Greatest protection is early detection

Allison Hall, of the Village of Mallory Square, left, and Sue Nock, of the Village of Lake Deaton, belong to Dragon Sisters, a dragon-boating team made up those who strive to raise breast cancer awareness.

Rhonda Anton expected to hear the same news she did every year after her mammogram: Everything’s OK. So the ovarian cancer survivor was surprised in August 2016 when abnormal results eventually led to a breast cancer diagnosis. Without the annual screening, she wouldn’t have known. “Mammograms are so very important,” the Village of Dunedin resident said. “They’re lifesaving.” October is Breast Cancer Awareness Month, which highlights the most common form of cancer in women after skin. The average woman has a 1 in 8 chance that she will develop breast cancer in her lifetime. Despite recent changes by some organizations to mammography recommended guidelines, survivors and medical professionals are reminding women of the importance of annual screening.

In May, the American College of Physicians updated its recommendations for average-risk women to receive mammograms every other year starting at age 50 instead of annually at age 40, to cut down on the emotional toll of false positives.

That’s also the recommendation of the U.S. Preventive Services Task Force.

Many disagree with the change, said Dr. Dana Ataya, a breast radiologist at Moffitt Cancer Center.

“We recommend annual screening mammography beginning at age 40 because it saves the most lives,” she said. “Women and health care providers should be very skeptical of the ACP and USPTS guidance for average-risk women. Unfortunately, that may result in up to 10,000 additional and unnecessary breast cancer deaths in the U.S. each year.”

When mammography became widespread in the 1980s, breast cancer deaths dropped dramatically, Ataya said.

Dr. Cathrine Keller, managing physician at Lake Medical Imaging, agreed that evidence shows annual mammograms starting at age 40 saves the most lives.

“The best protection is early detection,” she said. “If you can find it early, you might get cured.”

A growing list of screening options in the last decade has helped doctors detect more breast cancers, said Keller, who has worked in radiology for 37 years.

When determining what imaging is best, patients should consider their breast density, which is not determined by the size of breasts or how they feel. 

Dense breasts, though normal and common, have more fibrous tissue than fat, which makes cancer harder to see on a standard mammogram. A third of all breast cancers are not visible in screening mammography for women with dense breasts, Keller said.

Patients with dense breasts may choose tomosynthesis, or 3D mammography, which finds an additional one to two cancers per 1,000 screenings than a 2D mammogram.

For clearer imaging, patients also may choose to undergo automated breast ultrasound, contrast enhanced spectral mammography or an MRI.

ABUS uses 3D ultrasound images, not radiation, finding an additional three to five cancers on average.

For CESM, patients are injected with iodinated contrast to subtract away the dense tissue in the image, highlighting abnormal blood flow and the presence of cancer, detecting an additional 10-13 cancers.

“In terms of efficiency and use of resources and the patient’s time and money and anxiety, boy this is a great test,” Keller said.

Another option, MRIs, are recommended for women at high risk of developing breast cancer.

They find a similar number of additional cancers to CESM but are more expensive and require patients to lie on their backs for 45 minutes.

Keller said it’s been great to have more options for patients become available in the last decade.

“There are all these things that used to be big problems with no solution. But now there are other things that I can offer the patient,” she said. “It’s much easier to tailor to the needs of the particular patient and give them a better result. The whole idea is to find more breast cancers.”

Though rare, men can also get breast cancer.

“If a man detects a palpable area in the breast, don’t ignore that,” Ataya said. “Bring it to the attention of their provider.”

Women should be sure to find the right screening for them, said Deb Gruber, co-facilitator of the Tri-County Breast Cancer Support Group.

The group, which now has more than 250 members, meets for a breakfast social at 10 a.m. on the first Thursday each month at Steak ‘n Shake, 3980 Wedgewood Lane, and for a business meeting at 2 p.m. on the third Thursday at Community Bank & Trust of Florida, 2285 Parr Drive.

“Do your due diligence,” Gruber said.

That includes when it comes to self-exams. Those are how the majority of women in the support group found their cancer, Gruber said.

Sue Nock knew something was wrong with her breast after an at-home exam, so she went to her doctor. After several screenings, she was diagnosed. She’s been an advocate for self-checks ever since.

“You know your own body,” said Nock, of the Village of Lake Deaton.

Both Nock and Anton found strength after their mastectomies by joining Dragon Sisters, a local dragon boating team made up of survivors and others who strive to raise awareness of breast cancer. They’re looking for more survivors to join the team, no experience required. Call 352-638-8309 for information.

“To know that you’re not going through something alone is very powerful,” Nock said.

Nock, who has been in remission for 13 years, has a message for those facing breast cancer.

“This diagnosis shouldn’t stop you,” she said. “It should be a motivator to figure out what you really want in life and go after it.”

Nock said that because of her cancer experience, she no longer dreads the festivities of turning another year older.

“It’s a good thing to have another birthday,” she said.

Though there are more breast cancer survivors than before, patients shouldn’t become complacent about the disease, Ataya said.

“We’ve certainly made strides. Those strides can be attributable to annual screening mammography and advancements in breast cancer treatment,” she said. “It needs to be taken seriously at all ages.”

Senior writer Ciara Varone can be reached at 352-753-1119, ext. 5395, or