Leading the Way in Early Breast Cancer Detection

In July 2011, Evergreen Hospital Medical Center’s Breast Health Center was the first comprehensive breast center in the Pacific Northwest to implement tomosynthesis. The growing 272-bed community hospital serves the Eastside suburbs of Seattle. Its goal is to provide leading-edge technology while focusing on a personalized, compassionate patient experience.

“Our incidence rates of Stage 0 and Stage 1 breast cancers are 10% higher when compared to other institutions in our state and the rest of the country,” reports Kara Carlson, M.D., Medical Director of the Evergreen Hospital Breast Center. “The multi-disciplinary breast cancer team at Evergreen takes great pride in these quality outcomes. Our 12-year recurrence rate is 2% for all breast cancers.”

Screening Tomosynthesis Reduced Recall Rates by 31 Percent
Starting with just one tomosynthesis unit, the Breast Center decided to make tomosynthesis available to all women and providers who requested this new technology for screening.

“We did not establish strict criteria as to who would be selected to have tomosynthesis. We recognized that women with heterogeneously and extremely dense breast tissue, women at high risk and women undergoing a baseline exam may benefit more,” explains Dr. Carlson. “Research indicates that tomosynthesis has the potential to increase cancer detection and accuracy while reducing recall rates. We chose to focus on women undergoing screening mammography performing a 2D/3D combination exam. In addition, over the last 6 months, we have come to appreciate the benefit of tomosynthesis for diagnostic evaluation in select cases as recommended by the radiologists.”

Prior to tomosynthesis, the Breast Center performed 20,000 screening exams and 8,000 diagnostic exams annually using six Hologic Selenia digital mammography systems (which includes a mobile coach).

“Since we added our tomosynthesis unit, the number of screening patients has increased,” reports Debby Kendall, lead mammographer. “Most women, whether consciously or not, have a fear of being called back. A reduction of 31% in our recall rate goes a long way to alleviate that fear. This creates a better state of mind during the screening procedure, which enhances the experience for both the patient and technologist. The technology has made us better at what we do, benefiting most importantly the patient and ultimately the entire healthcare system.”

To meet the high demand for breast tomosynthesis exams, the Breast Center is staying open later in the evening and scheduling appointments on Saturday. “We will be increasing our capacity with another Hologic Dimensions unit in the center and a third one for our mobile coach. Our goal is to offer tomosynthesis to all of our screening patients by mid-2012,” explains Dr. Carlson.

At the Center, all tomosynthesis exams are done in combo-mode (2D+breast tomosynthesis) in all four standard screening views. Having a conventional 2D exam in addition to the breast tomosynthesis exam makes it easier for the radiologists to compare the current exam with the patients’ prior images. After using tomosynthesis for a few months, Dr. Carlson reports many radiologists felt they were better at interpreting 2D images because they have a better appreciation for the anatomical structures of the breast after looking at the 3D images. “Tomosynthesis provides more information for radiologists to interpret and does require more time, but as a result, we spend less time wondering if we should call someone back,” she says.

“Tomosynthesis is helping us find cancers we could not have visualized on the 2D images because they were superimposed by normal structures,” adds Dr. Carlson. “In the short time we have had tomosynthesis, we have found a surprising number of cancers that we didn’t see with 2D alone. One cancer was even 2 centimeters in size. To think these would have been interval cancers presenting as diagnostic exams in the near future reinforces our decision to provide this leading-edge technology for earlier detection.”

Breaking Down Barriers to Mammograms
Three years ago, the Breast Center received a mobile coach funded by the Evergreen Healthcare Foundation to increase access and awareness of mammography throughout the community. “We want to overcome any potential barrier women may face in getting an annual mammogram,” says Rosemary Fisher, the Breast Center manager. “What better way than outreach to make it easier for women to get regular mammograms?”

Another potential barrier to women seeking mammograms is the discomfort of compression. A year ago, the Breast Health Center began offering all patients, both at the center and on the mobile coach, Hologic’s MammoPad breast cushion, without charge. “The patient’s comfort is important to us, and the pad offers a warmer and softer experience. That alone helps them relax. This has enabled us to improve positioning and compression, ultimately resulting in enhanced, personalized patient care,” states Dr. Carlson.

Putting Patient Care First
Is tomosynthesis making a difference? “Tomosynthesis is a very exciting technology,” says Kendall. “Having seen the evolution of mammography from 1971 to present day, 3D is the most revolutionary change that I’ve seen.”

Dr. Carlson concludes, “All the radiologists feel more confident that they are doing a better job with their interpretations and finding cancers sooner. Tomosynthesis has revolutionized the mammogram. It allows us to look through the tissue in a different way, which increases our early detection and decreases patient anxiety by not having us call back patients with normal findings. Ultimately, for us, tomosynthesis is about putting patient care first.”

Case study supplied by Hologic Inc.

The views and opinions expressed herein are those of Dr. Carlson and her colleagues at the Evergreen Hospital and are not necessarily those of Hologic.
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