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News | Dec. 15, 2022

Breast Cancer Reminder: Get Your Annual Screening

By JANET A. AKER

Breast health and annual mammogram screenings should be your top priorities to protect against cancers and are easier than ever to schedule wherever you are.

TRICARE covers breast health services and has guidelines for those at risk of developing breast cancers.

The guidelines lay out which patients need early screening, versus patients who can start breast cancer screening between the ages of 40 and 50.

"The most important thing is starting a conversation with your primary physician or your primary provider to learn when you should start annual screenings," said U.S. Navy Lt. Cmdr. (Dr.) Matthew Nealeigh, director of the Breast Care and Research Center at Walter Reed National Military Medical Center, and an assistant professor of surgery at the Uniformed Services University of the Health Sciences, both in Bethesda, Maryland.

No Need for Doctor Referral

TRICARE covers mammograms during a health promotion and disease prevention exam without a referral for women over 40 or younger if they have an increased risk for breast cancer, according to their health care provider, said Tonya Utterback, referral manager of the clinical oversight and integration section of the TRICARE health plan.

Naval Hospital Bremerton in Washington makes the annual mammography screening exam easy to schedule.

"When a patient comes in for an annual mammogram, the technologist lets them know they do not need a doctor's order for their next annual screening mammogram visit," said Marde Buchart, lead mammography technologist for the hospital's radiology department.

"As a mammogram technologist, under the American College of Radiology's rules and regulations, we can create an order under "self-referral." As long as the patient has their provider established, we can do it for them, "Buchart explained.

"We also encourage patients to be aware of any changes they may see or feel in their breasts."

Bremerton also offers walk-in mammograms on a space-available basis so patients can get their exams when they are at the hospital.

The hospital is responsible for serving the third largest fleet concentration in the U.S. Navy and is one of the most active medical facilities across the Military Health System.

Mammography Gold Standard and Early Detection

Digital mammography using digital breast tomosynthesis, also known as DBT, is the current gold standard for mammography, said U.S. Navy Cmdr. (Dr.) Matthew Bauer, the radiology department head at Bremerton.

"This technique obtains multiple images of the breast in different planes and creates a 3D image series similar to a computerized tomography scan."

"All screening mammograms performed at Bremerton use DBT, and all breast densities can benefit from the use of the technology," Buchart explained.

"DBT is able to see sub-centimeter masses that can then be further assessed by ultrasound," Bauer said.

"Both DBT and conventional 2D mammography can identify suspicious micro-calcifications that can be the first indication of cancer, which is the classic benefit of screening mammography," he explained.

"The 3D nature of DBT allows the radiologist to define small masses within the denser breast tissue," Buchart said.

"Women with denser breasts may have greater benefit from DBT, as increased breast density does limit the sensitivity of mammograms."

"DBT has also been shown to both decrease recall rates for negative or benign diagnostic mammograms, as well as increasing sensitivity for detecting small cancers," Buchart added.

That can be a comfort to patients.

Digital imaging and advances in equipment have lowered the radiation dose associated with mammography, "which is reassuring for patients having these screening exams performed annually," she said.

Your Records Go with You

Current digital mammographic technology has advanced annual screenings in several ways, making your breast health records portable.

"With digital images, the exams can be transferred easily between facilities, whether via computer connections or CDs, which is especially important in the military community as service members change duty stations," Buchart said.

The MHS GENESIS patient electronic health record portals, which are customized to patients' wellness needs, include a specific reminder for annual mammograms and breast exams.

What's Coming Next?

The newest innovation in breast screening involves the use of a contrast agent administered via IV so radiologists can see more small tumors or suspicious breast tissue.

"Contrast-enhanced mammography is an evolving technique, where an iodinated contrast dye is administered intravenously prior to performing the mammogram," Bauer said. "Much like the use of iodinated contrast with CT scans, this technique may allow radiologists to more easily identify masses in the breast."

What if You are Diagnosed with Breast Cancer?

Madigan Army Medical Center at Joint Base Lewis-McChord in Washington offers top-notch treatment and care for patients diagnosed with breast cancers.

While other military medical hospitals and clinics offer similar programs, Madigan's Breast Cancer Diagnosis and Treatment Pathway is one of the first programs of its kind in the U.S. military and civilian medical systems and is more than 25 years old.

The goals of the program are prevention of fragmented care after a diagnosis, a coordinated multidisciplinary approach, reduction of risk-management problems, seamless personalized patient care and increased efficiency.

Cancer survivorship is also included in the program to give the patient a plan of continued care related to breast cancer once treatment is complete.

In addition, Walter Reed's Breast Care and Research Center is certified by the National Accreditation Program for Breast Centers under the American College of Surgeons.

"It certifies that a given center has a world-class level of medical care for all breast diseases," Nealeigh said. "It emphasizes our partnership with the breast imaging center. It emphasizes our multidisciplinary care between the surgical oncology service, the medical oncology service, the radiation oncology service, the pathology team, and different support services, including physical therapy and an oncology-certified social worker who are embedded to help patients and the families with the anxiety and mental health component that comes with these diseases."

The final word from Buchart is "get your annual screening mammogram! There's really no excuse because the system has been made so simple."

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