Breast exams, mammograms can catch cancer before tragedy arrives
October is Breast Cancer Awareness Month, but it’s so much more than ribbons and the color pink. Those are just reminders that the risk of breast cancer is real for women, and men, of all ages. And regular screenings are key to avoiding a tragedy that often can be prevented.
Dr. Joshua Manghelli is a board-certified breast surgeon who devotes his practice to the diagnosis and management of all breast health issues, from benign disease to breast cancer. As a Community Health Network MD Anderson Cancer Center participating provider, he offers individualized treatment tailored to specific cancers along with a multidisciplinary team of highly specialized cancer care experts.
Manghelli operates in Kokomo at Community Howard Regional Health, and it is his life’s work to treat breast cancer patients, saving lives in the process. Fortunately, not everyone will need his services, but he explained who might be a potential patient, based upon what the medical community knows about breast cancer.
“Breast cancers happen when cells mutate and become cancerous, divide and multiply to become a tumor,” said Manghelli. “We actually aren’t 100-percent sure what triggers this change. However, through research, we’ve found many risk factors that that are linked to breast cancer.
“Some of these include age, and sex is a big one. You know, women are much more likely to develop breast cancer than men, which suggests a hormonal role. Family history plays a large role in breast cancer risk, and furthermore, up to about 15 percent of people with breast cancer develop the disease because they have inherited genetic mutations.
“Smoking and alcohol have been linked in the increased risk of breast cancer. Obesity is a risk factor, and radiation exposure in the past and prolonged hormone therapy have also been linked to an elevated risk of breast cancer.”
With all of these risk factors, it would seem that most women should be screened regularly for the disease. Manghelli explained that there are recommendations for who should be screened, how early, and how often.
“Most physicians recommend that women who are at average risk of breast cancer get screening mammograms every year starting at age 40,” said Manghelli. “This is a recommendation currently from the American College of Radiology, American Society of Breast Surgeons, and the National Comprehensive Cancer Network.
“For women at higher risk for breast cancer based off genetics or family history -- we define these women as having a 20-percent risk or greater for breast cancer -- to start earlier. In these patients, we recommend starting mammograms or age 30 and an annual MRI starting generally at age 25.”
Before reaching the age where a mammogram is recommended, people are encouraged to perform regular self-examinations. As there has been a documented increase in cancers occurring in younger individuals, Manghelli strongly recommends women at all ages to check their breasts for any irregularities.
“It starts with inspection, just looking in the mirror or having a partner look to ensure there’s no skin changes, skin dimpling, or obvious masses,” said Manghelli. “Then, what I do in my exams is use the whole surface area of my hand, placing the breast between both hands, and using the entire surface area of my hands to palpate for masses, check for nipple discharge, and assess for any skin changes.”
If a self-exam turns up something suspicious, it may be time for a mammogram or MRI. But not all mammogram screenings are alike. For decades the medical community has relied upon the standard mammogram, which takes a two-dimensional scan of the breast, depicting the tissue within. Today, technology has advanced, and now women can opt for a three-dimensional scan, which gives physicians a better look at the tissue.
“A 3-D mammogram takes more images of each breast,” said Manghelli. “A computer assembles these images into cross sections or slices, and that gives a radiologist the ability to see breast tissue through overlapping layers to improve breast cancer detection, especially in women with more dense breast tissue. There have been studies now that have shown that 3-D mammograms are more efficient at detecting breast cancers.”
Manghelli said the 3-D scan, which is available locally, takes a little bit longer than a traditional mammogram, but otherwise is the same procedure.
Kokomo residents are particularly fortunate when it comes to fighting cancer of all types, thanks to Community Howard’s partnership with MD Anderson Cancer Center in Texas. It gives local patients access to some of the best treatment options available.
“MD Anderson is one of the world’s most premier cancer centers, and our partnership with them truly allows us to provide the most up-to-date care for patients,” said Manghelli. “We have access to their multidisciplinary clinics and trials, which really allows us to provide the most current treatment options for our patients.
“And if we have complex patients who we just want a second opinion on, we’re able to schedule televisits with MD Anderson to talk through treatment strategies for these patients.”
The goal is for breast cancers to be eliminated altogether, but that day is still well into the future. Until then, Manghelli strongly recommends diligence and regular self-exams and screenings.
“We have all of the most current treatment options available to us at Community Hospital and specifically in Kokomo,” said Manghelli. “My message to the community at large is really to be diligent about self breast exams and screening with mammograms, because breast cancer is very treatable when detected early.
“If someone feels that they are at high risk for breast cancer, come see me so I can help you through that process, whether it be screening with MRI and mammograms yearly, or sometimes if there’s a genetic mutation, we do recommend mastectomies, but those are very personalized treatment plans. I recommend calling the breast surgical oncology office and coming to see us so we can help you through that.”
If surgery is necessary, whether that involves a lumpectomy or even a full mastectomy, patients in Kokomo have a unique opportunity available to them. Manghelli disclosed that Community Howard Regional Health is the only hospital system offering reconstruction locally.
Regardless of individual need, Manghelli and Community Howard are well positioned to help patients through the screening a treatment processes.
“My message to every one of my patients is that I’ve dedicated my life to surgery, and specifically to surgical management of breast cancer,” said Manghelli. “I absolutely love what I do, and my job is to help guide them through this complex time.”
For more information, or to schedule a consultation, call 765-776-3780.