This is Roswell. Rookie by Roswell Park Cancer Institute European opinion or your total options your -- him -- Welcome back to Roswell and since we continue -- -- show you know hell yeah. During this breast cancer awareness month. And as always we do so with a comprehensive resources of Roswell Park Cancer Institute a truly comprehensive cancer treatment and research facility in Buffalo, New York. I'm Tim Wenger and this time we focus on two very important specialties and specialists. Involved in the fight against breast cancer. Radiology and pathology. Two great guests with me today we'll start with doctor air Melinda did not geo director of the tomography center and assistant professor. And the department of diagnostic radiology at Roswell doctor -- Q thank you for being here thank you for having me appreciate that titles always amazed. You know an awful like going man so I I more than respect that. Also with us today is doctor Leno line. She is pathologist with the department of pathology and laboratory medicine at Roswell doctor thank you for being here appreciate. The doctor -- shield tomography I think is pretty much again and people know what that is especially women they know it demography is. But for the layperson exactly what is at what is a mammogram it's happening -- It in him with a mammogram we are actually using a special kind of acts -- to take an image of the priced. And to book for small breast cancers and there's two ways to basic ways we can find. Hoping to find breast cancer when -- -- And we can. I'll find them as a lump and again hoping to find the four advocates feel -- lump that's an idea of having a screening mammogram. And or sometimes. We can find cancer on and very early stage. When. Because we CDs Michael -- vacations on the mammogram that you can't be. And they can be very early -- of breast cancer they can also be. Not cancer they can be deposited and normal tissue but those are the two of the ways that we can -- breast cancer very early stage. And mammography really use it it's it I mean you really has changed. On the detection of breast cancer and. As that the past couple decades yes it hats on. That actually has been proven to decrease the death rate from breast cancer to peak season. The number of women who die from breast cancer. It and it is however is not a perfect tool bars and certainly cancers that it doesn't -- only exit picks up about 85% -- cancer so that's -- the so much research to find. Better ways to do tomography and other my other tests that might actually improve on it that the task but it is the best we have right now. And it allows us to find -- cancers. When there are smaller earlier stage so. We can decrease the death from cancer and also use. Less invasive forms of treatments or. One last surgery for treatment more women can get a lumpectomy instead of the mastectomy. And that is and that's one of the benefits of of finding a breast cancer early -- up. They note breast cancer can be you know as other cancers -- some some cases can be self. Detected self knows that knows the detective. Are most breast cancers in women detected through mammography is correct statement. -- you know I don't have that statistic off the top of my hat but I would I would think -- think most are probably detected by mammography at this point. Is that if you what is actually happening with that type of test and answer area expertise so. So you mean what how do we do the tasks actually. I'm it's thing that's really just like any other X ray that we meaning you can take an X -- your arm or you're. -- fantasy of a broken moment basically easy next -- to look inside the body. And with the with -- we use a special kind of X -- that's tailored for looking within the breast. And to. And that's what allows us to see inside the Preston and and pick up -- cancer now at. The the the mammography center in Roswell park. It's now you do you know it's if there are other some of testing and -- that we don't really do screening mammography that means green not screening and McAfee correct on -- basically two types of democracy and women who come in for their annual mammogram and that's what most women in when you referred to his smile don't know what they're doing what they're talking about we're talking about. And -- -- women who have no symptoms don't feel -- they just there every year to get their annual mammogram and we don't do that part at this point. What we do do is what's called diagnostic. Them imaging diagnostic tomography. And those are women who have had a mammogram on the outside which has an abnormality. Com or of. Feel -- lot and and they're getting additional imaging and basically the additional imaging we do. If if it is an abnormality on the outside we tried Fiat isn't really. A true -- because what we're doing is taking an 82 dimensional picture of a three dimensional structures that tissue can overlap. And almost look like there's something there but it's not a real finding. So sometimes the additional pictures that they -- just a few mammogram pictures if there is a real fight the American typically will do ultrasound. To figure out if it's a sister not assessed