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Breast Imaging: Beyond the Basics

Why breast imaging specialists, 3D mammography are so important.

This fall, the CalvertHealth Sheldon E. Goldberg Center for Breast Care was pleased to welcome Dr. Chandra Baker, a dedicated breast imager from Johns Hopkins, to its multidisciplinary team. Dr. Baker specializes in women’s imaging including mammography, breast ultrasound, breast MRI and image-guided biopsy.

Dr. Baker has been seeing patients in the Calvert Medical Imaging Center (CMIC) since 2018 and works closely with the medical center’s cancer program. She also serves as medical director for CalvertHealth’s breast imaging program.

“Dr. Baker’s expertise and her commitment to women’s health are impressive,” said Kasia Sweeney, who oversees oncology services at CalvertHealth Medical Center. “We’re delighted she chose to join the team at our breast center. She has sophisticated skills informed by more than a decade of radiology experience.”

Since opening in 2010, the CalvertHealth Sheldon E. Goldberg Center for Breast Care has changed the landscape of how breast care is provided in Southern Maryland. The center brings together in one convenient location a multidisciplinary team of breast health experts with an experienced navigator backed by the latest breast-imaging technology like lower-dose 3D mammography – designed to detect even the most subtle signs of early cancer.

Recently, Dr. Baker sat down for a one-on-one interview to talk about CalvertHealth’s breast imaging program, its technological capabilities, screening guidelines and other breast imaging topics.

Q. Why is breast imaging important?

If we could only rely on clinical symptoms to make a diagnosis of breast cancer, we would rarely find lesions in the earliest stages when we have the best chance to cure the disease. The purpose of screening mammography is to try to find breast cancers early, when they are smaller and thus easier to treat successfully. (CMIC is designated as a “Breast Imaging Center of Excellence” by the American College of Radiology.)

Q. Why should women choose to come here?

Calvert performs full-service breast care. That means whether you have benign or malignant breast disease, you can receive all of your care locally. Calvert is large enough to play that role while ensuring patients receive personalized care.

Q. Why are breast imaging specialists important?

Medicine in general has become so complicated it is difficult for physicians to keep up with all aspects, even within a specialty – particularly a specialty as broad as radiology. When physicians subspecialize it is much easier to master one’s chosen domain. It can take quite some time to become confident interpreting mammograms and diagnosing various breast diseases so it is beneficial to be able to dedicate one’s entire practice to this field. (All mammograms at CMIC are read by specialized breast imagers, who exclusively read breast images.)

Q. When should I start having mammograms?

For patients of normal risk we recommend starting routine screening mammography at age 40. For patients with increased risk either due to family history or personal history, screening with mammography can start as early as age 25. Those patients would likely need to be screened with MRI in addition to mammography.

Q. Why is it important to know if I have dense breasts?

For most women this information is not particularly helpful; however, for those with very dense breasts, the utility of mammography may be limited and they may benefit from adding breast ultrasound to their annual screening mammogram.

Q. What are the benefits of a 3D mammogram?

A 3D mammogram compared to traditional full-field digital mammography (2D) is like comparing a chest X-ray to a chest CT. Because it essentially takes image slices through the breast, you see much more detail. (CMIC added 3D mammography in 2013.)

Q. What are the advantages of an image-guided biopsy vs. a surgical biopsy?

Image-guided biopsies are generally pretty easy. They are done with local anesthesia (lidocaine injection) only. You are completely awake and the procedure usually takes no more than 30 minutes. The pathology results are usually available within a few days. If the patient requires surgery, then planning can be done so that only one trip is made to the operating room. If the patient goes to surgery for a biopsy just to get the diagnosis, she may find herself having to return to the operating room for a more definitive surgery if needed after diagnosis.

Q. How is breast MRI beneficial?

Breast MRI is extraordinarily sensitive and it can pick up early tiny cancers; however, this means it often will pick up benign lesions as well. It is generally reserved for determining the extent of disease in someone who has been diagnosed with breast cancer or response to chemotherapy, for screening along with mammography in very high-risk patients and for evaluating breast implants.

(The dedicated women’s suite at CMIC features a state-of-the-art PET/CT scanner, digital mammography and breast MRI as well as 3D mammography, breast ultrasound and stereotactic biopsy.)
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