What's New with Center?
What's new? Our entire center has been reorganized, and we have made some exciting changes. In short, RadNet, the largest provider of women's imaging services in the U.S.A., has acquired both the original Breast Center and the Breastlink organization (link to RadNet; link to Breastlink). These two newly added breast care organizations will join our expanded existing breast imaging program. The newly created entity is now called, “The Breast Care & Imaging Center of Orange County” .

State-of-the-art breast care requires a multi-disciplinary approach, which includes a team of specialists. From the patients' point of view, there are three key members of the team: breast imagers (radiologists/mammographers), breast surgeons, and the breast oncologists (see our team). Supporting the basic team are several other key players, including pathologists, plastic surgeons, and a psychologist. The efficient functioning of a multi-disciplinary breast care team requires a complex and expensive infrastructure, which in part includes a management structure, information technology, and a major investment in complex breast imaging technology.

To achieve our vision, we needed a strategic partner who fully understood our vision, and had the resources to make the necessary investments in infrastructure. Fortunately, the RadNet organization shared our vision. Dr. Howard Berger, the president and founder of RadNet, was personally committed to creating a fully-integrated breast care program. It was through his leadership and vision that the creation of our new center was accomplished in record time.

The newly organized Breastcare & Imaging Center opened its doors in June 2008. The center provides a coordinated approach to treating the entire spectrum of breast care issues, from prevention and early detection, through diagnosis and treatment, and finally to emotional and physical recovery. A single management structure coordinates all these services. A common electronic medical record system ensures that all members of the team are in instant communication with each other. An infrastructure is being developed to measure the cost and quality of care so that the value of our services can be measured. We believe that our fully integrated approach to breast care will lead to improved outcomes, lower costs, and improved patient satisfaction. We predict that our center will set a new standard in the treatment of women with breast care issues.

A single call is all it takes for a patient to take advantage of our services. For more information go to: contact us or just call : 714-541-0101.

Digital Mammography :

We were the first to introduce digital mammography to Orange County in October 2003. From the patients’ point of view, the advantages of digital images are improved detection of early breast cancer in women under the age of 50 with dense breasts, efficiency, and convenience. Although the digital mammographic equipment looks like the traditional equipment, the breast image is seen on a computer screen rather than on traditional x-ray film. Since the process is digital, the mammographic image is visualized in a split-second, and therefore the breast is compressed for a shorter time. The computer can manipulate the image, meaning fewer additional views may be required, which further reduces the total time for imaging.

The entire process usually takes only a few minutes. The images are stored on the computer and can be sent out over phone lines or saved on a compact disc. This eliminates the need for patients to carry around films, and also eliminates the problem of lost films. At our center, the images are sent directly to computers in all of the surgeon's examination rooms. The report of the mammogram is faxed to the surgeon within a few minutes of its completion. In most cases, the mammographic evaluation and the examination by the surgeon can be completed in less than two hours ( same day service).

As physicians, we have been quite impressed with the technical quality of the digital films. Our patients are pleased with the speed and efficiency of the digital process. Research studies have shown that the digital mammogram has an advantage over standard film screen mammography in the dense breast. By manipulating the image, the computer can often see subtle changes that would be more difficult to appreciate on standard mammography films. As a result, we have been able to reduce the number of biopsies in dense breasts by 50%.

Our early adaptation to digital mammography has allowed us to become among the most experienced users of this technology in the State of California. We are committed to providing our patients and physicians with the most cutting-edge technology available.

PET-CT Fusion :
One of our newest technologies is the PET-CT fusion. This is an examination that combines a PET scan with a CT scan, to yield more precise information and accurate diagnosis. In a PET scan, a small amount of the radioactive drug F-18-labeled-glucose is injected into the body. Fast-growing cancer cells feed on sugars and absorb it more quickly than do normal cells, so they "light up" on the images created by the PET scanner. The CT component allows for visualization of the tumor itself (i.e. as a growth or mass of malignant tissue). The scan gives great anatomical detail including the size, shape and location of the tumor. Together, the tests provide the most complete data on the tumor and its spread.

Studies have shown that PET-CT scans have an important role in initial staging and therapy management of newly diagnosed breast cancers. It can detect unsuspected contralateral (opposite breast) breast cancer, and unsuspected metastases. We have also used it for the follow-up assessment of response to therapy, especially for evaluation of distant metastases.

