Making a Difference in the Peace Corps
Mammography Pioneer Sees Eye to Eye with Patients
Innovative Lectures Engage Students’ Interest
Challenging Conventional Wisdom
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Mammography Pioneer Sees Eye to Eye with Patients
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Ellen Shaw de Paredes '74 |
How many women would recall the name of the radiologist who read their last screening mammogram, much less recognize her or his face? After all, radiologists tend to review mammograms in batches and communicate the results via letter. But Ellen Shaw de Paredes '74 is not the average radiologist. At the Ellen Shaw de Paredes Institute for Women's Imaging, her private practice in Richmond, Va., de Paredes prefers to review each screening mammogram and meet with her patients to discuss the results before they leave.
Moreover, as a breast-imaging specialist, de Paredes is one of a rare breed of radiologists. Only 10 percent of radiologists in the United States, between 2,700 and 2,800, are breast imaging specialists — five percent, if one counts only those who spend 70 percent or more of their time performing breast imaging, according to a 2006 study published in the American Journal of Radiology. And of the 38 million mammograms performed in the United States in 2002, only about 30 percent were interpreted by breast imaging specialists.
A clinician, educator and researcher with numerous publications in the medical literature, including a textbook, Atlas of Film-Screen Mammography, de Paredes is a nationally recognized expert in breast imaging and breast cancer diagnosis — one of only 85 fellows of the Society of Breast Imaging (SBI).
De Paredes combines clinical expertise with "great loyalty" to her patients, says Stephen Feig, a professor of radiology at the University of California-Irvine School of Medicine, director of breast imaging at UCLA Medical Center, and an SBI founder. As a result, many patients followed her when she left a prior academic and clinical position in 2005 to establish her private practice, and many support the Ellen Shaw de Paredes Research Foundation, which promotes breast cancer early detection, education and research. (Feig is on the board of directors.)
Technology Advances
De Paredes earned her M.D. in 1978 from the West Virginia University School of Medicine and completed her residency in diagnostic radiology at the Medical College of Virginia in 1982. She then joined the faculty of the University of Virginia School of Medicine, which had developed one of the country's first breast imaging programs. "Mammography was in its infancy," she recalls. "I was really self-taught because there was little training in our radiology residency."
Conventional X-ray equipment was used to produce mammograms until dedicated mammography equipment became available in the late 1960s. Film-screen mammography and xeromammography, introduced in the early 1970s, used lower radiation doses and produced sharper images. The second generation of this equipment was introduced in the early 1980s. "It was still antiquated by today's standards," de Paredes says, "but even so, we found a lot of tiny breast cancers, which is amazing."
Film-screen mammography is still the most widely used technology, but today's state of the art is digital mammography, which electronically captures and stores the X-ray image on a computer, enabling the image to be enlarged and manipulated. The American College of Radiology's (ACR) Imaging Network found that digital mammography detected up to 28 percent more cancers than film-screen mammography in women age 50 and younger, premenopausal and perimenopausal women, and women with dense breasts, as reported in October 2005 in the New England Journal of Medicine.
As of January 2007, 16.4 percent of breast imaging facilities in the United States had digital mammography equipment, according to the ACR. De Paredes' practice is one of the few. "As I have made the transition from film to digital mammography, I find many more pre-cancers," she observes.
The interpretation of mammograms remains challenging, says de Paredes, who trains residents and fellows as a clinical professor of medicine at Virginia Commonwealth University and a clinical professor of radiology at the University of Virginia . "The findings are often microscopic," she explains, "and there are hundreds of normal patterns in breast tissue, so deciphering what is abnormal within a particular pattern can be very challenging."
De Paredes also performs ultrasound-guided and stereotactic-assisted breast biopsies, in which a computer maps the location of a breast lump using mammograms taken from two angles and guides the needle. "The field has progressed from surgical lumpectomies for any suspicious finding to the use of stereotactic or ultrasound-guided needle biopsies performed by a radiologist in an office," de Paredes says. "This has made the process much less invasive and, I think, much less threatening to the patient."
The role of magnetic resonance imaging (MRI) is also expanding, says de Paredes. "Breast MRI has developed within the last five years or so to evaluate the extent of newly detected breast cancer," she says.
Indeed, ACRIN researchers found that 3.1 percent of patients with newly diagnosed breast cancer in one breast also had cancers in the other breast that were missed by standard practice mammography and clinical breast exam, while a negative result reduced the likelihood of cancer being found in that breast over the next year to 0.3 percent, as reported in the March 29 issue of the New England Journal of Medicine .
"I think we will see more development in the field of MRI," de Paredes observes, "including improvement in image quality that might expand the role of MRI as a cancer screening tool for high-risk women."
De Paredes anticipates the increasing use of a variety of imaging technologies in breast screening and diagnosis, including tomosynthesis. "This is an application to digital mammography that takes multiple thin digital image 'slices' through the breast, which lets us potentially see a small mass within dense tissue more easily," she says.
Fear Factor
This year, 178,480 new cases of breast cancer will be diagnosed in women, and 40,460 women will die of the disease, according to the National Cancer Institute. Studies have shown that mammogram screening reduces the number of breast cancer deaths for women ages 40 to 69. Yet, as of 2003, only 69.7 percent of American women age 40 and older had had a mammogram within the past two years, and only 54.9 percent within the past year, according to the American Cancer Society, with education level, race/ethnicity and health insurance among the factors.
There is also the fear factor. "It troubles me greatly when I see educated, affluent women with immediate access to mammography who come in with advanced breast cancers and have never had a mammogram," de Paredes says. "I think fear is driving that: fear of having breast cancer and all that it can mean to a woman's life."
Dorothy Wright contributes news and feature articles on science, technology, engineering and general-interest topics to a variety of publications, including Civil Engineering and Engineering News Record .