Long Island's notoriously high rate of breast cancer makes routine screening for the disease all the more critical.
Fortunately for area women, the tools for identifying breast malignancies are becoming ever more refined. Radiology departments and breast imaging centers are increasingly switching from mammography units that produce images of the breast on X-ray film to newer units that capture digital images that can be magnified and manipulated on a computer.
"Pretty much any good center that does breast imaging now does digital mammography," said Dr. Jay Hammel, managing partner with Sitron-Hammel Radiology Group in Bethpage.
At the same time, researchers are seeking new and better ways to detect more and smaller cancers earlier and to improve the accuracy of breast cancer screening results.
The mammogram is still the most widely performed test to screen for breast cancer. Studies show that mammography can help to reduce the number of deaths from the disease among women ages 40 to 74, according to the U.S. National Cancer Institute.
Digital and conventional mammography are equally effective in detecting breast cancer, the agency has stated, but the digital format may make subtle differences between normal and abnormal breast tissue easier to detect and can reduce the need for repeat images and any follow-up. A large study that compared the two X-ray techniques found that digital mammography may also be more accurate in women with dense breasts who are postmenopausal, perimenopausal or younger than 50.
Still, neither conventional nor digital mammography is foolproof.
"There's at least a 10 percent false negative rate, so the mammogram, whether it's digital or film-screen, is not the panacea," noted Dr. Scott Sherman, chief radiologist and director of the radiology department at St. Joseph Hospital in Bethpage and a radiologist at St. Francis Hospital in Roslyn, both part of Catholic Health Services of Long Island.
Some radiologists are using computer-assisted detection software designed to detect potential abnormalities in mammograms.
In a study published in late 2008 in the New England Journal of Medicine, researchers reported that a single physician or film-reading technologist using computer-assisted detection software was just as accurate in detecting cancers as two readers.
The software provides "a second look for potential breast cancer," said Hammel, who also serves as medical director of radiology at Plainview Hospital.
OTHER IMAGING TESTS
In certain circumstances, other diagnostic imaging technologies may be used to explore breast tissue.
Ultrasound, for one, uses high-frequency sound waves. "I can't tell you how many negative mammograms had positive findings on breast ultrasound," Sherman said.
Also, certain women may be candidates for a magnetic resonance imaging, or MRI, scan of the breast. An MRI doesn't replace mammography or ultrasound imaging, but it may be helpful in detecting breast cancer and in determining how extensive it is in the body, known as staging, report the American College of Radiology and the Radiological Society of North America.
MRI is used to detect malignancies in women who are at high risk for breast cancer, such as those with the BRCA1 or BRCA2 gene, Hammel explained.
Other methods of breast imaging also exist, but they are generally considered experimental, are not covered by most insurance plans and are not yet used for routine screening. These include:
"By far and away, the best study still is screening digital mammography with the use of, when needed, breast ultrasound," Hammel said.
THE LONG ISLAND SCENE
Like many national health experts, both Hammel and Sherman strongly agree that women should undergo annual mammography screening beginning at age 40. A federal panel's recommendations last year that screening for most women should be delayed until age 50 and that the frequency of those tests should be reduced to every other year have been largely ignored.
"I think that the statistics locally are certainly so worrisome that for women in our area not to undergo annual screening mammography starting at age 40, in my view, puts them at a great risk of not being detected," Sherman cautioned.
Recent data from the New York State cancer registry shows a breast cancer rate in Nassau County of 138.2 per 100,000 women and in Suffolk County of 136.5 per 100,000 women. Those rates exceed the state average of 124.3 per 100,000 women.
Anyone with questions about screening or breast cancer may find help through the website of the Adelphi NY Statewide Breast Cancer Hotline & Support Program, based in Garden City (adelphi.edu /nysbreastcancer), or by calling its hotline (800-877-8077) to speak with a trained volunteer.
This is the last installment of a 26-week series in which Newsday presents Castle Connolly's list of top L.I. doctors. Today: radiologists
Dr. Jay Bosworth
Dr. Ezriel Diamond
688 Old Country Rd., Plainview, 516-932-6007
Dr. Richard Gewanter
MSKCC Long Island, 1000 N. Village Ave., Rockville Centre, 516-256-3600
Dr. Jonathan Haas
Winthrop Univ. Hosp., Radiation Oncology, 259 First St., Mineola, 516-663-2501
Dr. Alan Katz
North Shore, Radiation Therapy, 270 Pulaski Rd., Greenlawn, 631-427-2273
Dr. Lorraine Marin
HealthCare Partners, 1225 Franklin Ave., Garden City, 516-515-8820
Dr. Allen Meek
Stony Brook Univ. Med. Ctr., Dept. Radiation Oncology, 100 Nicolls Rd., Stony Brook, 631-444-2327
Dr. Edward Mullen
South Nassau Community Hospital, 1 Healthy Way, Oceanside, 516-632-3330
Dr. Tae Park
Stony Brook Univ. Med. Ctr., Stony Brook, 631-444-2210
Dr. Jed Pollack
Long Island Radiation Therapy, 6 Ohio Dr., Lake Success, 516-394-8100
Dr. Louis Potters
LIJ Medical Center, Dept. Radiation, Oncology, 270-05 76th Ave., New Hyde Park, 718-470-7190
Dr. William Brancaccio
240 Meeting House Lane, Southampton, 631-726-8411
Dr. Kenneth Goodman
100 Port Washington Blvd., Roslyn, 516-562-6500
Dr. Jay Hammel
4277 Hempstead Tpke., Bethpage, 516-796-4340
Dr. Janet Hoffman
270-05 76th Ave., New Hyde Park, 718-470-4177
Dr. Arfa Khan
270-05 76th Ave., New Hyde Park, 718-470-3456
Dr. David Kirshy
Southampton Hospital, Dept. Radiology, 240 Meeting House Lane, Southampton, 631-727-2755
Dr. Michael Laucella
375 E. Main St., Bay Shore, 631-665-2261
Dr. Seth Mankes
Stony Brook Univ. Med. Center, Radiology Department, Stony Brook
Dr. Mark Novick
Diagnostic Radiology & Women's Imaging, Dept. Radiology, 200 Belleterre Rd., Port Jefferson, 212-744-8000
Dr. Matthew Rifkin
Dr. Dennis Rossi
545 Elmont Rd., Elmont, 516-354-4200
Dr. Scott Sherman
40 The Birches, Roslyn, 516-562-6511
Dr. Steven Weck
Glen Cove Hospital, Dept. Radiology, 101 St. Andrew's Lane, Glen Cove
Dr. Christopher Palestro
Nuclear Medicine, 270-05 76th Ave., New Hyde Park, 718-470-7080
Dr. Elizabeth Yung
259 First St., Mineola, 516-663-2778
VASCULAR & INTERVENTIONAL RADIOLOGY
Dr. Kenneth Crystal
100 Port Washington Blvd., Roslyn, 516-562-6509
h4>How they were picked
Castle Connolly Medical Ltd. is a health care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.
Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Newsday is not part of the selection process.
Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.
h4>To see the whole list . . .
Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The soft-cover list price is $34.95.
For more information, go to castleconnolly.com, or call 800-399-DOCS.