Dr. Robert C. Ward, a radiologist at Rhode Island Medical Imaging, specializes in women’s imaging and cryoablation, a nonsurgical breast cancer treatment.
Ward discusses the COVID-19 pandemic’s impact on routine cancer screenings and mammograms, and what breast cancer patients who opt for cryoablation can expect.
PBN: Health care leaders are being vocal right now as they urge women not to delay getting their mammograms despite the continuing COVID-19 health crisis. Is RIMI back up to pre-pandemic levels, or are you still seeing patients opting to delay screenings?
WARD: Rhode Island Medical Imaging has been very proactive in creating and maintaining safe access to care during the COVID-19 pandemic. We follow all government and agency guidelines, perform symptom checks, practice social distancing by limiting in-office waiting, and employ all appropriate personal protective equipment to keep our patients and staff safe at all times.
We know some patients have opted to continue delaying screening studies, including annual mammography. As a result, in the first few months of the pandemic, we saw a decline in new breast cancer diagnoses. Unfortunately, cancer doesn’t pause during a pandemic. By delaying mammograms too long, people risk having breast cancer diagnosed at a more advanced stage, when it’s more difficult to treat. Screening mammography saves lives by early detection, and we should never forget that, even during a pandemic.
Because of the safety precautions we’ve taken at our RIMI offices, the risk of COVID-19 transmission is minimal and the benefits of screening outweigh that risk for the vast majority of people.
PBN: Have you seen instances of patients whose cancer diagnosis was delayed because of a missed mammogram due to COVID concerns?
WARD: The COVID-19 pandemic began to take a foothold in Rhode Island in March and April of this year, so it’s been about seven months since patients started opting to delay their breast imaging exams. It’s still too early to tell, but based on the relatively high incidence of breast cancer, we would certainly expect some patients to present with a delayed diagnosis because of a missed annual mammogram. Breast cancer is best treated when detected and diagnosed early, so the sooner patients return to care, the better outcomes they should expect.
PBN: COVID-19 seems to have longer-lasting and wider-ranging effects than were originally thought. Is there any evidence that the virus causes complications in breast cancer patients?
WARD: It’s important to know that being diagnosed with breast cancer doesn’t automatically increase your risk of having serious complications from COVID-19. But people in treatment for breast cancer may be at higher risk for complications if their treatments have caused them to have a weakened immune system or have lung problems.
Certain underlying medical conditions increase the risk of COVID-19 complications more than breast cancer treatments. Those factors include older age (greater than 65), being obese, having Type 2 diabetes, chronic kidney disease, a serious heart condition, and chronic obstructive pulmonary disease.
PBN: One of your specialties is cryoablation, a minimally invasive treatment for breast cancer. How does it work, and what is the typical recovery time? Are there certain types of patients in whom this treatment is most effective?
WARD: Cryoablation is an office-based procedure that is, in many ways, similar to a routine ultrasound-guided biopsy. We use ultrasound to guide placement of a small needle into the targeted lesion. Instead of taking a tissue sample, like we do for a biopsy, extremely cold temperatures are generated at the tip of the cryo needle. In real-time, with ultrasound imaging, we watch the ice form and engulf the lesion. The temperatures at the core of the ice ball are so cold that the targeted breast cancer cells are killed immediately.
Amazingly, the procedure is virtually painless, requires only local anesthesia and 30-40 minutes of time. Patients are able to resume most routine activities right away. We simply ask them to take it easy for about 24 hours with no heavy lifting. Patients may experience some bruising afterward, but that resolves within about a week or so. Patients will also feel a small lump at the ablation site for weeks to months.
We’ve been offering cryoablation to patients at RIMI as an alternative to surgery in a variety of different cases, and always with the input from our colleagues from multidisciplinary tumor boards, which include breast surgeons, medical oncologists, radiation oncologists and pathologists, among others. Cancer care always involves a team approach.
Generally, the best candidates for breast cancer cryoablation are those with a single site of early-stage invasive breast cancer, less than 1.5 centimeters in size, not too close to the skin surface or nipple, with a favorable receptor profile (i.e. ER/PR+ HER2-), and normal-appearing lymph nodes suggesting the cancer has not spread beyond its site in the breast.
Since 2016, we’ve had excellent results and have successfully treated nearly 50 patients with breast cancer. Patients are followed routinely, every six months for the first two years and then annually, with routine breast imaging, which includes mammography, ultrasound and, in some cases, MRI, as well.
PBN: What changes in women’s imaging have you seen since you first began working in the field?
WARD: I’ve noticed a continued trend toward more efficacious and less-invasive diagnostic and treatment options for breast cancer. RIMI has been at the forefront in developing and employing these technologies and techniques.
Some of the new and improving technologies that help us maximize our ability to detect breast cancer as early as possible include transitioning from 2D digital mammography to 3D digital breast tomosynthesis, allowing us to better find cancers that are obscured by overlying normal breast tissue; performing supplemental screening ultrasound for women with dense breast tissue, helping us find cancers that might otherwise be missed by mammography alone; and offering breast MRI, allowing us to best screen women with an elevated lifetime risk for breast cancer.
Once a suspicious lesion is detected using our state-of-the-art equipment, today we’re able to use any one of those imaging modalities to precisely target even the smallest of areas for tissue sampling.
If breast cancer is diagnosed, especially when picked up at an early stage, patients are seeing less-invasive and caustic treatment options that are better targeted to their own individual tumor. For example, breast cancer surgery used to involve radical mastectomy, but now, smaller surgeries, such as segmental mastectomy or lumpectomy, or even the nonsurgical option of cryoablation, are often sufficient and in the patient’s best interest. Less is often more.
Patients are also increasingly aware and discerning. Patients recognize the importance of addressing their medical imaging needs at a facility that not only has the best equipment but also has the best and most specialized radiologists in the region. RIMI provides fully subspecialized interpretation of all medical imaging exams. For example, your breast imaging exam will be interpreted by a radiologist with specialized training in breast imaging. Nobody else in the area can provide that level of service.
Elizabeth Graham is a PBN contributing writer.
