Manatee Memorial, Blake waging war on breast cancer

In recognition of Breast Cancer Awareness Month, which runs Oct. 1-31, both Blake Medical Center and Manatee Memorial Hospital this past week revealed new equipment and procedures they are bringing to the fight against breast cancer.

Metastatic breast cancer, which is cancer that has spread from the breast to other parts of the body, claims roughly 40,000 women a year. Almost 200,000 women are diagnosed with the disease annually.

The Manatee Memorial-owned Manatee Diagnostic Center has, since July, been offering digital breast tomosynthesis, also known as 3D mammography, which is especially effective in seeing abnormalities in breasts with dense tissue, said Karin J. Ohlig, M.D., a breast imaging radiologist at Manatee Diagnostic Center.

3D mammograms use the same X-ray technology that 2D does and the patient’s breasts are still placed between two plates and compressed, but the difference, Ohlig explained, is that 3D provides pictures of the breast in “slices,” which can reveal abnormalities that have evaded traditional 2D detection.

A few miles west, Blake Medical Center administrators have noticed that one of their general surgeons and breast cancer specialists, Dr. Paige Pennebacker, M.D., has recorded very low rates of “re-incision” for the lumpectomies he performs, which is a procedure where a cancerous tumor is removed and the breast is saved, said Tricia McKay Powers, director of Blake’s surgical business development team.

Pennebacker revealed that some of the credit for his low rate of having to take patients back to surgery to cut away more cancer in lumpectomy cases goes to a new device he is using called a MarginProbe that uses radio-frequency electric fields to spot residual breast cancer cells following a lumpectomy.

After reading the MarginProbe, Pennebacker said he can decide to remove additional tissue from the breast at the time of surgery or close the incision.

Besides the success he has had with the MarginProbe, Pennebacker and four plastic surgeons at Blake are also doing “immediate reconstruction” surgeries now where Pennebacker removes one or both breasts and a plastic surgeon on his team reconstructs the breasts with tissue from the stomach, or using an implant, all during the same surgery.

Manatee Diagnostic’s 3D tackles dense tissue

3D mammography is especially important for patients with dense breast tissue, Ohlig said.

“With the 3D mammography we can look through and see if there is anything hiding within the dense tissue,” Ohlig added. “That’s where the improvement comes in.

“On the flip side, there are patients who have fattier breasts who, when you do the 3D, there may not be a mass in the breast but you might see an area of what we call architectural distortion where the tissue doesn’t have the normal flowing planes and you see a subtle area of change in the breast that you may not pick up on a 2D image, but it is quite obvious on the 3D when you are cutting through on the thin slices.

“So it does help both patients but it is designed more optimally for the patients with dense breasts,” Ohlig said. “That’s the whole reason 3D came out.”

Ohlig can recall several cases she has had over her five years of experience with 3D mammography involving denser breast tissue where she has found small breast masses and areas of distortion on the 3D screening that would have been impossible to see on the standard 2D.

“If you discover a finding on the 3D mammogram, a breast ultrasound may be required for additional work up,” Ohlig said. “If a corresponding abnormality is identified on the breast ultrasound a follow up biopsy will be required for histologic evaluation.”

Speaking in general about mammography, Ohlig said that a baseline mammography between ages 35 and 40 is still recommended as well as an annual mammography every year after age 40.

“People ask me when do I stop getting my mammogram,” Ohlig said. “I say don’t stop, even when you are 80 and 90.”

Manatee Diagnostic Center practice administrator Kobee Masiello said some insurances will cover 3D mammography.

“Medicare does cover 3D mammography as well as some of the Cigna insurance plans and United Health Care,” Masiello said. “Other insurance companies do cover 3D mammography, but I would encourage patients to check with their insurance company to find out if they cover 3D mammography.”

“There is an additional cash price for 3D mammography of $59,” Masiello added.

The price for 2D mammography during October is $50, Masiello said.

Manatee Diagnostic Center, which has been in business since 1988, has four locations between Manatee and DeSoto counties and does approximately 30,000 breast imaging procedures annually in all locations, making it an area leader in volume of mammography, Masiello said.

The center offers 3D mammography at its Riverside office, 300 Riverside Drive E., Suite 4300, Bradenton and Pointe West, 2301 60th St. Ct. W., Suite C, Bradenton.

Information: 941-747-3034.

Pennebacker’s MarginProbe at Blake

A lumpectomy is an excellent choice for some women with breast cancer because, though it is a cancer operation, it’s a much smaller operation allowing a woman to get back to full activity with less pain more quickly and also preserving the aesthetics of her breast tissue, Pennebacker said.

“But there’s a tricky part of a lumpectomy,” Pennebacker said. “To have it successful, we have to go in and take out the breast cancer. But we have to do one other thing. We have to get a margin of normal breast tissue around it. So, the cancer can’t be at the margin. That’s the tricky part. I wish when we went into surgery all the cancer was green and all the normal tissue was yellow and we take out all the green and we would know we were successful but it’s a microscopic type of diagnosis.”

“The difficulty is that in the operating room to get those clean margins we enlist the aid of our pathologist and they look at the tissue,” Pennebacker added. “They do microscopic assessments, but that’s slow, time consuming and sometimes inaccurate.”

The MarginProbe, made by Dune Medical Devices, is a wand connected to a monitoring device that uses radio frequency fields.

“With a MarginProbe, we can actually look at the tissue we are taking from the breast right in the operating room,” Pennebacker said. “It’s a high-tech way of looking at the margins in tissue to tell abnormal tissue from normal tissue. It’s very quick, easy to use and very accurate and we use it on almost every lumpectomy that we do.”

Pennebacker and ‘immediate reconstruction’

Pennebacker, who does about 200 cancer surgeries a year, said he and his team are one of a select few teams in the area doing an “immediate reconstruction” which combines nipple and skin sparing mastectomies and the creation of new breasts out of tissue from other parts of the body or implants in the same surgery.

“We have done it for about five years but over the last one to two years it has really come to the forefront,” Pennebacker said.

“Some women are learning how breast cancer can have a genetic mutation component,” Pennebacker explained. “So, through their physicians, if they do have a strong family history, they are asking for genetic testing. If they are positive, that puts them through a roller coaster of emotions. They know that by the time they are 70 they have an 80 percent chance of developing breast cancer.”

Many women who find they have a genetic predisposition are now deciding to take out all of their breast tissue, which is called a mastectomy, to reduce the chance of breast cancer, Pennebacker said.

“If you do a mastectomy that is emotionally very difficult,” Pennebacker said. “What we are offering them now is doing their surgery where we go in under the mammary fold, so you don’t see the scar, taking out all the breast tissue but leaving everything else intact and then our plastic surgeons are coming in and reconstructing either abdominal wall tissue and bringing it up underneath as a more natural breast tissue or using implants.”

“After it is over,” Pennebacker said. “We hope they look in the mirror and they feel their breasts are still intact and they have the comfort of markedly reducing the chance of ever developing breast cancer.”

Pennebacker is part of West Coast Surgical Group, 5953 17th Ave. W., Bradenton. Information: 941-761-0500.

This story was originally published October 2, 2017 at 5:17 PM with the headline "Manatee Memorial, Blake waging war on breast cancer."