is typically benign nothing more needs to be done. And then if it's not a says store fits that those micro pacification as we see we figure out whether or not you need a biopsy. And we can do biopsies. With needles using the imaging needed the ultrasound and mammogram to guidance to these small area that's. And often times if the pirates seized the nine. -- the patient and the need to have surgery that and if it's cancer and then move on to. Having surgery. So these imaging tests are really really important and in in advancing a patient or or reducing that perhaps they don't need needs treatment. Cracked and you know one of the downsides of mammograms it's it picks up breast cancer. But it also picks up a lot of the -- that we just can't tell whether it's cancer. Sometimes you can tell by doing some of these additional pitches an ultrasound sometimes we can't. So I'm having the ability to do it a biopsy with a needle as opposed to sending these women to surgery. Has been a real. -- V ads in our area before if you haven't them about it we weren't sure if it was cancer right after the surgery now we can do the needle biopsy. And only about actually twenty to 40% of women who have a needle biopsy end up actually having cancer so we're by Epstein a lot -- -- ninety. Which. Is you know it's that's stressful itself but our but it's so that we can make sure we find those small cancers in the middle of the -- You raised a couple of things first of all it won't mention. Going to panic mode if they have some sort of an abnormal. Abnormalities in in a screening mammogram. And mean it doesn't necessarily mean. That's absolutely correct it does not necessarily mean you have cancer. In fact most of them will turn out to not -- its. But it often requires additional work to figure that out sometimes a simple as just a few more mammogram pictures sometimes as much as and you. And when you get. Miniature power if you can answer this question that if there is an abnormality. And you know there are some you know benign findings. Is that -- -- down the road immediate you've actually had the by Nancy it's -- and you know his cancer that person and potentially any more susceptible to breast cancer than. Normal most of the times and sometimes there are some. And this for probably got more on the players' area I'm there are some. I'm lesions that will biopsies finding that biopsy. That don't come back cancer and they'll come back completely benign comeback atypical. In various forms of Ethiopia. Com and those patients tent and it -- that both patient and that being at higher risk for breast cancer. It's so you do you see patients and regular basis -- in dealing with. -- human refuse Senator McCain usually gets to a point where obviously are probably always it's the point where doctor. And want you you get involved in these cases your your more behind the scenes but. Every bit as important tell me the role of the policies in this entire process. Right so. One Paramount and -- does a biopsy of repressed. The pathologist receipts that tissue and we are the ones that will give a final diagnosis. So Amylin that was talking about well sometimes we don't know whether. What we're seeing as benign and malignant. So they will do a biopsy. The pathologists will receive that tissue we able to examine it and determine whether. They're lesion is benign or malignant. Them sometimes as Amylin stated we give a diagnosis of a typical it status. In degrees on that is in between benign and malignant. And these patients do have a higher risk of developing. Cancer but their diagnosis at that point is not cancer and -- in and of itself. And into you know when you get that that -- how is it tested what are some of the different tests against them. Right exactly so basically if it is denying you know we are done with that we just examined the tissue it's denying and and that's and of that case. If however the patient has. Malignancy. Then we perform additional -- on the tissue. And these additional tests will help to determine therapy and also. It tells us about the prognosis of the patient. So for instance. We make give -- -- tissue and we -- -- invasive carcinoma. On. On that on that tissue. And then we had a diagnosis of based carcinoma and be able routinely do. Hormone testing and hurt too testy. And hormone testing includes. Estrogen -- sector and progesterone receptor testing. And what this tells us says if this tumor expresses. But -- able to skull ER PR which is estrogen receptor protester interceptors. If they expressed ER PR these patients are eligible for hormone therapy. Verses if they are not expressing yeah -- PR and they have. They haven't decreased likelihood of responding to hormone therapy. There is an additional test called her to and this is very specific for breast cancer. And this test is. Very unique and that. If patients have and tumor that it's -- that is over expressing hurt too. They are eligible to be treated with a certain type of therapy called trust -- map. So these are three tests that are routinely performed on invasive carcinoma of the past. In Howell you know how in depth these tests how long does this take a that