SALEM - When it comes to battling breast cancer, Dr. Peter Apicella said "public knowledge is key."
Apicella serves as the chairman of the Department of Medical Imaging at Salem Community Hospital, which offers both digital mammography and 3T Open Magnetic Resonance Imaging as tools for early detection.
The entire hospital staff has been asked to wear pink Friday as part of Breast Cancer Awareness Month.
Some members of the Salem Community Hospital Department of Medical Imaging display their pink outfits during Breast Cancer Awareness Month, along with department chairman Dr. Peter Apicella, whose tie boasts tiny pink ribbons. On Friday, the entire hospital staff has been asked to wear pink. During October, all patients for breast-related procedures will receive a pink carnation as part of the hospital’s awareness efforts. (Salem News photo by Mary Ann Greier)
As a means to understand how cancer grows, Apicella said it all begins with one abnormal cell which then becomes an overgrowth of cells, grabbing the surrounding tissue and feeding off of the body's nutrients and blood supply.
That one cell divides into two cells, then four cells and just keeps dividing until there are millions of cancer cells. After 10 divisions, one cell has become 1,000 cells. After 10 more divisions, there are 1 million cells, which he said can be seen on a mammogram. Another 10 divisions and there are 1 billion cells, which can be felt in the form of a lump in a breast.
In one to two years, something that you couldn't feel, you can now feel.
The Greek physician Hippocrates gave cancer its name because of its crab-like appearance as cells grab tissue, Apicella explained. In Latin, the term cancer means crab.
"Once you feel something, the cancer has grown," he said.
According to Apicella, the benefit of having a mammogram every year is that cancer can be caught at the smallest size possible, which offers the best chance for survival. In the case of digital mammography, something as small as the head of a pin can be seen and in many cases can offer a 100 percent five-year survival rate. Mammography can be used to identify cancer two years before it can be felt. Cancer the size of a pea won't be felt for about a year.
A localized cancer that hasn't had a chance to spread can have a five-year survival rate of 98 percent. With regional spread, the five-year survival rate drops to 80 percent. With distant spread, the percentage drops to 26 percent.
He admitted that not all breast cancers can be detected through mammogram, stressing the importance of a regimen of monthly self-exams, an annual exam by a physician and a yearly mammogram starting at age 40 for the rest of a woman's life. Breast cancer increases with age, with 1 in 8 women at risk of developing breast cancer in their lifetime.
Apicella told a story about an elderly patient who had been advised by her doctor that she didn't have to continue getting mammograms after a certain age. She ended up finding a lump diagnosed as breast cancer in her 80s. A mammogram would have caught the cancer before it could be felt, making it easier to treat.
For women at high risk for breast cancer, the MRI has become the screening tool of choice, with a recommendation of a yearly screening MRI beginning at age 25 and an annual MRI and mammogram beginning at age 30.
Women at high risk would include those with a family history of premenopausal breast cancer, breast cancer and ovarian cancer or two separate breast cancers in a mother, grandmother, sister or daughter, giving them a 20 percent higher risk of developing the disease. They should also be tested for genetic risk. With the BRCA1 gene, they have a 65 percent chance of developing breast cancer by age 70. With the BRCA2 gene, the risk is 45 percent by age 70. They can also be high risk if they've had chest radiation for Hodgkin disease.
Besides using the MRI for high risk screening, it can also be used for problem solving when a mammogram and ultrasound are inconclusive, for a biopsy to verify the needle position for accuracy and prior to breast cancer surgery to check the margins and avoid the need for a second surgery. In some cases, additional cancer may be found, including in the opposite breast.
Apicella said people with silicon breast implants are recommended to begin MRI screening at least three years after implant insertion and then every two years after that, according to the Food and Drug Administration. He said it was his understanding that the implant company has to foot the bill. An MRI can also check for leakage.
The hospital installed its new 3T Open MRI in May and he said "it's making a difference."
When asked why someone with high risk should also get a mammogram, he said some cancers don't show up on MRI as soon as they show up on a mammogram, such as ductile carcinoma in situ, which spreads along the ducts before spreading into the breasts. The survival rate is 100 percent if it's caught in the ducts.
Breast cancer deaths in 2013 are expected to exceed 40,000, with women in the majority, although the disease will affect some men (an estimated 400 out of the more than 40,000).
Apicella attributed the decrease in cancer deaths over the past decade to increased awareness, earlier detection and improved treatment.