ISSUE 145: Special Section

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Mammography Is Not Black and White

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LEXINGTON Almost everyone has been touched by the diagnosis of breast cancer in a loved one. The potentially devastating results of this diagnosis underscore the need for high quality breast care for women in Kentucky. Screening and early, accurate diagnosis remain lynchpins in the fight to reduce morbidity and mortality from breast cancer.

Drawn to Women’s Imaging

Richard Budde, MD, breast imaging specialist, joined partners Marta Kenney, MD, and Kimberly Stigers, MD, at KentuckyOne Health Breast Care in the fall of 2014. This practice, located at Saint Joseph East in Lexington, provides breast imaging services for KentuckyOne Health facilities. Budde’s passion is using his expertise to provide the best and most timely care to patients undergoing mammography and breast biopsy procedures.

Budde brings a wealth of radiology experience to the practice. A graduate of University of Cincinnati College of Medicine, Budde completed his diagnostic radiology residency in Pittsburgh and his interventional radiology fellowship at The Ohio State University. Coming from a medical family, his father is a retired neurosurgeon with Mayfield Neurological Institute, now known as Mayfield Clinic, in Cincinnati. Budde was drawn to the field of radiology by the technology boom in medical imaging during the 1980s. “I was attracted by the ability to deliver direct patient care through image-guided procedures,” says Budde. During his career in private practice in Cincinnati, Budde gravitated to the women’s imaging realm and served as section chief of Breast Imaging at the Christ Hospital. He came to Lexington for the opportunity to practice exclusively in breast imaging and intervention.

Detection of Breast Disease

Breast disease can run the gamut from benign tumors, fibrocystic disease, infections, and trauma to malignant disease, according to Budde. He describes the breast as a complex, glandular structure. “There are multiple shapes and forms of breast cancer, and on mammography it’s not typically as clear as black and white but more often displayed as many shades of gray in between. This highlights the importance of utilizing breast imaging specialists who are experienced in navigating the subtleties of mammographic interpretation,” states Budde. He adds, “The diagnosis of breast cancer is intricate from an anatomic, disease, and pathology standpoint.” Budde cites the fact that breast cancer affects one out of eight women. His patients, predominately female, come from a wide geographic area including central, east, and southeast Kentucky. While he does see patients in their 20s and 30s, most patients are ages 40–80, the common age spectrum for mammography screening. Budde adds, “I do see an occasional male patient. Breast cancer in males has an incidence of approximately one percent and can be familial.”

Budde recognizes the emotional impact of a breast cancer diagnosis stating, “It’s a very stressful moment in a woman’s life. We treat our patients with compassion and concern, and, in the event of a biopsy yielding atypia or malignancy, we assemble a team of specialists who develop a dedicated treatment plan as soon as possible.”

Annual Screening Still a Priority

Women are bombarded by the mainstream media with multiple confusing recommendations about breast cancer screening. Despite controversies in the medical literature, Budde strongly believes in annual mammograms for average risk women between 40–75 years of age, stating, “The data from several landmark randomized controlled studies continue to support annual mammograms as an effective tool for significantly decreasing the morbidity and mortality rate of breast cancer.” This recommendation is endorsed by the American Cancer Society, the American College of Obstetrics and Gynecology, and the American College of Radiology. According to Budde, a high risk woman, generally defined as having a first-degree relative with breast cancer, should start annual screening 10 years prior to the age of diagnosis for their relative, but not before age 25. For women above age 75, the decision on screening should be made in conjunction with their primary care provider or gynecologist. Many older women who are in good health and have life expectancies of at least five-to-10 years, continue regular screening.

3D Mammography – The Gold Standard

KentuckyOne Health Breast Care uses 3D mammography, also known as tomosythesis, to provide state-of-the-art breast imaging services to their patients. Budde reports that early studies demonstrate tomosynthesis can improve early breast cancer detection in patients with dense breast tissue by up to 30 percent. He recognizes that mammograms are an anxiety-provoking experience, especially when recalling patients for additional images of suspected abnormalities. “It’s important to treat the patient and not just the medical image,” notes Budde.

When suspicious abnormalities are noted, a biopsy can usually be scheduled on the same day. His practice was the first in Kentucky to have 3D biopsy capability. This enables the patient to be seated upright instead of lying prone for the typical 2D biopsy procedure. “Not only is the patient more comfortable, the breast imaging specialist can more easily biopsy certain lesions, especially those close to the chest wall” states Budde. The ultimate goal is accurate and timely detection of breast pathology. “We strive to shrink the time line down between diagnosis and starting a treatment plan,” adds Budde.

Budde eventually sees a conversion to 3D imaging for all mammography in the United States, saying “It will very likely become the standard of care.” Software improvements have advanced ultrasound and MRI technology in diagnostic breast imaging. In addition, treatment options have become much more specific with targeted therapies based on genetic and tumor markers detected on tissue biopsy specimens. Treatment options range from chemotherapy, radiation therapy, and surgery to hormone and molecular therapies and are personalized to the patient. “The good news for all women is that mortality from breast cancer has decreased 30–35 percent since the 1980s,” adds Budde.

Budde says he and his partners at KentuckyOne Health Breast Care strive to give their patients expert breast imaging care using a personalized approach that minimizes anxiety by avoiding unnecessary testing and providing timely results.

Breast Care Saint Joseph East Medical Office Building 160 N. Eagle Creek Drive, Suite 101 Lexington, KY 40509 P: 859.967.5613