Breast Health Specialists | Full Clinical Evaluation | Breast Ultrasound
Minimally Invasive Breast Surgery | Ductoscopy | Genetic Testing

The facts are that every woman is at risk for breast cancer. Skilled advanced practice registered nurses at the Kathryn Candor Lundy Breast Health Center, however, can examine your health history and that of your family, your lifestyle habits and discuss risk factors with you. This assessment can help you understand and perhaps adjust your lifestyle, taking risk factors into account.

To schedule a Breast Cancer Risk Assessment with a Specialist, call the Center at 570-326-8200, Monday through Friday between 8 A.M. and 5 P.M.

The doctors at the Center clinically evaluate all breast problems, including breast cancer, lumps, abnormal mammograms, breast discharge, pain, infections and fibrocystic changes. A range of treatments are available based on your condition, including:

• Breast Ultrasound.
• Minimally Invasive Breast Surgery.
• Ultrasound Mammotomy.
• Stereotactic Mammotomy.

Breast ultrasound is a non-invasive, diagnostic imaging tool used to determine if there is a cyst or solid mass inside the breast. During an ultrasound examination, the ultrasonagrapher places a thin coating of lubricating jelly over the area to be imaged to improve conduction of the sound waves. A hand-held device directs the sound waves through the skin toward specific tissues. As the sound waves are reflected back from the tissues within the breast, the patterns formed by the waves create a two-dimensional image of the breast on a computer.

Preparing For A Breast Ultrasound

Call 570-320-7619 to schedule an appointment for a breast ultrasound. The clerk will ask you or your referring physician office for the following:

1. What is the reason for the ultrasound?.
2. Have you had previous ultrasounds, and if so, where?.
3. Have you had previous mammograms, and if so, where?.
4. Who is the healthcare provider ordering the ultrasound?.

It is very important to bring mammography or ultrasound films from previous tests with you, or have them sent to our Center prior to your appointment. To have them sent, you may need to contact the facility where you had your tests taken. They may require you to sign an authorization form allowing the films to be sent to our Center.

Please plan to arrive a few minutes before your scheduled appointment to complete registration. Bring the written order from your healthcare provider and a referral if it is required by your insurance company.

Minimally Invasive Breast Surgery (MIBS) is increasingly becoming an innovative component of more recently created breast centers. However, clinicians at The Kathryn Candor Lundy Breast Health Center have been doing minimally invasive breast surgeries for nearly 10 years. In that time, they have performed more than 10,000 procedures and are the most experienced in the region.

Minimally invasive procedures allow a doctor to remove most breast tumors through an incision that measures less than one-eighth of an inch-smaller than a fingertip! The benefits to patients who are eligible for MIBS are vast.

• No pre- or post-operative testing or preparation required.
• The procedure takes only one half-hour and is completed at the Center.
• No stitches are used-the incision in merely one-eighth of an inch long.
• Patients experience only minimal post-operative discomfort.
• Patients experience no disfiguration or scars as they would from open surgery.

Our doctors envision a time, in the not-too-distant-future, when all small breast cancers will be treated using minimally invasive surgery, eliminating the need for open surgery procedures.

Minimally Invasive Breast Surgery includes:

• Ultrasound Mammotomy.
• Stereo Mammotomy.

Mammotomy

Mammotomy is the use of probe that is inserted into the breast. A computerized guide directs the probe that can remove abnormal tissue, located by an ultrasound or X-ray.

Ultrasound Mammotomy

Ultrasound Mammotomy involves the use of digital, 3-D imaging projected on a screen much like a television screen. Watching the image on the screen, the doctor directs hand-held probe to the abnormal breast tissue to obtain a tissue samples.

The procedure is done in the Center, and takes 30 to 45 minutes. The patient receives only local anesthesia and requires a small bandage for the incision.

Stereotactic Mammotomy

Stereotactic Mammotomy involves using X-rays to locate abnormal tissue in the breast. During this procedure, the patient lays faced down on a padded table. Once the abnormal tissue is located on the X-ray, the doctor inserts the probe and removes tissue samples.

Stereotactic Mammotomy is also done in the Center, and takes 30 to 45 minutes. The patient receives only local anesthesia and requires a small bandage for the incision.

Finding Breast Cancers Sooner, Where They First Begin To Grow

Most breast cancers begin in cells that line the milk ducts. Until recently, the only way doctors could see into these ducts was with open surgery. Now, with a minimally invasive procedure called ductoscopy, doctors insert a tiny camera no larger than a string of thread into the nipple of the breast and into the smallest branches of the milk ducts. This allows them to obtain a closer look at the lining of the ducts to detect minor changes that may indicate the early stages of cancer and begin a course of treatment when the rate of cure is highest.

