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26 May, 2024
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Less Painful, More Accurate Mammograms?! What Took So Long?

'If men had to squeeze their genitals between two plates and hold still, someone would invent a less painful procedure.'



Source: Wells $treet by Jane Wells

Welcome to Wells $treet! If you know anything about me, you know I like an offbeat business story. So when I scheduled my annual mammogram this year, I thought, “Isn’t there a better, more comfortable way to do this? Can’t someone disrupt this industry? Doesn’t anyone care?”

If men had to squeeze their genitals between two plates and hold still, someone would invent a less painful procedure.

Radiologist Jason McKellop is looking at two X-ray images of a patient’s breast. One is from a year ago; the other was taken last week. As medical director for Breastlink, a mammography center in Los Angeles, it’s Dr. McKellop’s job to compare the images for changes and determine whether the woman may have breast cancer.

“At first glance, there is no significant difference,” he tells me as we look at the pictures while sitting in his office.

But then he points to something in the recent picture, an image captured by a new mammography machine that photographs in 3D. “There is, indeed, a subtle abnormality within her breast,” he says. “I don’t think this finding is visible on a 2D mammogram.”

He tells me he’s already taken a biopsy of the abnormal breast tissue, and he’s just received the pathology report.

“This was positive for malignancy.”

He hasn’t told the patient yet, and I can’t imagine calling her with such awful news. But Dr. McKellop is feeling upbeat. The cancer was caught early. “If we can diagnose the disease early, it’s the equivalent of curing the disease.”

Lying on a Garage Floor as a Car Backs Up Over Your Breast

If men had to squeeze their genitals between two plates and hold still, someone would invent a less painful procedure.

For decades, though, women over the age of 40 have reluctantly submitted to the dreaded mammogram. Here’s the best way I’ve heard it described: Imagine lying down on your side on the cold concrete floor of a garage, then shoving your upper breast out of the way so a car can back up over your lower breast to flatten it out. Hold! Don’t breathe!

What’s more, the pain of a mammogram often causes a patient to move during the procedure, which means that pictures have to be retaken. More pain; more radiation.

For some women, the screening is so uncomfortable that they skip this potentially life-saving exam. That was especially true during Covid.

“We’re seeing a lot more cancers that could’ve been prevented”

“A lot [of women] didn’t come in,” says Paul Colacchio, VP for RadNet, the largest network of outpatient imaging centers in the country. “Now, after two years of this Covid debacle, we’re seeing a lot more cancers that could’ve been prevented if they came in one or two years prior.”

Over 42,000 women (and 500 men) in the U.S. will die this year from breast cancer, according to the CDC. Women over the age of 50 are 14% less likely to die from the disease if they get an annual mammogram, a number that jumps to 33% once they turn 60, according to an analysis by the Susan G. Komen Breast Cancer Organization, a prevention non-profit.

I have some good news, though. Manufacturers of mammogram machines are now making machines that detect cancer earlier and are also more comfortable.

Ladies, they finally feel your pain.

“I don’t care how good your machine is. If your patient is dancing around, and they’re in pain and can’t tolerate standing still, that image is not going to be worth anything.”

Hologic is the biggest player in breast imaging. Tennis legend Martina Navratilova is one of the company’s spokespeople.

Five years ago Hologic introduced the SmartCurve — a plexiglass “paddle” to compress breasts.

The SmartCurve paddle/Photo by me.

Traditional paddles have been flat. “That’s what digs into the chest wall and that’s usually what’s most painful,” says Raul Martinez, who runs national sales accounts for Hologic. But the SmartCurve paddle is curved to follow the contours of a breast and reduce pinching. It improves imaging by applying pressure evenly around the breast and also stabilizes it, leading to less movement. “I don’t care how good your machine is,” Raul says. “If your patient is dancing around, and they’re in pain and can’t tolerate standing still, that image is not going to be worth anything.”

Stabilization also means fewer images have to be retaken, and that lessens a patient’s exposure to radiation.

It’s not just the paddle that’s gotten better. Many machines now combine 3D imaging with artificial intelligence. Dr. McKellop says the new technology allows him to scan through “slices” of the breast, like a loaf of bread. He compares the improvement in picture quality to the way televisions have progressed from SD to HD to 4K.

With 3D, “We can detect 20% to 65% more invasive cancers than 2D alone,” Raul tells me. But these new machines aren’t cheap. The fully loaded Hologic system costs significantly more than traditional equipment, according to Paul Colacchio at RadNet, who says his company bought over 300 of the machines for its imaging centers. “We need the best equipment and the best technology for our patients.” (FYI, many mammogram machines are still 2D. Ask for 3D. Paul says RadNet doesn’t charge more for 3D, and there’s no difference in radiation exposure.)

“A healthy dose of skepticism”

Raul says it was a challenge to convince imaging centers and hospitals to upgrade. “Oh, it’s just a paddle?” buyers asked him. Raul would then explain all the reasons why “it’s not just a paddle.”

Dr. McKellop admits he needed convincing. The Breastlink center where he works is one of RadNet’s busiest facilities, performing 25,000 screenings a year. He recently wrote about his initial reaction to the new equipment: “My colleagues and I met this transition with a healthy dose of skepticism.”

He soon changed his mind. “The impact has been substantial.”

I find it interesting that I’m talking to three men about this. They smile when I ask, “Why are you in this business?” Dr. McKellop replies that it’s his mission to save women’s lives through better diagnostic tools. “Any advancement in that direction helps me make an earlier diagnosis and ultimately helps patients live longer.”

Raul Martinez of Hologic actually started his career as an MRI technician. Back in those days, he’d literally have to eyeball the right levels of radiation to use. “We were using dials and just had a chart on the wall.” He loves promoting the advances in technology — ”It’s night and day.”

Paul Colacchio says he may be a man, but loved ones have had breast cancer. “I have a newfound respect for women and what they go through.”

So what’s the next step? How could mammograms be even more comfortable? “The answer would be not to have to put your breast between two plates,” Paul says.

No one has figured out how to do that yet. But at least it’s better than it used to be. More important is the improvement in detection, according to Dr. McKellop. “In the case of small cancers, I am able to diagnose maybe a year or two earlier than I would have with lesser technology.”

That can be the difference between life and death.

Now if they could do something about that speculum for Pap smears…

Attention, men! This was probably not the Wells $treet you came for, but if there’s a woman you care about who’s over the age of 40, please encourage her to get a mammogram. Ladies, you already know this… right?

What other medical devices or procedures need to be disrupted? What exam or test do you most dread? (*cough* colonoscopy prep *cough*) I look forward to the day when doctors have those non-invasive medical scanners from “Star Trek.”

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