Top doctors: Diagnosing breast cancer
Detecting breast cancer is no longer as simple -- or as imprecise -- as it used to be. Now, a suspicious mammogram may be followed by an ultrasound examination and then an MRI scan in a process designed to prevent unnecessary biopsies.
Here's what you should know about advances in diagnosing breast cancer:
1. EXAMS AND MAMMOGRAMS REMAIN CRUCIAL
Though doctors are trying to improve breast-cancer screening, women still play a major role by regularly checking their breasts. "Self-discovery of a breast lump likely represents the best 'save' for women diagnosed with breast cancer," said Dr. Louis Potters, chairman of radiation medicine at the North Shore-LIJ Health System in Manhasset.
With or without breast self-exams, though, women without cancer symptoms should have a clinical breast exam every three years during their 20s and 30s and then annually, along with a mammogram, starting at age 40, according to American Cancer Society recommendations.
Despite other advances, the mammogram is crucial to detecting breast cancer and is "really a step that can't be bypassed," said Dr. Kenneth Goodman, chairman of radiology at St. Francis Hospital in Roslyn.
2. ULTRASOUND MAY BE USED TO GAUGE A SUSPICIOUS LUMP
A mammogram can indicate a lump in the breast, "but you may not be able to tell if it's solid and of concern or a fluid-filled mass -- cystic -- that doesn't have as much reason for concern," Goodman explained.
That's when an ultrasound examination becomes helpful. It can provide information that allows the doctor to decide on the next step -- a biopsy, no further action or an MRI scan. An MRI may be used if the ultrasound results are inconclusive, if the woman has very dense breasts or if there's a strong history of breast cancer in her family, Goodman said.
3. AN MRI SCAN IS A FAIRLY NEW ADDITION TO THE PROTOCOL
Goodman said that doctors have been requesting MRI scans for women with suspicious breast lumps for about five to 10 years. The scans help doctors avoid unnecessary biopsies because they can indicate whether a mass is harmless, he said, where previously "you'd go straight to biopsy" after an ultrasound that showed signs of potential cancer. Potters added that it's still not clear, however, whether MRI scans should play a role in routine screening.
4. ADVANCES MAY NOT LOWER THE DEATH RATE FOR BREAST CANCER
Questions remain about whether advances in breast cancer screening are actually leading to longer life spans for women with the disease.
"We know that advanced imaging is likely to discover more cancers," Potters said, "but the data strongly suggest we are over-diagnosing cancers, and that some of these cancers may not need to be treated. In time, we will learn whether such aggressive imaging approaches pay off where it counts -- in saving lives."
5. FURTHER IMPROVEMENT IS ON THE HORIZON
A new type of mammogram offers a three-dimensional look at the breast through a technology called digital tomosynthesis. "It will be a very important technology going forward, but it's still being tested," Goodman said. "Preliminary results show that it's easier to read and more sensitive than a mammogram, but the problem is that it has a higher radiation dose."
If researchers can reduce the radiation level, he said, it may become the standard for mammography.
Radiation oncologists, diagnostic radiologists, nuclear medicine, vascular & interventional radiologist
This is the final installment of a 26-week series in which Newsday presents Castle Connolly's list of top Long Island doctors.
RADIATION ONCOLOGISTS
Dr. Jay Bosworth
6 Ohio Dr.
516-365-6544
Dr. Ezriel Diamond
688 Old Country Rd.
516-932-6007
Dr. Richard Gewanter
MSKCC Long Island
1000 N. Village Ave.
516-256-3600
Dr. Jonathan Haas
Radiation, Oncology and Cyberknife
264 Old Country Rd.
516-663-2501
Dr. Lorraine Marin
HealthCare Partners
1225 Franklin Ave.
516-515-8820
Dr. Allen Meek
Stony Brook Univ. Med. Center
Dept. Rad. Onc. - L2
100 Nicolls Rd.
Stony Brook
631-444-2327
Dr. Edward Mullen
South Nassau Comm. Hospital
One Healthy Way
516-632-3330
Dr. Tae Park
Stony Brook Univ. Med. Center
Fl. Level 2 - Rm. 664
Stony Brook
631-444-2210
Dr. Jed Pollack
Long Island Radiation Therapy
6 Ohio Dr.
516-394-8100
Dr. Louis Potters
LIJ Medical Center
Dept. Radiation Oncology
270-05 76th Ave.
718-470-7190
DIAGNOSTIC RADIOLOGISTS
Dr. William Brancaccio
240 Meeting House Lane
Radiology Dept.
631-726-8411
Dr. Kenneth Goodman
100 Port Washington Blvd.
516-562-6500
Dr. Jay Hammel
4277 Hempstead Tpke.
516-796-4340
Dr. Janet Hoffman
270-05 76th Ave.
718-470-7144
Dr. Arfa Khan
270-05 76th Ave.
718-470-3456
Dr. David Kirshy
1333 Roanoke Ave.
631-727-2755
Dr. Michael Laucella
375 E. Main St.
631-665-2261
Dr. Seth Mankes
Stony Brook Univ. Med. Center
Radiology Dept.
HSC/Level 4/Rm. 120
Stony Brook
631-444-7224
Dr. Abraham Port
Complete Women's Imaging
440 Merrick Rd.
516-222-4873
Dr. Dennis Rossi
Elmont MRI
545 Elmont Rd.
516-328-7200
Dr. Scott Sherman
100 Port Washington Blvd.
516-562-6511
Dr. Steven Weck
Glen Cove Hospital
Dept. Radiology
101 St. Andrew's Lane
516-674-7540
Dr. Sydney Yoon
1 Healthy Way
516-632-4660
NUCLEAR MEDICINE
Dr. Christopher Palestro
Nuclear Medicine
270-05 76th Ave.
New Hyde Park
718-470-7080
Dr. Elizabeth Yung
259 First St.
516-663-2778
VASCULAR & INTERVENTIONAL RADIOLOGIST
Dr. Kenneth Crystal
100 Port Washington Blvd.
Roslyn
516-562-6509
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. Not every good physician makes the list. Rather, the list is a way for patients to get started on their search for the best medical professional. Newsday is not part of the selection process.
Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.
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 softcover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.
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