idea of what it is, Craft said.
“A cyst doesn’t usually have increased blood flow but a cancer does,” he said. The 3-D technology also tells the radiologist more precisely where he is in the breast to better gauge depth to help with biopsy, Bedenbaugh said.
“In my business, finding it is the first thing,” Craft said. “But then, I’ve got to find it well enough to localize it and do a biopsy.”
From a patient standpoint, the technology should help lower the number of needless callbacks and the costs for the patient, Bedenbaugh said. It also takes less compression, and uses less radiation while giving a much better image, she said.
“This will help us stay on top of things,” she told McFarlin.
It was less painful and less uncomfortable, McFarlin said afterward. But more so is her sense that she can trust the results.
“Nothing like peace of mind,” McFarlin said.