ROBERT PIERCE
• Leader & Times
There was a time when the mortality rate for breast cancer, or any cancer for that matter, made the disease seem like a death sentence.
As the years have progressed, though, so too have technology, education and treatment for breast cancer, and with that in mind, between 1989 and 2022, mortality rates have dropped 44 percent, nearly in half.
Kelly Denton, director of the Diagnostic Imaging department at Liberal’s Southwest Medical Center, said in the early days of breast cancer treatment in the late 1980s and early 1990s, screenings were done mostly through the use of film.
“The film was dipped in the chemicals and then run through the processor,” she said. “The picture you had was the picture you had.”
In more recent years, though, digital technology has made its way to the world of photography, and Denton said just as with normal pictures, screenings can now be lightened and darkened digital. She added the technological improvements did not stop there.
“We’ve moved on to three-dimensional or what’s called tomosynthesis,” she said. “Now, when we take an image, we have 3D or tomosynthesis here at the hospital. When we take a breast image, it’s not just one image. Now, the actual camera takes nine pictures, but as it goes to the radiologist through all that computer magic, it takes that image and reprocesses it, and the doctor can get from that one image between 60 and 90 images of the breast.”
Denton said this depends on how the thick the breast is when it is compressed and how thin doctors want to look at images.
“He can look at it every millimeter from top to bottom, every two millimeters from top to bottom so you can see into the breast tissue a lot better,” she said. “That’s the newest technology as far as mammography imaging.”
In spite of all of the changes, Denton said mammography is still the standard for screening, but one new way of performing tests has evolved in the form of breast MRI, which she said is available at SWMC.
“Breast MRI is not a screening mechanism,” she said. “It is if you have a finding. Maybe we found something on the mammogram or the ultrasound we need to dig deeper into, or maybe the patient has a lump, and mammography and ultrasound don’t show everything. Maybe the patient has such dense breasts that an MRI may help look at things better.”
Denton said MRI can likewise be used for a patient who had what she called a first-degree relative with breast cancer.
“We should start some sort of imaging 10 years prior to that development of breast cancer,” she said. “If they have a mother, sister or daughter who had breast cancer at an early age, we would want to screen that person a little earlier. The problem with mammography is let’s say a woman has breast cancer at age 40. Her daughter should start some sort of method of screening at age 30. At age 30, our breasts are so dense, it’s difficult to see into the tissue.”
Denton said while an annual MRI is not necessarily in order in this case, treatment should start with a breast MRI to see the tissue to start the screening discussion by age 35 and maybe even earlier.
“Starting screening at age 30 in mammography is not solely beneficial because of how dense the breasts are,” she said. “That’s when we start bringing MRI into the mix – when we have very dense breasts and we want to A, take a look at something, or B, start an early type of screening because of family history.”
Along with technology and treatment, breast cancer education has evolved over the years, with many more sources available.
“One of the things that’s really nice about Kansas is we have Early Detection Works,” Denton said. “When women cannot afford the cost of screening, they can get with Genesis Family Health or Early Detection Works and apply for their program.”
Denton emphasized there are income requirements with these programs.
“As long as you meet their income requirements, you can get put into the state program to have free mammograms and free health care for preventative care,” she said. “That has not been out there as much, and we really promoted that in the last few years.”
Local education has been promoted through events such as the recent Community Health Fair, and nationally, Denton said preventative education is available through organizations such as the Susan G. Komen for the Cure Foundation, the American College of Radiology and the American Cancer Society.
Denton said there are other factors that have led to the decline of breast cancer deaths as well such as early detection, which in turn has dramatically changed treatment in recent years.
“Now when you have breast cancer, they send the tissue off to do some genetic testing,” she said. “You can see if it’s hormone receptor positive, if it’s estrogen positive, if it’s progesterone positive, and they can gear the chemotherapy treatment or whatever treatment plan toward the hormones that are in the breast cancer. They define the type of treatment because of being able to dig deeper into the genetics of the tumor.”
BRCA, or hereditary breast cancer, is past on through genetics, and Denton said blood tests are now available to find out if a person has the BRCA gene.
“If you have daughters, did you pass it on to your daughters?” she said. “They can have a blood test to see if they’re BRCA positive. If they are, there’s preventative measures you can do before you get breast cancer, or you can start screening a little earlier. That would put you in the high risk category to be able to qualify for the MRI of the breast at an earlier age and earlier screenings versus later in life.”
