HERSHEY, Pa. — Every day, Dr. Alison Chetlen works as a lookout to stop one of the planet’s most notorious killers. And her view keeps getting better.
Chetlen, a staff physician in general diagnostic radiology, and her colleagues at the Penn State Health Breast Center use state-of-the-art technology to root out the second most common cancer and cause of death among women in the U.S. Doctors diagnose about 264,000 cases of breast cancer in women in the U.S. every year, according to data from the U.S. Centers for Disease Control and Prevention, and 2,400 cases in men. The disease will kill 42,000 women and 500 men in the U.S. annually.
Early detection often can stop it, and that’s where Chetlen and her fellow mammographers and technologists come in. They have an arsenal of imaging tools and technology to find even the smallest cause for concern, but nothing bests the bellwether ― a tried and true annual mammogram.
“We have breast MRI, we have whole-breast ultrasound, we have a lot of supplemental imaging that we can use, but a mammogram will always be the gold standard for cancer detection,” said Lisa O’Brien, chief mammography technologist at the center. “This will never go away. It’s here to stay.”
You hear the reminders every year. Women in their 40s begin regular screening. But technologists at the center aren’t performing your mother’s mammogram. The images offer more sophisticated views of breast tissue than ever before.
“We’re able to find more cancers,” Chetlen said. “And we’re able to recall fewer women from screening mammogram because we can actually see through the breast tissue. Our patients can have increased confidence with 3D mammography technology.”
But the mechanisms are still the same. The breast is compressed for a few seconds ― technologists work with the patient to make that as painless as possible. They take four photos. The entire exam ― from the opening consultation to “See you next year” ― takes about 10 minutes.
For the uninitiated, below is a look at the inside of a breast exam room and a little information about what’s in store for the screening.
The device
The front portion of the camera can spin in most directions, allowing for multiple angles. And the paddle, the front portion where the patient places his or her breast, applies light pressure.
Why the squeeze?
“It lowers radiation dose to the breast,” Chetlen said. “And it eliminates blur in the picture. It spreads out the breast tissue so we can carefully see all the fine detail that we need to.”
Technologists aim for enough tension so they can’t indent their fingers into the breast. They’ll work with the patient on this. “They’d feel pressure for a few seconds for each image,” Chetlen said. Answer a few questions, allow four images, and the patient is on his or her way.
3D mammography
At clinics like the Penn State Health Breast Center, they call it tomosynthesis. Tomo for short.
It means 3D mammography. Technologists and mammographers used to capture only two-dimensional images of the inside of a breast. Now, leading-edge technology eliminates the guess work. With tomosynthesis, radiologists are able to see multiple layers of the breast in a 3D image because multiple low-dose pictures of the breast are taken from multiple angles. The mammogram images are a mix of black, gray and white.
“With 3-D digital breast tomosynthesis, we are able to find cancers that may have otherwise been hidden in dense breast tissue,” Chetlen said.
The conversation
“When they come for a mammogram, it’s not just the pictures,” O’Brien said. “We actually do a risk assessment of the patient.”
The exam starts with this conversation with someone like Mammography Technologist Stynci Toth, who is pictured above and below.