In the Spotlight

Robert L. Fincher, M.D.

The Breast Center at the University of Arkansas for Medical Sciences has access to the most advanced technology in breast imaging right here in Arkansas. The recent addition of the only FDA cleared dedicated breast MRI system, the Aurora[R] 1.5T Dedicated Breast Magnetic Resonance Imaging (MRI), was specifically designed for 3-D bilateral breast imaging. Dr. Robert L. Fincher (Bob) had a heavy hand in bringing the Aurora S System to UAMS. The system goes beyond patient convenience, as the MRI is very helpful in determining if breast tissues are significant or not. "Several cancer cases have been discovered on the Aurora System that were not visible on any other imaging modality,? Dr. Fincher remarked. The breast MRI is a compliment, not a substitute for a mammogram. MRIs are also being used for high-risk patients, many of who are now getting annual screening MRIs with their annual mammogram. Both procedures are tailored in such ways that women who are at high risk for breast cancer are checked every six months. Dr. Fincher graduated from UAMS and has been a Radiologist since 1972. He's married to Bonnie Fincher, whom Dr. Fincher credits for "keeping him grounded and humble.? He and Bonnie have 5 wonderful children and 7 grandchildren, all scattered across the country from Nashville, TN, through Little Rock, and west to San Francisco. What are the limitations of a mammogram? While mammograms remain the gold standard for diagnosing breast cancer, they are not a perfect science. Since breast cancers arise from breast tissue, they have the same density; therefore, a cancer surrounded by glandular tissue may not be visible. This is particularly true in women with dense breasts. In patients with fatty breast tissues, virtually all breast cancers are visible. We are now complementing mammography with other imaging options, such as breast MRI and ultrasound. There are other new breast diagnostic modalities that will be available in the near future. I've never had a digital mammogram. But it seems so many doctors are switching to this type of detection system. Why the change? Digital mammography is the latest advancement in mammograms. I have been involved in digital for over 6 years, and I am a believer that it has increased our ability to diagnose breast cancers particularly in young women and perimenopausal women with dense breast tissue. Currently, 40% of the breast cancer centers around the country have digital capability. One of the main benefits of digital is the ability to alter the breast image after the mammogram is obtained and the patient has left the breast center. You can change the contrast, magnify the images, make them darker or lighter. This enhances your ability to diagnose the small cancers, particularly in dense breasts. What exactly does a mammogram show? Breast Tissue? Cancer? DIVISION OF DIAGNOSTIC RADIOLOGY Medical Director, UAMS Breast Imaging Medical Director, UAMS-ACRC Breast Center A mammogram reveals all of the different types of breast tissue, which consists of glandular tissue, fatty tissue, fibrous tissue and blood vessels. The more glandular tissue a patient has, the more dense the mammogram is. The more dense the breast tissue is, the more difficult the mammogram interpretation is. Breast cancer arises from breast tissue and often has the same appearance as the surrounding dense breast tissue, leaving breast cancer obscured. Does a mammogram hurt as bad as everyone says it does? Most patients comment that a mammogram is a little uncomfortable, but not really painful. Only a few patients believe a mammogram is really painful. What are the common uses for the results of a mammogram? The vast majority of mammograms are normal. About 8-10% of screening mammograms (patients having a routine mammogram with no breast symptoms) are called back for additional imaging or ultrasound. The vast majority of these are determined to be okay. In routine screening mammograms, 4-5 women per 1,000 screened are diagnosed with breast cancer. My family has a history of breast cancer. I'm in my 20s. Is it too soon to begin regular mammogram? In patients with a family history of breast cancer, the initial mammogram should be at age 35 or 10 years earlier than the age the first degree relative (mother, daughter, sister) was di- agnosed with breast cancer. How often should the average person receive a mammogram? The national recommendation for mammograms is annually beginning at age 40. However, in my practice, I see so many breast cancers in patients in their late 20s and 30s that I recommend annual mammograms beginning at age 35. Additionally, breast cancer in younger women is usually more aggressive, and the earlier it is diagnosed, the better the prognosis. Is there anything I should do beforehand to make it go smoothly? The best time to have a mammogram for premenopausal women is 7-14 days after your menstrual cycle begins. During this time, the hormones are lower and the breast is less dense and less tender. Who interprets the results of my mammogram and how long does it take to receive results? In my practice, all of the diagnostic mammogram patients receive the results before they leave our clinic. I personally talk to all of my patients. The patients who come in for routine annual screening (they have no breast complaints) are notified by mail. The letters are mailed 24-48 hours after their mammogram. Someone told me that a mammogram uses radiation. Isn't that counterproductive? Mammography does use radiation, but with the newer mammography units, it is a very low dose. This is one case when the benefits 37 Inviting Arkansas

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