Overall, Denton said there are likely hundreds of types of breast cancer, one of the most aggressive being ductal carcinoma in situ.
“It’s one of the earliest forms of breast cancer,” she said. “When we’re looking at a mammogram for just screening, if you don’t have any palpable lumps, we’re looking for what’s called micro-calcification. That can indicate some sort of breast cancer or growth in there.”
This kind of cancer can also be benign, but Denton said until an investigation and tissue samples are done, there is not a way to know what calcifications are in the breasts.
“The doctors, because they have all the extra education, they know what types of calcifications are concerning,” she said. “We have blood vessels in our breasts. We have milk ducts in our breasts, and those can calcify. Those types of calcifications look a little bit different than the types of calcification they’re concerned about when you talk about breast cancer.”
Denton said this is why it is important to get mammograms done and have comparison studies done to see if there is consistency in prior screenings. She added testing for breast cancer naturally starts with looking at the breast itself.
“One of the things we look at are the skin of the breast,” she said. “If the skin starts dimpling or having what we can an orange peel appearance, that can be very concerning for types of cancer. If your nipple is normal to start and all of a sudden it’s inverted, that can be concerning for a type of cancer as well. If you have dimples in your breasts, that can be concerning for something growing in the breasts.”
Denton detailed further how the breast cancer mortality rate has declined over the years.
“Now, at least 91 percent of breast cancers have a five-year survival rate,” she said. “When you break it down by stages, stage one, breast cancer at its earliest form, has almost 100 percent survival rate at five years. That’s why we want to get you in early. If it’s breast cancer stage two, a five-year survival is about 90 percent of patients. Stage three is 70 percent. Stage four is 25 percent. It dramatically switches at stage three as far as survival rates. Over a 10-year span, breast cancer has an 84 percent survival rate and 80 percent for over 15 years.”
Denton said 10-year survival rates show similar increases.
“When you look at the 10-year survival rate, if we found it on mammogram, if you didn’t feel it yourself, there was no lump, bump, 95 percent survival rate, but if it progresses and it’s a lump and we feel it physically, that survival rate drops to 85 percent in 10 years,” she said.
So what does the foreseeable future have in store for the survival rate for breast cancer? Denton said more than likely, current trends will continue.
“I see technology as far as treatment of breast cancer improving continuously as they learn more about cancer,” she said. “There are studies constantly going on the types of cancer and what treatment does for each type of cancer. I think we’ll continue to see that growth.”
Denton said one great improvement in treatment is with findings from mammograms.
“It used to be you had to go to surgery to get that piece of breast removed and sent to pathology,” she said. “We can now, almost always either do a biopsy using the ultrasound machine or using the mammography machine.”
Both of these options are now available at SWMC, and Denton said patients no longer have to be put to sleep and leave with big scars on their breasts.
“If it’s benign, we don’t have to do anything further,” she said. “If it is cancer, you’ll probably have to have surgery and have it removed, but we can at least decide what it is with a very simple biopsy that takes about 30 minutes. It’s not even an incision, but the little nick in your breast that is less than two millimeters, three millimeters. It’s a very small entry of a needle that goes in. We can go in and get samples, send those small pieces of tissue off to the pathologist to get a diagnosis. That has improved greatly over the years.”
As for what she hopes to see happen with breast cancer, while she knows a zero percent mortality rate is likely not realistic, Denton did say stage one cancer could be at an almost 100 percent survival rate in five years.
“I’d love to see that for stage two,” she said. “I would love to see it be 100 percent at stage one, and maybe we can get a little bit closer with time and better treatments.”
Denton did say, however, there is still a large discrepancy in survival rate amongst various ethnicities.
“Traditionally, African American, Indian, the native Alaskan community, their numbers have not declined liked caucasian women,” she said. “I think we need to target some of those other ethnicities to see if we can get more education to them and understanding of better care.”
With Liberal’s large Hispanic population, Denton said the local survival rate is getting better with that group, but there is still a constant need to improve preventative care for all races and cancers.
“Reaching out to the underserved in the community or different ethnicities, whether we use the different Spanish radio stations or social media in different languages, we need to get that information out to all people so they know about preventative care and how to get preventative care if you can’t afford it,” she said.