Kathryn Candor Lundy Breast Health Center breast surgeons, Linda Myers, M.D., Susan Branton, M.D., F.A.C.S. and Timothy Pagana, M.D., F.A.C.S., medical director, are the first in the region to perform this procedure.

Noting the importance of this procedure, Dr. Pagana says, "Ductoscopy represents our effort to bring to our communities the newest technology associated with the diagnosis and treatment of breast diseases. The surgeons at our Center are committed to not only finding serious breast diseases at their earliest stage, but have launched a major initiative to prevent breast cancer. Ductoscopy is one method in our new medical arsenal that allows us to identify women who are at risk for the future development of breast cancer. It is in these women, we would direct all efforts to prevent cancer."

"Ductoscopy can identify cancers so small that mammography, ultrasound or even MRI cannot see them, says Dr. Branton. "It is also a valuable tool to evaluate high-risk women, primarily those women who have a strong family history of breast cancer."

For the procedure, doctors use a miniature endoscope whose tiny outer sheath is only about the diameter of a piece of thread. The breast is numbed and the endoscope is inserted into the nipple. The sheath actually has two channels. In one channel, the camera light source is inserted. In the other channel, water is injected to dilate the ducts for better visibility. The miniature camera is connected to a video system and the scope is then advanced to the smallest branches of the milk ducts.

The procedure can be done at the Center. If there is a strong suspicion, additional surgery may be needed, and is performed in the operating room. Ductoscopy usually requires no hospitalization and the patient can go home following the procedure.

When Is Ductoscopy Used?

According to Dr. Branton, two major uses for ductoscpy are:

• Diagnosing and treating women with nipple discharge---In the past, patients with suspicious nipple discharge needed to have extensive surgery to remove most of the central ducts of their breast. With ductoscopy, the disease causing the discharge can be seen and often treated through a tiny incision and selective removal of only one duct.
• Determining the extent of a breast cancer in cancer patients---When surgeons performed a lumpectomy to remove a cancerous area of the breast, they could not know for sure if they had removed a wide area of cancer free tissue from the area around the tumor until several days later when the pathology report was complete. In some 20 percent of the cases, the margins were not clear and the patient would have to have additional surgery. Ductoscopy can help identify the margin of tissue to be removed and direct where the surgeon needs to operate to obtain clear margins with the least disfiguring surgery possible.

Ductoscopy also has potential in the treatment of breast cancer. For example, Dr. Branton says, "it can be used as a follow-up test for women with premalignant cells that were detected by a previous ductal flushing procedure, who are considered high risk for cancer but as yet, have no evidence of breast malignancy on a mammogram. These women may actually have premalignant tumors, but we had no way to see or treat them. Now, using ductoscopy, we can see them and dissolve them without the need for surgery."

The Kathryn Candor Lundy Breast Health Center was among the first in the region to offer genetic testing.

Genetic testing is a valuable service since having a genetic defect places family members at a far higher risk for developing either breast or ovarian cancer or both than those who do not have the genetic defect. Both men and women can have this defect and can pass it on down to their children.

Breast Cancer-with the genetic defect, a woman has up to a 50 percent chance of getting breast cancer before the age of 50, compared with only two percent in the general population Ovarian Cancer-with the genetic defect, she has up to 40 percent chance of having ovarian cancer by age 70 compared with only 2 percent in the general population.

Genetic Testing

The first step in genetic testing is a thorough review of the patient's family history to identify red flags that may signal a genetic defect such as:

• Breast cancer at a young age.
• Breast cancer in both breasts.
• Ovarian cancer.
• Male breast cancer.
• Two or more close family members with cancer at any age.
• Ashkenazi and Jewish ancestry.

As part of the process, there is a discussion on all the options available to the patient if she decides to have the test and it comes back positive. Options may be to:

• Take medicine such as Tamoxifen to prevent breast cancer.
• Have surgery to remove both breasts and or ovaries.
• Have more frequent checkups.
• Discontinue birth control medicine.

If the patient decides to have the test, blood is drawn and results are typically back in four to six weeks. If the results are negative in a family with a known genetic defect, the patient has only the same risk as the general public for developing these two cancers. If however, the cancer in the family has not yet been explained by a genetic defect, the family members remain at increased risk for these cancers and should be monitored more closely.

When the results are positive, care options are reviewed with the patient.

Genetic testing costs about $3,000 and is covered by most insurances. For additional information, call the Breast Health Center at 570-326-8200.