Top Doctors: Breast cancer imaging improves

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Long Island's notoriously high rate of breast cancer makes routine screening for the disease all the more critical.

Fortunately for area women, the tools for identifying breast malignancies are becoming ever more refined. Radiology departments and breast imaging centers are increasingly switching from mammography units that produce images of the breast on X-ray film to newer units that capture digital images that can be magnified and manipulated on a computer.

"Pretty much any good center that does breast imaging now does digital mammography," said Dr. Jay Hammel, managing partner with Sitron-Hammel Radiology Group in Bethpage.


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At the same time, researchers are seeking new and better ways to detect more and smaller cancers earlier and to improve the accuracy of breast cancer screening results.


MAMMO SCREENING

The mammogram is still the most widely performed test to screen for breast cancer. Studies show that mammography can help to reduce the number of deaths from the disease among women ages 40 to 74, according to the U.S. National Cancer Institute.

Digital and conventional mammography are equally effective in detecting breast cancer, the agency has stated, but the digital format may make subtle differences between normal and abnormal breast tissue easier to detect and can reduce the need for repeat images and any follow-up. A large study that compared the two X-ray techniques found that digital mammography may also be more accurate in women with dense breasts who are postmenopausal, perimenopausal or younger than 50.

Still, neither conventional nor digital mammography is foolproof.

"There's at least a 10 percent false negative rate, so the mammogram, whether it's digital or film-screen, is not the panacea," noted Dr. Scott Sherman, chief radiologist and director of the radiology department at St. Joseph Hospital in Bethpage and a radiologist at St. Francis Hospital in Roslyn, both part of Catholic Health Services of Long Island.

Some radiologists are using computer-assisted detection software designed to detect potential abnormalities in mammograms.

In a study published in late 2008 in the New England Journal of Medicine, researchers reported that a single physician or film-reading technologist using computer-assisted detection software was just as accurate in detecting cancers as two readers.

The software provides "a second look for potential breast cancer," said Hammel, who also serves as medical director of radiology at Plainview Hospital.


OTHER IMAGING TESTS

In certain circumstances, other diagnostic imaging technologies may be used to explore breast tissue.

Ultrasound, for one, uses high-frequency sound waves. "I can't tell you how many negative mammograms had positive findings on breast ultrasound," Sherman said.

Also, certain women may be candidates for a magnetic resonance imaging, or MRI, scan of the breast. An MRI doesn't replace mammography or ultrasound imaging, but it may be helpful in detecting breast cancer and in determining how extensive it is in the body, known as staging, report the American College of Radiology and the Radiological Society of North America.

MRI is used to detect malignancies in women who are at high risk for breast cancer, such as those with the BRCA1 or BRCA2 gene, Hammel explained.


EMERGING TECHNOLOGIES

Other methods of breast imaging also exist, but they are generally considered experimental, are not covered by most insurance plans and are not yet used for routine screening. These include:

  • Positron emission mammography, or PEM This imaging technique involves injecting radioactive material into the body. Sherman said it's used to identify additional malignancies and to stage the cancer.
  • Breast tomosynthesis Using low-dose X-rays, multiple pictures of the breast are taken to create a three-dimensional picture. At this point, the technology is available only in clinical trials.
  • "By far and away, the best study still is screening digital mammography with the use of, when needed, breast ultrasound," Hammel said.


    THE LONG ISLAND SCENE

    Like many national health experts, both Hammel and Sherman strongly agree that women should undergo annual mammography screening beginning at age 40. A federal panel's recommendations last year that screening for most women should be delayed until age 50 and that the frequency of those tests should be reduced to every other year have been largely ignored.

    "I think that the statistics locally are certainly so worrisome that for women in our area not to undergo annual screening mammography starting at age 40, in my view, puts them at a great risk of not being detected," Sherman cautioned.

    Recent data from the New York State cancer registry shows a breast cancer rate in Nassau County of 138.2 per 100,000 women and in Suffolk County of 136.5 per 100,000 women. Those rates exceed the state average of 124.3 per 100,000 women.

