East Texas hospitals discuss new technology, programs for breast cancer | Local News

Over the years, technology continues to advance allowing more services to become available to better identify and combat breast cancer.

From small chips that more easily identify the location of cancer in the breast to survivorship programs to keep patients informed and connect them with resources, the progressions in breast cancer have come a long way.

Technology

“I think we have the top notch technology at (UT Health East Texas),” said Dr. Christine Moulds-Merritt, breast cancer surgeon.

Some of the biggest developments in technology have been the Radio Frequency Identification tag and the 3D mammography machine, or tomosynthesis.

The RFID tag is a technology that places a chip in the cancerous area of a breast, pinpointing exactly where it is for surgeons, said Dr. Michael Klouda, UT Health East Texas Breast Care Center diagnostic radiologist.

“It's like a GPS for the cancer,” said Moulds-Merritt.

The chip is put into the breast with a hollowed needle type of tool. The tool can make a small incision and deploy the chip into the breast.

Klouda said to insert the chip the breast will be numbed before the incision is made. To ensure the chip is put in the right place, things such as ultrasound can be used simultaneously so doctors can watch what they are doing in the breast.

Each chip has an identification number unique to the patient, he said. Doctors can scan the chip to locate it and pull up this individual number.

Prior to RFID tags, Moulds-Merritt said patients would have to come in the morning before their surgery for another mammogram, have the area numbed and then a wire would be put into the breast around the cancerous tissue. Due to this wire sticking out of the breast in part, patients could not leave the hospital once the wire was in.

With an RFID tag, patients can schedule a surgery at their convenience and if needed even go to another hospital for the procedure, she said.

Another benefit is that for surgery, the patient comes into the operating room and a probe can be used to find exactly where the chip was implanted, Moulds-Merritt said. As such, during surgery she can choose a better place for an incision to remove the cancer.

With the wire method of locating cancer, doctors have to follow the wire to the cancerous mass, putting the doctor in a harder position when determining where to make incisions, leading to more tissue being removed than needed at times, said Dr. Brandon Ashton, UT Health East Texas Breast Care Center diagnostic radiologist.

“This RFID, you place it in the mast and then the surgeon can choose maybe the best anatomic place – the closest place – to make the incision and hide the scar, make a smaller scar," Ashton said. “And so there's some advantage there to the surgical approach too.”

With this being a chip, you can also confirm it is removed during surgery, Ashton said. Doctors also ensure it is removed through using a device to make sure the chip is in the removed tissue and an X-ray.

Other than the RFID tag, 3D mammography has changed and improved the way doctors find cancerous masses.

Before 3D mammography, 2D mammography was used, Ashton said. With 2D, the breast was flattened, everything was overlapping and images could only be taken from a couple of different views. 3D mammography takes pictures in an arc, dividing the breast into little slices and giving doctors a view that is not overlapped.

“We do what's called callbacks if we see something abnormal on a screening mammogram, '' Ashton said. “We have less callbacks for things that aren't important with 3D mammography, or tomosynthesis, and more callbacks that identify cancer. So you're finding the right things with the technology.”

UT Health East Texas also has a mobile mammography bus with 3D mammography machines. This bus can visit rural areas and provide patients with the “best” treatment.

The hospital got its first 3D mammography machine around four years ago and has since switched all screening machines to be 3D, Ashton said.

While 3D mammography machines are used the most to examine breasts for cancer, MRIs and ultrasounds can also be used.

“Ultrasound is a real boom because you have no radiation exposure,” said Klouda.

Ultrasounds use sound waves to capture images, Ashton said. On the 3D mammography machine, cancer and the dense tissue of the breast is white whereas with ultrasound the cancerous areas will be dark.

MRIs use magnets to create pictures from different tissue characteristics, Ashton said. There is no radiation involved, but patients will be injected with contrast. This allows “a level of information that mammograms don't have, and that is blood flow,” he said.

When you can look at blood flow, Ashton said you can sometimes find cancers that have not made a structural change yet, but you can see the blood flow difference where cancer could be developing.

An MRI is even better at picking up cancer than the 3D mammography, but it is not used on an annual basis for patients unless they have a cancer diagnosis or family history of cancer, he said.

In the future Aston said he would like to see “MRIs becoming cheap enough and available enough to use as a screening method. It's too cost prohibitive and there's not enough available to screen all the women, so that could improve.”

Programs

At Christus Health, a new survivorship program for breast cancer survivors has recently started. 

The survivorship program is for those who have undergone the final treatment of breast cancer, be that surgery, chemo or radiation, said Dr. Jacob Krause, survivorship advanced practice clinician.

Ideally, Krause said he likes patients to visit a few weeks after the final treatment, but he will see them up to six months after.

The initial visit Krause has with patients is “all encompassing,” he said. While he will still do things such as physical exams, he also sits and talks about how everything is going post treatment, explaining everything about their cancer in depth, why they got the treatment they did, if they're experiencing depression or anxiety and other things.

The biggest thing with the survivorship program is going back and explaining the pathology of a patient's cancer so they understand everything, Krause said. Some doctor visits during the process of getting treatment will be short and things can get “brushed over,” so it is important to help people understand, he added.

During the visit, Krause said there are some times where he talks about the cancer very little with a patient and more about how life is going and vice versa. It is really just whatever the patient

needs.

“Some people need a little bit more as far as kind of getting their life back together and doing everything,” he said. “And of course, every patient is different so it all just depends on what the scenario is.”

“I think for a lot of them just having another resource, another person to talk to you, is helpful.”

After the initial visit, he said he will see patients once a year after that to make sure they are still getting mammograms and everything is going well.

The survivorship program has been actively seeing patients since about April, Krause said. In this time, he said he has visited with about 90 people. In a year about 400 people will go through the hospital with breast cancer.

Sometimes it is difficult to explain to people what the survivorship program is exactly, but those who do participate “seem really happy and glad that they actually did it whenever they come and finally go through everything,” he said.

Through talking with people, Krause said he is able to direct them to other resources as needed such as one's for physical therapy and counseling services.

So long as people are able to provide access to their records so he knows about their cancer and treatment, they can be a part of the survivorship program, Krause said. With this information he is able to create a survivorship note with details about their cancer.

“I'm happy to talk to anybody, if they're having problems. I may not be able to do a very good survivorship note form if I don't have all the information, but I'd always be willing to talk to anybody,” he said.

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