Breast Imaging Program
Nearly all professional screening guidelines call for women to begin screening for breast cancer at the age of 40, with mammograms.
Drs. Gruen & Pass, Dir. Women's Imaging; Dir. Breast Surgery
Mammography can be a highly anxiety-provoking procedure for many women. Though one in eight women will be diagnosed with breast cancer in their lifetime, cancer is found in only 4-8 mammograms, for every thousand performed. To find these very few women who do have breast cancer, as many as one in five need to be recalled for additional imaging tests, the vast majority of whom turn out to not have breast cancer.
Because of the limitations of these standard mammography techniques, women may undergo unnecessary testing, be exposed to unnecessary procedures and discomfort, and experience the uncertainty of not knowing results for several days or weeks.
The Stamford Health Breast Imaging Center uses an interdisciplinary team approach and the latest in technology to improve care and the patient experience for women receiving breast imaging services. The approach has been developed and led by radiologist David Gruen, MD, in partnership with breast surgeon Helen Pass, MD, both of whom are national leaders in their fields.
The Stamford Health breast imaging team seeks to dramatically improve the care and experience of women undergoing screening procedures. The team’s goals are to:
- Improve patient satisfaction
- Decrease rates of “recall” for follow-up testing
- Provide results immediately
To achieve these goals, the team integrated a new and improved breast imaging technology with a redesigned workflow.
2-D and 3-D for detection of early cancer
The organization uses a three dimensional imaging (tomosynthesis) technology at both of its breast imaging centers. This 3D Tomography improves greatly over standard mammogram technology that is commonly used elsewhere. It puts together many more images, creating a much more high resolution and accurate view of the breast. Cancers that are often missed by conventional mammograms can be seen by 3D Tomography.
The few breast imaging centers in the US with this technology are using it only on a case by case basis. Because early studies demonstrated very positive results, our organization has decided to use 3D Tomography on all of its patients for every screening mammography examination.
Since 3D Tomography eliminates many unnecessary breast imaging procedures, the time has been able to be reclaimed to provide women with immediate results for their annual mammography and/or breast ultrasound studies.
In summary, every woman who comes to the Stamford Breast Center during normal business hours leaves with her results. If an extra imaging study or breast ultrasound is needed for any reason, she receives those studies and results at the same appointment, eliminating the anxiety and uncertainty associated with waiting for results in the mail and waiting for a follow-up appointment.
The team started this approach in August 2012, and did a careful study to understand the effect of 3D Tomography on patient outcomes. A number of quality measures were looked at. The team compared results from before August 2012 with standard conventional mammography in use then, to results after 3D Tomography was implemented.
Click Image to Enlarge (Fig. 1)
One important measure was to see how often women are called back for further studies after having their first mammogram—the “Recall Rate.” A lower number is better because it means that the first test was more accurate and there is less need for further testing, unnecessary radiation exposure and anxiety awaiting results. As shown in Figure 1, the recall rate was 55% lower after 3D Tomography was implemented. Figure 2 shows mortality rates compared to the national average.
Another measure, the Positive Predictive Value, looks at how often a positive imaging study result proved to be an actual breast cancer. A higher result is better because it means that there are more true positives and less false positives. False positives can lead to a great deal of un-needed worry and anxiety. As shown in Figure 2, the Positive Predictive Value was over 500% higher after 3D Tomography was used.
Click Image to Enlarge (Fig. 2)
By using technology in a unique and innovative way, the breast imaging team has been able to eliminate thousands of unnecessary breast imaging studies and unnecessary radiation exposure. The team has also identified several tumors with 3D Tomography that were not seen on routine mammography. The Breast Center earned distinction as a 2013 Gold Prize Recipient of the Connecticut Quality Improvement Award (CQIA) for integrating 3D Tomography for all screening mammography patients in both of its breast imaging center locations.
Making results available to women the same day, before leaving the imaging centers, and at no additional charge, has greatly improved the experience and comfort level of patients seen at Stamford.
More information on mammography can be found on the American College of Radiology website. More information on breast cancer can be found at the American Cancer Society website.