    Anyone with questions about screening or breast cancer may find help through the website of the Adelphi NY Statewide Breast Cancer Hotline & Support Program, based in Garden City (adelphi.edu /nysbreastcancer), or by calling its hotline (800-877-8077) to speak with a trained volunteer.

    This is the last installment of a 26-week series in which Newsday presents Castle Connolly's list of top L.I. doctors. Today: radiologists


    Who's who

    RADIATION ONCOLOGY

    Dr. Jay Bosworth

    6 Ohio Dr., Lake Success, 516-365-6544

    Dr. Ezriel Diamond

    688 Old Country Rd., Plainview, 516-932-6007

    Dr. Richard Gewanter

    MSKCC Long Island, 1000 N. Village Ave., Rockville Centre, 516-256-3600

    Dr. Jonathan Haas

    Winthrop Univ. Hosp., Radiation Oncology, 259 First St., Mineola, 516-663-2501

    Dr. Alan Katz

    North Shore, Radiation Therapy, 270 Pulaski Rd., Greenlawn, 631-427-2273

    Dr. Lorraine Marin

    HealthCare Partners, 1225 Franklin Ave., Garden City, 516-515-8820

    Dr. Allen Meek

    Stony Brook Univ. Med. Ctr., Dept. Radiation Oncology, 100 Nicolls Rd., Stony Brook, 631-444-2327

    Dr. Edward Mullen

    South Nassau Community Hospital, 1 Healthy Way, Oceanside, 516-632-3330

    Dr. Tae Park

    Stony Brook Univ. Med. Ctr., Stony Brook, 631-444-2210

    Dr. Jed Pollack

    Long Island Radiation Therapy, 6 Ohio Dr., Lake Success, 516-394-8100

    Dr. Louis Potters

    LIJ Medical Center, Dept. Radiation, Oncology, 270-05 76th Ave., New Hyde Park, 718-470-7190


    DIAGNOSTIC RADIOLOGY

    Dr. William Brancaccio

    240 Meeting House Lane, Southampton, 631-726-8411

    Dr. Kenneth Goodman

    100 Port Washington Blvd., Roslyn, 516-562-6500

    Dr. Jay Hammel

    4277 Hempstead Tpke., Bethpage, 516-796-4340

    Dr. Janet Hoffman

    270-05 76th Ave., New Hyde Park, 718-470-4177

    Dr. Arfa Khan

    270-05 76th Ave., New Hyde Park, 718-470-3456

    Dr. David Kirshy

    Southampton Hospital, Dept. Radiology, 240 Meeting House Lane, Southampton, 631-727-2755

    Dr. Michael Laucella

    375 E. Main St., Bay Shore, 631-665-2261

    Dr. Seth Mankes

    Stony Brook Univ. Med. Center, Radiology Department, Stony Brook

    631-444-7224

    Dr. Mark Novick

    Diagnostic Radiology & Women's Imaging, Dept. Radiology, 200 Belleterre Rd., Port Jefferson, 212-744-8000

    Dr. Matthew Rifkin

    1000 Montauk Hwy., West Islip, 631-376-4027

    Dr. Dennis Rossi

    545 Elmont Rd., Elmont, 516-354-4200

    Dr. Scott Sherman

    40 The Birches, Roslyn, 516-562-6511

    Dr. Steven Weck

    Glen Cove Hospital, Dept. Radiology, 101 St. Andrew's Lane, Glen Cove

    516-674-7540


    NUCLEAR MEDICINE

    Dr. Christopher Palestro

    Nuclear Medicine, 270-05 76th Ave., New Hyde Park, 718-470-7080

    Dr. Elizabeth Yung

    259 First St., Mineola, 516-663-2778


    VASCULAR & INTERVENTIONAL RADIOLOGY

    Dr. Kenneth Crystal

    100 Port Washington Blvd., Roslyn, 516-562-6509


    h4>How they were picked

    Castle Connolly Medical Ltd. is a health care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.

    Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Newsday is not part of the selection process.

    Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.


    h4>To see the whole list . . .

    Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The soft-cover list price is $34.95.

    For more information, go to castleconnolly.com, or call 800-399-DOCS.

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