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Health Talk - Lori S. Gormley, M.D.
Lori S. Gormley, M.D.
Breast Imaging & Biopsy Associates
187 Rte. 36, MPCCI (Bldg A, Ste. 130)
W. Long Branch, NJ 07764
Iíve heard recently mammograms for women 40 to 50 years old are harder to read and that they should only have mammograms every two years.
In general, younger women have denser breasts, which can hide a cancer more easily. However, cancers also tend to grow more quickly in younger women, making yearly screening even more important in that age group. Breast cancer in women in their 40s accounts for 25% of all breast cancers diagnosed and over 50% of years of life lost to breast cancer.
What is meant by ďbreast densityĒ?
Density is determined by the relative amounts of breast tissue (white on the mammogram) versus fatty tissue (black on a mammogram) which together compose the entire breast. This is important because cancer also shows up white on a mammogram. If you have a fatty breast, cancers show up more easily on your mammogram; while if your breasts are dense, a small cancer is more easily hidden by the breast tissue. Breasts are variable in their density, ranging from almost entirely fatty to extremely dense. If a breast is fatty, mammography is very sensitive and can easily pick up very small tumors. Mammography may detect only 6 of every ten breast cancers in women with dense breasts.
How does someone know what their breast density is, and is there anything they can do to influence the density of breasts so mammograms are easier to read?
A womanís breast density is primarily an inherited trait over which you have no control. Breast density changes over a womanís lifetime, with a trend towards more fat instead of dense tissue as we age. This varies from person to person, and is mainly influenced by hormonal changes. During pregnancy and lactation, breast density increases dramatically, while after decades of estrogen depletion during menopause there may be a gradual change towards more fatty breasts. Breast density is not dictated by breast size, shape or structure, and is not related to a personís weight. Breast density should be included in every mammogram report.
Are there other ways to detect breast cancer early in women who have dense breasts?
There are several other ways now available to help detect early breast cancer in women with dense breasts, and many more are in the process of being developed. Screening Breast Ultrasound is becoming more widely available, and is very exciting. It does not use radiation, is a relatively quick exam and considerably less expensive than other options. Breast MRI is very sensitive in detecting small breast cancers. Unfortunately, Breast MRI is sometimes too sensitive, and false positive studies can result in unnecessary biopsies and a lot of anxiety on the part of the patient, and is therefore used primarily for screening high risk women. Breast Specific Gamma Imaging is a fairly new modality in breast imaging. It uses radiopharmaceuticals to evaluate the energy consumption of the breast cells. Digital tomomammography is the next step in digital mammography. Instead of generating a picture of the breast which is a composite of all the tissue superimposed on one 2-dimensional image, tomomammography allows generation of 1mm thick slices of the breast, which alleviates the big problem of surrounding dense glandular tissue obscuring cancers. Positron Emission Mammography or PEM is a dedicated PET study for the breast and uses the higher glucose metabolism of cancer cells as a way of imaging cancer.
What are the major risk factors for breast cancer?
A family history of breast cancer in any first or second degree relative, from either the maternal or paternal side, especially if the cancer was present before menopause. Other important factors to be aware of are a family history of ovarian cancer, a personal history of atypical lesion on breast biopsy or Ashkenazi heritage. Low level risk factors include early menarche, late menopause, nulliparity and long term hormone replacement therapy in postmenopausal women.
Dr. Lori Gormley, one of the foremost board certified Breast Radiologists in the State of New Jersey, recently joined Dr. Beth Deutch at HerSpace in West Long Branch. She has, since 1988, been at the forefront of Women's Imaging, having worked in both hospital-based and outpatient environments. She has lectured and published on numerous topics including digital mammography, breast biopsy, and numerous patient oriented education programs. She graduated Magna Cum Laude with a BA in Chemistry from Barnard College at Columbia University and received her medical degree from the University of Chicago (Pritzker School of Medicine), where she was awarded both the American Medical Women's Citation for Academic Achievement, and membership into the Alpha Omega Alpha Honor Society.
Dr. Gormley completed both her Diagnostic Radiology Residency and specialty Fellowship at the University of California, Los Angeles at the prestigious UCLA Medical Center. Her combined Mammography/Ultrasound Fellowship was the first ever offered in the United States.
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