this does not take a long time actually beat -- -- it depends but if -- perceive a biopsy. You know one date by the next day -- could potentially have all of those tests performed on the patients patent case. In those results would be known them okay that's terrific I mean it now -- are centered curricula stresses you both well known that goes along with. A woman going through this you know whether it turns out to be something. That needs to be taken care. You know quickly or not. Let's go back to you doctor cannot GO. We've we've referred a lot to biopsies here I know there are many different ways biopsies can be accomplished some of which you do. Rate in the in the mammography center -- guess -- get a different. Right now the standard of care whether it's my -- -- -- -- found on the mammogram or even something woman feels the standard of care is to have a needle biopsy first except in those where circumstances. That for whatever reason. And they're usually technical ones we can't. Get to go to the lesion with a needle biopsy and then have to go to surgical precision but women really should be getting a needle buyouts in the vast majority cases before they have surgery. The types and he'll biopsies we do mostly core biopsies which means that we actually take pieces -- tissue from whatever -- abnormality -- And then basically. Because these are typically smile lesions are hopefully small lesions. We. We need some imaging to guide assets to be able to see allegiance seething needle the -- -- so that's how we fighter weight to it. And if we see it passed on the mammogram we have await a special table that we can use the mammogram to -- -- if at least the past on the ultrasound. We can use the ultrasound to guide us and that's typically the quickest and easiest for the patient if we can do an ultrasound guided biopsies. Not all abnormalities are seen on ultrasound and thus far distant NAFTA and -- up against its okay. Thus far are we dealing with an outpatient type of scenario correct -- we're actually dealing with an outpatient scenario where all you received is local anesthesia I hate to compare myself to it but it's sort of like Atlantis -- forget that local anesthesia. -- no sedation and you can target south home after the procedures done this is op patient. And and Europe to do with the -- I think you -- oh there is we we do also image the past with MRI and if we find an am amounted and we don't see an ultrasound. Alarm tomography. We can actually do biopsy using MRI to guide -- to. In and be the the the -- -- C. There's surgical. -- it typically. We don't do a surgical biopsy that's an that's an on. And in usual circumstance like it's it's only in the situation that for whenever technical reason we. And we can't get to the -- by using the mammogram ultrasound to guide -- and tied the needles that we have. And and that rare circumstance. The surging well. That take out the areas that were concerned about we still end up having to use -- a needle in the sense that we have to put. I'm marker next city abnormality. So that the surging and find it so easy needle to put a small wire right next to what were concerned about and then the surgeon follows that wire and most of most are gold Bo is to do that needle biopsy I had time and figure out they have cancer. Or no cancer. And that they don't have cancer they typically don't need surgery if they do have cancer. Because we know it's cancer had a time them in the surgeons go when they know that they have to take a wide Marge -- around that area. They know they have to check went to -- notes under their arm and the surgery is more likely to be -- and one -- then coming back if you have a biopsy find out it's cancer and you. Oftentimes don't take -- a lot of tissue around it because it could be benign you wanna take. A lot of breast -- out for benign lesion for something that's cancer. So you might have to go back for to take up more tissue to make sure it's I'll removed and then have to check -- and under your arm to make sure that the cancer hasn't spread their. Some part of the benefits of having needle biopsy purses. You can you're more likely to appeal to get the surgery done and once -- not have to go back to the operating. You are listening to Roswell as we continue our conversation. This month breast cancer awareness month. About that of course which is breast cancer in studio today we have. Doctor Melinda did not yoshi's director of the tomography sender and assistant professor in the department of diagnostic radiology at Roswell that's who you just heard from. And doctor Helena Hwang she is a pathologist with the department of pathology and laboratory medicine. At Roswell park. We always on the program talk about the multi disciplinary the team met at Roswell park and here are two great examples you are too great great examples of that. Where patience. And families are exposed. You know to the initial diagnosis phase in in -- involved with that that doctor cannot show. You know from from the get go as as well both of you are. There is this team in place at Roswell. Some you know right out and and center stage in some behind the scenes. I'd like to