This interview has been conducted in partnership with the National Breast Cancer Foundation (NBCF). Recognized as one of the leading breast cancer organizations in the world, NBCF is Helping Women Now® by providing early detection, education, and support services to those affected by breast cancer. A recipient of Charity Navigator's highest 4-star rating for 14 years, NBCF provides support through their National Mammography Program, Patient Navigation, breast health education, and patient support programs. For more information, please visit https://www.nationalbreastcancer.org/

Oncology Data Advisor: Welcome to Oncology Data Advisor. I am Selma Khenissi from I3 Health. We are here today with Ms. Tricia Trammell of UT Southwestern Simmons Comprehensive Cancer Center. She will be discussing screening, detection, and imaging and radiology issues related to breast cancer. Welcome, Ms. Trammell.

Tricia Trammell, BA, CRA, FAHRA, R.T. (R)(M)(QM)(BS), CN-BI: Thank you.

Oncology Data Advisor: So have there been any recent advances in the field of breast imaging and radiology?

Ms. Trammell: Sure, I can discuss that. It's not very new, but digital breast tomosynthesis came about several years ago and has become the standard in breast imaging. It's also referred to as DBT or 3D mammography. Thankfully, as of September 1, 2017, Texas commercial insurance companies have been required to cover 3D mammography under a house bill, which was signed into law in June 2017 by Governor Greg Abbott. Thankfully, that has been a great advancement in 3D, and getting that bill signed has also been wonderful in ensuring that patients have access to that technology. So that's one thing.

One of the other things that's been really wonderful and is still new and considered an emerging technology is contrast-enhanced mammography. What that is, is it's an alternative to breast magnetic resonance imaging (MRI). It may increase access to vascular imaging while reducing examination cost. We use an iodinated contrast material, and it enhances the visualization of tumor neovascularity. After an injection, imaging is performed using mammography. It helps provide a low-energy image, and that enhances lesions in the breast.

Some of the applications for contrast-enhanced mammography are maybe applicable for MRI. Maybe a patient can't tolerate MRI—whether they're claustrophobic or they have metal or there's some other reason why they cannot have an MRI. Contrast-enhanced mammography might be a good alternative for that patient. It's also very good for evaluating preoperative staging for breast cancer or to evaluate the extent of the disease. That's also a good application. Another good application for contrast-enhanced mammography might be to evaluate patients who are having neoadjuvant chemotherapy. Those are all really great applications for contrast enhanced mammography. Again, it's still considered investigational, so it's not necessarily available to everyone, but it is becoming more of an advanced technology that is being used. I think it's something that will become more available as time goes on, just like how digital breast tomosynthesis became the standard.

Oncology Data Advisor: How does family history affect the age at which women should begin undergoing breast cancer screening?

Ms. Trammell: That's a really great question. While the guidelines for breast cancer screening in average-risk women are clear and well established, screening in high-risk women is not as clear. For women with a BRCA mutation, current guidelines recommend screening by clinical breast examination and mammography starting at age 30. One can refer to breastsurgeons.org for additional information regarding screening guidelines.

Oncology Data Advisor: What are some of the considerations that must be taken into account regarding breast cancer screening around the time of COVID-19 vaccination?

Ms. Trammell: That's a great question. About 10% to 15% of people who have the vaccine do get enlarged lymph nodes under their arms. Breast cancer can also cause swollen lymph nodes under the arms. A mammography should be scheduled 4 to 6 weeks after your second vaccine if you're getting the vaccine that requires two shots. Also, if you're getting a booster, you should also wait 4 to 6 weeks. If you have a lump in your breast, you should not wait; you should go ahead and get evaluated immediately; but for screening purposes, if you're just having a screening and you're not having any problems at all, then you should wait 4 to 6 weeks.

Oncology Data Advisor: How do you foresee the field of breast imaging and radiology evolving in the coming years?

Ms. Trammell: Things that were once considered experimental or investigational have become the standard. For example, mammography used to be analog, and then we went digital. That was considered experimental at one time. Digital breast tomosynthesis was once considered investigational, and now it's become the standard. That's been a great stride towards detecting early breast cancers, especially in women with dense breast tissue.

Now, contrast-enhanced mammography is in the spotlight. We're learning all the clinical applications that are valuable for contrast-enhanced mammography. Insurance still considers contrast-enhanced mammography investigational, but we've kind of been through this before with tomosynthesis. We'll see how that plays out. We're also very excited to see all the ways that contrast-enhanced mammography is helping us with the applications where maybe MRI is not feasible. Also, again, we're looking at patients with neoadjuvant chemotherapy and then even in screening for high-risk women. We're just very excited about contrast-enhanced mammography and really looking forward to seeing all the things that we're going to be able to do with that technology.

We're also involved in a lot of clinical imaging trials. It's very exciting to see what things will come about from those clinical imaging trials, and that's what's really amazing about being part of an academic environment: getting to see those things and the technology that evolves. We're really excited about that here. Ultrasound has also had some amazing advancements in the last 10 years, such as things that were once very difficult to see; we're now able to even lesions less than five mm on ultrasound.

Elastography has become very important with ultrasound. Elastography is a tool with ultrasound where we're able to evaluate the stiffness of a lesion. That's information that's very important for a radiologist. It can help a radiologist decide whether to biopsy a lesion or whether to watch it, or maybe just to give him a little more information on the benignity of a lesion. Malignant lesions tend to be more stiff, whereas benign lesions tend to be more soft. Elastography has been an amazing tool with ultrasound to help give us that additional information. Before, ultrasound just told us whether something was solid or cystic, and now we know whether something is stiff or soft. That's been an amazing addition with ultrasound and something that we're also very excited about.

Oncology Data Advisor: I agree. This is all very exciting. Thank you so much, Ms. Trammell. If you wish to see more expert perspectives from our other medical interviewees, please sure to check out our website at oncdata.com. Thanks again.

Ms. Trammell: Thank you.

About Ms. Trammell

Tricia Trammell, BA, CRA, FAHRA, R.T. (R)(M)(QM)(BS), CN-BI is the Breast Center Manager at UT Southwestern Simmons Comprehensive Cancer Center. With over 20 years of imaging experience, she is a Certified Radiology Administrator, a Certified Breast Patient Navigator, and a Certified Breast Self-Examination Instructor. Ms. Trammell has participated in several public speaking forums and educational events with organizations such as the Association of Perioperative Registered Nurses (AORN), American Healthcare Radiology Administrators (AHRA), and the National Consortium of Breast Centers (NCBC).

For More Information

The American Society of Breast Surgeons (2021). Available at: https://www.breastsurgeons.org

This transcript has been edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.