Breast Cancer Awareness Columns

Patient Centered Women’s Imaging

Kelly Biggs, M.D.

There is no doubt among breast cancer specialists that mammography saves lives.  Decades of research validate annual screening mammography for all women age 40 and older, and for younger women with special risk factors.

Despite its benefits, mammography can be anxiety provoking.  A screening mammogram may demonstrate an abnormality that requires additional testing, and often a woman doesn’t learn about the abnormality until she receives her written results by mail.   Scheduling follow-up can take days or even weeks at some institutions, and such a wait can be agonizing.

At Tyrone Hospital we understand the impact abnormal findings can have, and we work hard to minimize the distress.  The majority of screening mammograms performed at Tyrone are interpreted immediately after images are acquired, and the patient is promptly informed of her results.  If additional imaging is necessary, most women can complete the workup right after the screening mammogram.  Should biopsy be necessary, same day or next day scheduling is usually available.

Education is another important means of reducing anxiety.  At Tyrone Hospital your radiologist is available to answer your questions.  If you are getting a mammogram for the first time, you’ll speak directly with the radiologist not only about your results, but also about the whole process of breast cancer detection.

In the event that your imaging results require referral to a treatment specialist, the Tyrone Hospital Radiology Department works closely with the Breast Cancer and Women’s Health Institute of Central Pennsylvania to ensure timely management of your care.

Please contact us if you have questions about women’s imaging.

Ultrasound and Breast Disorders

Kelly Biggs, M.D.

Ultrasound is a valuable tool for diagnosing breast disorders. It is an inexpensive, easy to use, and fast means to assess breast pain and lumps. Ultrasound works by transmitting sound waves into breast tissue, and thus uses no ionizing radiation.

Breast ultrasound often compliments mammography. Ultrasound, unlike mammography, can differentiate a solid mass from a benign water-filled cyst. This is extremely important because cysts can usually be ignored while many solid masses must be biopsied. Ultrasound is also great for determining how much blood flow is inside a breast mass, which can be associated with malignancy.

When biopsy is necessary, ultrasound is the preferred tool for image guidance. This is because ultrasound provides a real time dynamic picture rather than still shot image, like a mammogram.

Ultrasound has limitations. Unlike a mammogram, which acquires a picture of the whole breast in 2 views, conventional ultrasound only images a small window of tissue at any one time. Imagine looking for a bird in your yard in daytime versus searching for a bird at night with a flashlight. For this reason, ultrasound is not widely used as a screening tool for asymptomatic women. It is best employed for targeted evaluation based on symptoms or other imaging findings. Some imaging centers will use ultrasound as a supplemental screening tool for women with dense breasts, because mammograms are less sensitive for detecting breast cancers in dense tissue. So far, there is no strong medical evidence to support this practice.

Breast Cancer Staging

David Arbutina M.D., FACS

Not all breast cancers are the same. There is a very wide range of disease that we call breast cancer. There are different types of cancer cells, different grades for each type of cell and it can be found in different stages of spread. The most common type of cancer cell is ductal carcinoma which accounts for 85% of all breast cancers. These cells arise from the breast milk ducts. Ductal carcinoma in its early stage is confined to the milk duct and is what we call in situ (DCIS) or non-invasive cancer. DCIS does not spread to other organs. Most commonly, however, ductal carcinoma is found as infiltrating or invasive cancer which can spread to other body organs.

The cancer grade tells how much change has occurred in the cancer cells when compared to normal breast tissue. The grades are from 1 to 3, and the higher the grade, the more bizarre the cells, the more aggressive the cells get and the higher the chance of spread to other organs.

Finally, the stage of a tumor is based on the size, lymph node status, and distant spread of the breast cancer. The stages go from 0 to 4. The point of staging is that the higher the stage, the worse the prognosis because the tumor has spread further in the body. As you can see, not all breast cancers are alike and as a result they are treated differently.

Fortunately, because of patient awareness and mammograms most cancers are found in an early stage and the overall prognosis is good.

When Breast Cancer Returns!

David Arbutina, M.D., FACS

Unfortunately, women who have had breast cancer are at a higher risk of getting it again. There are two ways in which this can occur. They can cancer or they can have a recurrence of the previous cancer. Once a woman has had breast cancer, her risk for a new cancer goes up to 18% for ductal carcinoma and as high as 28% for lobular carcinoma.