explore that a little bit I mean you really are part of a group of people that are dealing with. You know on a case by case basis with with individuals. Likelihood in their futures it's pretty special. It is it's really special I I I -- worked in private practice for years after. This forays I started it Roswell and com and it was a good private practice I really enjoyed my work about one of things I like most now about working at Roswell is being part of that team. And it's a team that's we commented Helen it doesn't always see the patient but I certainly will talk -- if there's any question we talked to each other. Where house so we we know we have a multi disciplinary clinic. Conference once a week. Where we on review interesting cases are complicated cases so that we can all be one room and discussed his cases together we actually have a multi disciplinary clinic also where patients come in knowing that they are going to see. Multiple members of the team. I think that's a big part of why Andrew working there and why I think we provide the patients with really good hair. Mentioned something that's really important to me if I in -- who were patient every event at Roswell in. When you're in private practice and there's certainly nothing wrong with that I mean a test might be conducted -- sent out to somewhere a lab or some facility. But he in this case you know the test is being done you know by eight by her staff. And you can talk to each other year -- reindeer and it seems like a much more personal and and. Yeah I think it's very very important to have. You know multi disciplinary. That can help -- approach yes. Especially impressed cancer I mean I can give me an example that when the -- logger for for example going back to. Doing core biopsies. If demographer hats in the core biopsy. And it is not. Clear to me whether. What exactly was -- targeted for example health occasions -- if this was a mass lesion. And I am looking at the patient's tissue and I am not clear as to. Which lesion was being targeted I communicate their Melinda. Very directly and we can get this cleared up very efficiently. And the little issues like that they think are very important when we're talking about. This multi disciplinary approach especially in. And breast carcinoma. -- vehicle has -- -- I think it also makes it just keeps. It helps us improve to because we get the follow up from each other. And from the surgeons and we we opt unknown outcomes further down the line until I think it helps us to continue -- approved improve our. Practice. Let's talk about how a case might progress you know obviously we would we would hope that all cases you know -- -- new explorer through the the various aspects of the imaging that you have. Coming your disposal and find out that someone doesn't need to be treated obviously that doesn't happen all the time and any case moves along the way. You doctor but not -- would be involved I would I would think in in a person's case. Almost from the beginning rate until the the end of their treatment as they move on it braswell made. And eat eat the reigning Al does is it evolved at different points you know first when we figure out. What that there is on cancer or and -- and how much there is and then. Sometimes when it's a small lesion and it's something that the surging can find in guiding the -- to do the surgery. Com after the surgery. If they do -- chemotherapy and radiation and they do kind of go off and we don't see them for awhile now and and at least we'll see them back when there -- -- And whether it's the other breast or if they have a lumpectomy folk festival where they'll get their -- imaging with us into the -- the continually -- imaging done throughout the treatment process to not typically not typically not. Sometimes it. A few patients some of the patients look at chemotherapy before they get surgery and though wolf follow them. But I'm most patients don't need to be image during during the treatment process. -- doctor hung. Where is your involvement begin and you just in the diagnosis phase of of dealing with right. I mean essentially be give the patient the diagnosis. The starts usually with the core biopsy. But after that if the patient does have a malignancy tables have annexation whether it is a lumpectomy or and mastectomy. And the pathologist again overseas that tissue we will receive up lumpectomy or the mastectomy. And we will examine it one. And to determine again what type of tumor artists. Can be chip characteristics of the tumor which includes degrade of the tumor. And three to make sure that the tumor has been completely excised. So those are really three of the most important things. And just general pathology general surgical pathology and best apology again one of the fourth factor. They are and are at the special tests that we do which includes as mentioned previously the hormone markers as well as her two. Hurting. So. That's a role that we play and. And the patient segment there's only there's an awful lot going on arousal part of Lotta patience a lot of people that are being in other cases are being reviewed. How many people do you have on your team of of