Breast MRI :
Breast MRI uses Magnetic Resonance Imaging (MRI) to look specifically at the breast. MR imaging uses a powerful magnetic field, radio waves, and a computer to produce detailed pictures. MRI of the breast offers valuable information about many breast conditions that cannot be obtained by other imaging modalities, such as mammography or ultrasound. It does not replace mammography (which is considered the “gold-standard” for early detection of breast cancer), but it can serve as a very important supplemental examination to a mammogram in certain specific situations.

Breast MRI can be very important in further evaluation of both breasts in patients with newly diagnosed breast cancer. It is a study which allows a more detailed look at the extent of disease, and may allow for detection of additional unsuspected hidden cancers in either breast, as well as evaluation of any metastatic lymph nodes in the axillae (armpits). It can help determine whether a patient is a good candidate for breast conserving surgery, or if she should have a mastectomy. Breast MRI can also be used for evaluation of response to chemotherapy. In very high-risk patients (such as women with a known mutation of the BRCA 1 or 2 the breast cancer genes; women with extremely dense breasts and a very strong family history of breast cancer), it can be useful in identifying early breast cancer not detected through other means. Additionally, it can determine the integrity of breast implants.

There are many important uses for MRI as an adjunct study to mammography, but MRI sometimes has a hard time distinguishing between carcinoma and normal benign breast lesions. It is also a very expensive examination. However, we have found it to be of tremendous value in a subset of the population, and have had very impressive results.

Partial Breast Irradiation :
One of the most exciting new innovations in the treatment of women with breast cancer is partial breast irradiation (PBI). Our first choice in treating women with newly diagnosed breast cancer is to save the breast, rather than doing a mastectomy. Saving the breast requires that the tumor be completely removed (via lumpectomy), and in most cases the surgery is followed by a 6-8 week course of external beam radiation therapy (see link to radiation therapy).

The advantage of partial breast irradiation is that only 5 days of radiation therapy is required. Currently, the best method of doing PBI is with the use of the Mammosite or Contura catheter (see link). A small catheter is placed into the lumpectomy cavity a few weeks after surgery. This procedure takes less than 15 minutes, and is done in the office under local anesthesia, typically on a Friday. On the following Monday after placement of the catheter, the patient goes to the radiation therapy department, where a radium seed is directed through the catheter to the center of the biopsy cavity. This procedure is painless, and takes only a few minutes. At end of the week (Friday), the catheter balloon is deflated, and the catheter simply falls out.

We have been doing this procedure for over 5 years, with excellent results. Most patients have been extremely satisfied with the results, and as we gain even more experience, we anticipate even better results for the future.

Partial breast is not appropriate for every newly diagnosed breast cancer. For the most part, we offer PBI to women with small tumors (less than one inch) and negative sentinel lymph nodes. We are, however, participating in an experimental trial (called B-39), in which women with larger tumors and/or positive lymph nodes can be randomly selected to receive this treatment (contact us for details).

Another exciting new development in the treatment of women with newly diagnosed breast cancer is intra-operative radiation therapy (IORT). The concept is to provide irradiation to the breast immediately following lumpectomy while the patient is still in operating room. This procedure is still under investigation, but the initial results are encouraging.

St. Joseph Hospital has recently acquired an IORT device called the Mobitron. At the time of this writing (6/1/08 ), the machine is not available for clinical application. However, protocols are being written, and it should be available for selected patients in the near future. Initially, the dose given in the O.R. will be considered a “boost” (or initial) dose, and the patient will still require a 6 week course of radiation to follow.

Onco-type DX : top
One of the greatest challenges facing some women with newly diagnosed breast cancer is whether or not to take chemotherapy. Until recently, it was believed that for women less than 50 years of age with tumors less than 1 cm in size, chemotherapy was not needed. However, there were two major problems with this recommendation. Some women in this favorable sub-group of small tumors ended up getting a recurrence, and many women with larger tumors for which chemotherapy was advised did not appear to benefit from this treatment. Because the stakes were so high, it was natural for many patients to choose chemotherapy, even if the perceived benefits were low.

We now have a new test that can tell more precisely who will benefit from chemotherapy, and who will not. The test is called the Oncotype DX. It is used primarily in women with Stage I & II breast cancers with negative lymph nodes and positive estrogen receptors on the tumor (see link).

Tissue from the tumors is sent to a central lab that does a comprehensive genetic analysis of the tumors’ cells. Based on this analysis, a “tumor recurrence score” is calculated. A low tumor score indicates that chemotherapy has limited value and can be safely avoided, even with larger tumors. A high score indicates that chemotherapy would be beneficial, even if the tumor is small. Intermediate scores require more judgment based on clinical and pathologic factors. A research study (TAILORx) is being conducted to address the issue of the best approaches for an intermediate result. (For more information, see contact us).
 
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