The more ominous problem is a recurrence of the original cancer. Unfortunately, the stage of the cancer when it recurs is often higher and the cells have spread farther. Chemotherapy and hormone therapy during the original treatment should help prevent this recurrence but, if these therapies do not work, it means that the cancer cells have the ability to live through the treatment and are more aggressive.

Why do patients get recurrences?

  1. New cancer cells may develop.
  2. Cancer cells are left behind in the breast after treatment.
  3. Cancer cells may have already spread to the bone, lung or liver. Once treated for breast cancer women need to undergo very close surveillance to detect new cancers or recurrent cancer at an earlier stage when the cancer is more likely to respond to treatment.

Your Nurse Navigator


At the Breast Cancer & Women’s Health Institute, we recognize every woman is unique. We provide individualized attention to our breast cancer patients through our nursing staff that function as Nurse Navigators. We are very dedicated to our patients and believe in an empathetic and carting approach. Special effort is made to get to know each patient in order to find out their specific needs. Our goal is to bring knowledge and comfort to each patient and serve as a facilitator and guide, providing support through each phase of their diagnosis and treatment.

For our patients, we schedule surgeries and diagnostic tests, provide pre-op and post-op care, and coordinate visits to other physicians such as oncologists, radiation oncologists and plastic surgeons. We provide breast cancer educational information and are diligent about keeping accurate medical records. We also direct the patient to financial resources that are available.

Nancy, Joyce, and Naomi consider it a privilege to work with Dr. Arbutina and assist in the care of his patients. We see patients at their first office visit after being diagnosed with breast cancer, when they are very apprehensive and afraid. After meeting with our team, they are less anxious and feel confident in the plan of treatment that has been designed specifically for them. We then follow our patients through their therapy and follow up cancer appointments to assure all their needs are met.

It is unfortunate that so many women have breast cancer, but it is encouraging to know that professional care is close to home. We are here for you!

Breast Cancer Voucher Program


Costs associated with breast cancer care and recoveries are numerous and significant; including, medical co-pays, transportation costs, expenses for medical supplies, and other items such as wigs and prosthetic bras. Women who are underinsured or who do not have health insurance often find themselves with mounting expenses intensifying an already stressful experience. Additionally, the process of cancer treatment and recovery is typically lengthy keeping working women away from their jobs which can reduce a family’s income.

To ease this stress, the Breast Cancer & Women’s Health Institute has developed the Breast Cancer Voucher Program to assist their patients affected by breast cancer. Without this assistance, many women fall behind on bills, and face the difficult challenges of affording proper treatment. These women need the support of the Breast Cancer Voucher Program to help them fight for their health, and take control of what is happening. It is our goal at BCWHI to help our patients with these additional stressors through this program and other available resources.

The Breast Cancer Voucher Program is funded completely through charitable contributions from people in our communities, people who have family members with breast cancer, or anyone able to give. Every dollar raised for this program goes directly to patients of Dr. David Arbutina at the BCWHI. If you would like to make a significant difference in a breast cancer victim’s life with a donation, please send your check payable to the Tyrone Hospital Foundation, at 187 Hospital Drive, Tyrone, PA 16686.

Are You Due for Your Screening Mammogram?

Kelley Biggs M.D.

At the Breast Cancer and Women’s Health Institute of Central Pennsylvania, we are passionate about fighting breast cancer. It is a fundamental mission of radiologists nationwide to detect breast cancers as early as possible. The screening mammogram is a simple, fast, and inexpensive tool that saves lives. Older studies show that annual screening mammograms are associated with a 30% reduction in breast cancer death. Newer and ongoing studies are proving the benefit to be about 40%.

Chances are you know someone with breast cancer. Around 300,000 women in the U.S. are diagnosed with breast cancer each year, and about 40,000 will die. The American Cancer Society (ACS), among several organizations, recommends that annual screening mammography start at age 40. While a smaller number of organizations have suggested mammograms begin later and less than annually, these recommendations are not supported by the best evidence available. Thankfully insurance carriers, including Medicare, continue to cover annual screening mammograms.