a college. Rights -- Ross so we do we set specialize are breast pathology so we have three dedicated breast pathologist. So this is. -- -- they feel this is very important because. We get to see a lot of breast. Pathology specimens. And we have three dedicated people and doing that's. You know it's a -- you're you're in a very precise science you're conducting testing your your your staff conducting testing on a daily basis. Does that make it hard or is it. You know the you're not dealing with the patient is doctor -- show could be you know we'll see a patient is is dealing with that that the human emotion that's going on there. And in your behind the scenes conducting extremely important work. In really nothing attached you know you know that person and attached to a does that make your job difficult. Well I think. We all think about the patient Leon realized remote and patient -- even though we do not interact with the patience. And think you know we never forget that we are dealing with the patient. You know a lot of patients are anxious or in -- -- and you know we reconsider at this these factors. When BR. And we are dealing with the patients pathology. We realized you know how important we are in the process because we are giving. Them their final diagnosis and based on our pathology report. A lot of their achievement decisions are based on our pathology report. So. I don't think just because we do not interact with patients that we forget you know how important BR and the line of patient care -- No one in in no way it was -- Yeah. I think it makes it it's it's somewhat difficult you know to be dealing with this. And a daily basis and adventure right doctor -- -- you're seeing you know the guys in the face and in the people that. Are going through this and you know it brings it -- -- very close to home. I've heard from many of the positions of coming in here to talk about different aspects of cancer different types of cancer that the treatment is only as good as the image. That the imaging in the testing that goes into treating a patient is so important. The quality of it and and obviously. -- I think that's going to be something that's pretty close -- your hard -- you do responsible for our equality the imaging. Responsible. It yeah I think that's kind of thing but I think you know we both contribute important parts ended apple taking to take care patient -- I. I feel fortunate similar to you in this situation. That we we are. -- specialized so there's four of us. Who do breast imaging to Abbas who only do breast imaging and two other physicians who do. Breast imaging and -- the -- and body -- time I think when you're. When you are able to really focus and specialize in an area you really amount. To get very good at it and I'm very knowledgeable that area and -- I think -- important part of what we are able to do. There's so many. People who kept us. For their passion has made him focus in these areas. There's specialties. And eat it it's it's it's I I. I Presley like practicing. Like knowing very well that's one area -- And I'm sure the patients are happy to and to know that there are people like you that are are specializing in one specific area and doctor why it's it's. Interesting to -- united something I didn't know going into the show that you know there would be pathologist and a staff specific to. Breast cancer -- there are used to in on a daily basis looking at it you know that type of biopsy and a daily basis I'm back again I think a lot of people would assume that. Pathology is pathology -- -- looking you know it -- different types of cancers so there has to be about a benefit I would think for UN Roswell in the deaths. Mean I'd I'd appointing. It provides and manage. Them you know if you're seeing. You know -- -- Knology daily that is -- you see so many cases that lightning. You can't help them better cuts in that area I mean I think that goes -- saying versus somebody who might cease C a breast biopsy once a week. You know we we -- breast biopsies everything. You know -- Rasmussen okay. And we have approximately. Accession how many cases that we there -- cases yeah Russ Bynum pathology so. Yet they act I think it is an important part. And well you both really important parts of the the Roswell puzzle and I thank you both for taking time for coming in today thank you both think it's our pleasure -- with me in studio today as we continue a look at breast cancer in depth doctor air Melinda did not geo director of -- and I tomography center and assistant professor in the department of diagnostic radiology at Roswell. And doctor Helen -- She is pathologist with the department of pathology and laboratory medicine. At Roswell park when it comes to breast health check and double check with regular screening mammography. And go to Roswell park dot org slash double checked to keep yourself informed. You can always call Roswell with any questions toll free at 877 ask our PCI. That's 877275772. And. Listen to Roswell this Sunday mornings at 630 young WP year. -- by Roswell Park Cancer Institute your team opinion for your total options online at Roswell this god of war. And and hanging. Then.