Meet our doctors: Radiologist Lusi Tumyan on breast cancer screening

October 24, 2014 | by Kim Proescholdt

Mammograms are currently the best method to detect breast cancer early, when it's easier to treat and before it's big enough to feel or cause symptoms. But recent mammogram screening guidelines may have left some women confused about when to undergo annual testing.

tumyan-lusi-160x190 Lusi Tumyan says women should work with their physicians on a personalized screening program.

Here Lusi Tumyan, M.D., chief of the Breast Imaging Section at City of Hope, explains some of the current and new breast imaging tools, and encourages women to work with their physician to decide on a personalized plan, based on individual breast cancer risk, of when to get screened.

What are the current technologies available for breast cancer screening?

The best and gold standard breast cancer screening test for women with low or average risk for breast cancer is a mammogram. It's readily available and does not require special preparation other than washing off deodorants prior to the exam. For women who are at a higher risk for developing breast cancer (for example, women who have a family history of breast cancer, or possess the BRCA1 and BRCA2 genetic mutations), a breast ultrasound and/or magnetic resonance imaging (MRI) may be recommended for screening, in addition to mammogram.{C}

What is the difference between a screening and a diagnostic mammogram?

A screening mammogram is an X-ray exam of the breasts that is used for women who have no breast symptoms or signs of breast cancer. A screening mammogram usually takes two X-ray pictures (views) of each breast. The goal of a screening mammogram is to find breast cancer when it’s too small to be felt by a woman or her physician. Finding breast cancers early greatly improves a woman’s chance for successful treatment.

A diagnostic mammogram is also an X-ray exam of the breast, but is done for a different reason than a screening mammogram. A woman with a breast problem, such as a lump or nipple discharge, or an abnormal area found in a screening mammogram, typically receives a diagnostic mammogram. During the procedure, more pictures may be taken to carefully study an area of concern. In some cases, special images known as spot views or magnification views are used to make a small area of abnormal breast tissue easier to evaluate. Other types of imaging tests, such as ultrasound, may also be done in addition to the mammogram, depending on the type of problem and where it is in the breast.

Recently the U.S. Preventive Services Task Force recommended less frequent mammograms for women at lowest risk of the disease. What are your thoughts on this?

Risk assessment is really very important, but one size doesn’t necessarily fit all. Here at City of Hope, we focus on individualized health care, and that means understanding each woman’s risk. With this approach, we can better determine if a patient will benefit from additional screening. For example, if a patient is young and at high risk because there is a family history of breast cancer and has dense breasts, then a screening mammogram may not be adequate; she should probably get an ultrasound or an MRI.

If a patient is very low risk and doesn’t have any other prevalent risk factors, then a screening mammogram every other year might suffice. But it should truly be tailored to each patient. I strongly encourage women to work together with their physician to decide on a personalized plan, based on individual breast cancer risk, of when to get screened.

Is breast 3-D mammography (also known as digital breast tomosynthesis) more effective than screening using traditional mammography?

Tomosynthesis, often referred to as 3-D mammography, is a technology that takes advantage of all the benefits of standard mammography to create unparalleled high-quality, precise and detailed images of the breast from various angles. These images can be reconstructed to create a 3-D view of the breast, allowing doctors to examine its inner structure without distortion, which can lead to earlier detection of any abnormalities. With 3-D mammography, multiple studies demonstrate an increased cancer detection rate combined with a decreased patient recall rate.

However, further study is needed to determine which patients will benefit from the 3-D technology, e.g., young women, women with dense breasts, women with a strong family history of breast cancer or any women needing a screening. Regardless, the most important message about mammography – whether it’s standard or 3-D – is that screening for breast cancer saves lives, period.

What newer technologies are being developed for breast cancer screening?

One of the newer technologies coming out is contrast enhancement spectral mammography. For the patient, it's a routine mammogram with an intravenous contrast injection. But for the radiologist, it's a no-guesswork, easy-to-read exam. Just like a highlighter pen, the contrast highlights and enhances areas where lesions are likely to exist. This method takes away all of the mystery in a mammogram, while utilizing blood flow patterns to dim the normal breast tissue, leaving only vascular, cancerous areas in the picture.

Why did you choose this specialty?

I’ve been involved in breast cancer detection since high school when I worked at a breast cancer screening center. And it continued into medical school when breast cancer research was included in my studies. Breast cancer is a subject that I always seem to naturally migrate toward. It just feels like an innate, natural fit for me.

What do you do when you’re not working?

When I’m not working, I’m spending time with my three great kids aged 2, 5 and 12. We do lots of different fun activities. This summer, my 12-year-old went camping with 144 other kids and I took a week off to go on the trip as a medical counselor. It was quite an adventure! I hadn’t been camping since I was a teenager, so it was a great time out to spend time with my daughter in a beautiful place.

Do you have a question for Lusi Tumyan, M.D.? Let us know by posting it below.


Learn more about breast cancer screening and treatment options at City of Hope.

Learn more about becoming a patient or getting a second opinion by visiting our website or by calling 800-826-HOPE (4673). City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.



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