Happy Breast Cancer Awareness Month! In the latest installment of our conversations with Fort Worth newsmakers, Rebecca Wallace, supervisor of the Kupferle Breast Center, discusses why a person’s position during a mammogram matters in breast cancer prevention. 

This conversation has been edited for length and clarity. For a longer version, please listen to the audio file attached to this article.

Alexis Allison: So Rebecca, can you tell us first about the importance of early imaging in breast cancer detection?

Rebecca Wallace: According to the American Cancer Society, death rates from breast cancer in the U.S. have dropped 40% since 1989, way back when my grandmother, Mary Beth, had it. They attribute that decline mostly to the improvements in treatments and in imaging. 

Imaging has come so far — we do it in 3D now. It’s basically a CT or an MRI of the breast. We’ve always done two images, but now (the radiologist) has 15 images. She can page through the breast like a book.  

Mammography is the single most important examination that we can provide for early detection. What we find under (mammography) is what cannot be felt yet: small sizes, under two centimeters, where your treatment options and your surgery options are greater. 

Allison: Can you tell us when people should get mammograms?

Wallace: We follow the American College of Radiology and the Society of Breast Imaging. They recommend annually beginning at 40. 

Allison: I know that, at the Kupferle Breast Center, you’ve been working on a way to fine tune mammograms. Can you tell us a little bit about that project? 

Wallace: We are always looking for ways to improve. Your job really depends on patient satisfaction and compliance. If they’re happy with what you’re doing, they’re more compliant. And the more compliant, the better pictures I get. You know, ‘Can I get you in one millimeter more?’ That may mean the difference in me missing some calcifications this year that were there all along, and we don’t see until next year, because I couldn’t get you to relax enough that I could pull the tissue in.

So the American College of Radiology did a learning collaborative (about cancer screening). We applied and are one of six chosen. We have a lot to offer: The Kupferle Breast Center has a standalone breast center and then we have two satellites, one in Willow Park and one in Burleson. We also do mobile mammography, so we basically have two mammography rooms that go out on wheels. Each of these (presents) a different set of challenges for each tech.

We wanted to do the collaborative to learn from the best. We’re in there with Solis (Mammography), which is huge, Stanford University, things like that. Once a week, we do this ‘walk the wall,’ and it’s like, ‘Did you try this? Did you try this?’ It’s so diverse. 

Allison: What are some of the strategies or lessons that you’ve gleaned from this cohort?

Wallace: Positioning is so important. The positioning is critical to the radiologist: This is how she identifies these potential lesions. (We’ve been studying) to see, if we began to do some standardized positioning, (could more of our images) meet the standard American College of Radiology criteria? 

Because as it stands, when a radiologist looks at an image, she knows which tech did it — just because Tina is always going to get this, Amanda is always going to get this. If you explained to the technologist the importance of standardized positioning and gave them the tools to do it, could I reproduce the same images that the tech did last year? 

Allison: It’s like, making sure that your data is clean and consistent from year to year?

Wallace: Can we make it reproducible? Our main goal is to catch every single cancer in stage zero. And if we did this, you know, could we accomplish that goal? 

Allison: Out of curiosity, is there anything that the patient can do to help with positioning?

Wallace: No, not really. The biggest thing is compliance. If they’re anxious and nervous, then you’re not going to get good imaging. If you can get a patient more comfortable, then they can be more compliant (and) you get better pictures. It’s all up to us to make you feel comfortable and make you trust that I’m not going to hurt you.

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her at alexis.allison@fortworthreport.org or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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Alexis Allison

Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....