While a key component in the fight against breast cancer, mammograms are only part of a woman’s defenses. Mammograms can miss cancers, especially in women with dense breast tissue. Talk to your doctor about healthy habits that can reduce your risk. Know your family history of breast cancer, and be aware that for women with additional risk factors there are supplemental screening tools and other interventions available. To date, however, no single tool matches the effectiveness of the basic screening  mammogram, so know when you are due for your next exam and get it done!

Talk to Your Daughter About Breast Health and Awareness

David Arbutina M.D., FACS

Five percent of breast cancers occur in women under age 40. It’s rare, but talking to your daughter early about breast health is essential.

Topics can include:

  • Healthy Eating: University of California at Davis research finds that a diet linked to obesity can cause harmful metabolic changes and stimulate early breast growth with abnormal tissue that may produce cancer.
  • Self-Exams: Monthly self-exams can begin in puberty. By age 20, women have clinical breast exams about every three years, then annually after age 40. Finding a lump does not mean cancer; many normal changes take place as women age, and throughout the menstrual cycle.
  • Screening: Teenagers learn by example, so demonstrate the importance of screenings. Inform her primary care physician about breast cancer in your family so he or she may discuss risk factors and prevention. Early education may help reduce breast cancer fears.

Call the doctor if your daughter experiences any of the following:
• a hard knot or lump near her underarm
• changes in breast color, size, shape, or texture
• dimples, puckers, bulges, or ridges on the skin of the breast
• an inverted nipple
• redness, warmth, swelling, or pain
• itching, scales, sores, or rashes
• a clear or bloody nipple discharge

Lifestyle choices include maintaining a healthy weight, regular exercise, avoiding alcohol, and not smoking. Practicing these may help reduce your daughter’s breast cancer risk and other serious illnesses!

Obesity and Bone Health


The Obesity Epidemic is increasing at an alarming rate and is a severe public health crisis. “Obesity is generally defined as being more than 30 percent above one’s ideal body weight” (Makk, 2007). Obesity is often a result of poor diet and limited physical activity, which increases the risk of serious health conditions including: coronary heart disease, type 2 diabetes, cancer, hypertension, poor bone health, and stroke.

Obesity is linked to bone ailments including osteoporosis, joint and spinal problems, and low bone mass. Obesity also impacts the musculoskeletal system accelerating wear and tear on the joints. At the Breast Cancer and Women’s Health Institute, we want to help you achieve your optimal state of health. If you are struggling with your weight, you are not alone! We have the available resources to help you lose weight. Here are some helpful hints to guide you towards a healthier life:

  • Get a baseline physical from your doctor.
  • Set realistic goals.
  • Ask your doctor for a physical/occupational (PT/OT) evaluation to determine what your level of exercise should be.
  • If able, begin to walk each day and increase your distance little by little.
  • If you do not have any dietary restrictions, add more fresh fruits and vegetables to your diet.
  • Avoid foods that are high in fats and cholesterol.
  • Begin simple low impact exercises in the privacy of your own home.
  • Surround yourself by positive people who will encourage and support your efforts.

Breast Density: Mammogram Reporting

Kelley Biggs, M.D.

In 2013, Pennsylvania became the 13th state to pass a law requiring mammography providers to inform patients about breast density, to improve public awareness of its p potential to hide a breast cancer on mammogram.

Radiologists define breast tissue as: 1) mostly fatty; 2) scattered fibroglandular; 3) heterogeneously dense; and 4) extremely dense. Mammograms of dense breasts appear white because glandular and fibrous tissues reflect x-rays. Fatty breasts appear dark because x-rays easily pass through fat. Since cancers also reflect x-rays and appear white, a cancer can be hidden or harder to see in dense breasts. Women in categories 3 and 4 are considered to have dense breasts. If you have dense breasts, here are some things you can do for additional protection:

  • Have a breast exam done by a trained clinician every year.
  • Ask your clinician how to perform a self-assessment, and do a self-assessment once a month.
  •  Get a digital mammogram, now widely available and proven to be more sensitive for  women with dense breasts.
  • Consider getting a 3-D mammogram (tomosynthesis). This is new technology just now becoming more available. Early studies show a benefit for women with dense breasts.

Don’t be alarmed if you learn you have dense breasts, and by all means keep getting an annual mammogram! Even though it has limits, mammography is still the best screening tool for early detection of breast cancer.