Better Breast Cancer Odds Through Better DetectionAug 26, 2020 07:00AM ● By MED Magazine
By Alex Strauss
Breast cancer is the most common cancer in American women and the second leading cause of cancer death after lung cancer. For every eight women who live a full life expectancy, one will deal with breast cancer. Last year, the specialists at Edith Sanford Breast Center in Sioux Falls diagnosed 507 cases.
"The unique thing about breast cancer is, when you look at the population of women affected, these are usually mothers and wives," says Frederick Severs, MD, a fellowship-trained breast radiologist and Medical Director of Breast Radiology at Edith Sanford Breast Center who goes by "Joe". "These women are the glue of their families, the glue of American society. This cancer strikes a really critical segment of our population and represents a heavy burden on society."
Early & Accurate Diagnosis is Key
As with other types of cancer, early and accurate detection is the key to breast cancer survival and the screening mammogram remains the diagnostic gold standard. Nationwide, the breast cancer detection rate stands at about 4.7 per 1,000 mammograms. Among mammograms read by breast cancer specialists at Sanford, that figure is 45 percent higher, and climbing. Dr. Severs says the difference is fellowship training.
"As breast radiologists, all we do is breast cancer, so our skills are very honed," he says. Breast radiologists do an additional year of immersion in breast cancer after their general radiology training, resulting in 15 to 17 months of total breast cancer radiology training. A graduate of Texas Tech University School of Medicine, Dr. Severs did his training, including his internship, residency, and fellowship, at the University of Texas Southwestern in Dallas.
When he joined the Sanford team in July 2018, Severs was Sanford's second fellowship-trained breast radiologist, joining Melinda Talley, MD, who had been there since 2010. Sanford has since added three more breast radiologists including Chris Johansen, MD, in 2018, and Lilian Ebuoma, MD, and Jamie Williams, MD, in 2019.
As the size of the breast radiology team has grown, so have breast cancer detection rates. Sanford's specialists are finding 30 to 35 percent more breast cancers than the general radiologists do and 25 percent more of the hardest-to-detect tumors under 1 cm.
"Most of the cancers that we are finding are in that really small subset," says Severs. "These are very unlikely to have spread to the rest of the body and they approach about 100 percent cure rate. So these are really the cancers that you want to be finding for better outcomes."
The Art and the Science of Cancer Detection
In large university medical centers, most if not all screening mammograms may be read by fellowship-trained breast radiologists. But Severs says it is unusual for a city the size of Sioux Falls to offer this level of expertise. And that expertise is about more than technical skill. Dr. Severs says breast cancer detection is as much an art as it is a science. When you have seen enough of them, you begin to see things that others don't.
"Some things in medicine can be strictly science, but with breast imaging, we are skilled on the side of it being an art," says Severs. "What I said to young physicians trying to find cancer on mammograms is that it is like trying to find shapes in the clouds. Every breast is different and every cancer is different. Every cancer can easily hide within a breast."
Severs says even the most advanced computer algorithm cannot make reliable sense of the tiny shadows that could mean life-or-death for a patient. "I would be happy not to have a job if we could just do that and eliminate cancer in the world," says Severs.
As breast cancer detection rates rise at Sanford, mortality rates are declining. Advanced technology and training have led to a 30 percent reduction in breast cancer deaths nationwide since the 1990s. At the same time, the number of screenings is rising. Thanks to two mobile mammography units, 31,000 women were screened through Edith Sanford Breast Center in 2019. Including mammograms, ultrasounds, MRIs, and procedures, there were more than 43,000 total studies.
"We are a full service breast center with all the services that any large breast center would have," says Dr. Severs, who came to Sanford from Baylor University Medical Center in Houston. "I trained more than 100 radiologists and about 10 breast radiologists and I can tell you that the program we have at Edith Sanford is the match of anything we had in Houston."