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Ray W. Moody, M.D. Breast Center

Orange Regional Medical Pavilion
75 Crystal Run Road, Middletown, NY 10941
845-695-5900
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Breast Center  All-Digital Mammography  |  Breast Care Services  |  FAQs About Breast Imaging  |  About Your Screening Mammogram  |  Multidisciplinary Breast Care Team  |  Breast Evaluation and Treatment  | Physicians and Staff  |  Accreditation & Awards

Breast Center

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All-Digital Mammography

Film vs. Digital Mammography: a traditional film mammogram on the left, compared to a sharper, more detailed digital mammogram of the same breast, at right.

One of the distinctions of the Breast Center is that it offers all-digital mammography. This technology converts x-rays to electronic images of the breast which can be viewed, optimized and stored on a computer. In a recent study, digital mammography was better than traditional film mammography in detecting breast cancer in women under 50 and with dense breasts.

All-Digital mammograms mean:

  • quicker mammograms, since there is no need to wait for film images to be developed
  • images can be viewed instantly by the technologist and radiologist
  • images can be easily transferred electronically with no loss of image quality
  • computer-assisted optimization helps radiologists detect micro-calcifications that might be missed on traditional film mammograms

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Breast Care Services


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FAQs About Breast Imaging 

At what age should healthy women begin having regular mammograms, and how often should they have them?

The American College of Radiology recommends annual screening beginning at age 40 and this is what we recommend at the Breast Center. Women who are considered higher risk may need to begin mammography earlier; such as in these instances:

  1. Women with strong family history:
    • first-degree relatives diagnosed with breast cancer especially at pre-menopausal ages (i.e., parent, sibling or child), usually would begin screening with mammography at 5-10 years earlier than the age of diagnosis of the family member
    • patient or family member with one of the breast cancer genes (BCRA 1 or BCRA 2)
  2.  Women with a past history of receiving radiation to the chest between ages 10 and 30
  3.  

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How long does it take to have a mammogram and how/when do you find out the results?

For screening mammogram patients, our goal is that their exams will be performed and completed in 15 minutes. These exams will be interpreted by the radiologist within 1-2 working days, and letters will be mailed to the patient?s home address upon interpretation.
 
Diagnostic mammography often is a longer exam, because additional images and possibly ultrasound are performed. These patients are given their results at the time of their exam, both verbally and in writing.

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What is the difference between a screening mammogram and a diagnostic mammogram?

Screening mammography is performed in asymptomatic patients -- patients who have no clinical signs or symptoms of breast cancer. Two views of each breast are obtained and are checked for technical adequacy by the technologist. These are interpreted later by the radiologist with results sent to the patient by mail.

Diagnostic mammography is performed in symptomatic patients -- patients who have signs or symptoms of breast cancer such as a palpable lump,bump, nipple discharge, skin changes,pain, etc. We also perform diagnostic mammography in patients with a past history of breast cancer, for follow-up of an abnormal screening mammogram, or for short-term follow-up of probably benign findings. These studies begin with the typical mammography views, with additional views and ultrasound obtained as deemed necessary by the radiologist. The studies are interpreted on line, with results given to the patient immediately.

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How does digital mammography differ from traditional film mammography?

A digital mammogram takes less time to perform and typically involves a lower radiation dose to the patient. It also give us the ability to optimize the image, very similar to the way you optimize a digital photograph. Images are stored electronically so the is less chance of images being lost. In addition, images can be interpreted remotely, so second opinion interpretations may become easier.

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Is digital mammography better at detecting cancers?

Recent studies indicate a higher cancer detection rate of digital mammography in certain patients, including those with dense breasts, those under 50 years old, and those who are pre- or peri-menopausal.

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How do you know if you are at high risk for breast cancer?

High risk factors for breast cancer include:

  • Family history of breast cancer ? two or more first degree relatives with breast cancer; especially if they were diagnosed when premenopausal
  • Personal history or family history of the breast cancer gene BRCA 1 or BRCA 2
  • Personal history of radiation therapy to the chest between the ages of 10 and 30 years
  • Lifetime risk of breast cancer scored at 20%-25% or greater, based on one of several accepted risk assessment tools that look at family history and other factors. This category often requires consultation with a genetic counselor who can assess breast cancer risk using various computer models.

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What will happen to my old breast films if I have a digital mammogram?

The Ray W. Moody, M.D. Breast Center will keep the prior film mammograms in the patients x-ray jacket. We are located in the Westage Building of the Orange Regional Medical Pavilion at 75 Crystal Run Road, Middletown, NY 10941.

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Does it make a difference what type of radiologist reads your mammograms?

At the Ray W. Moody M.D. Breast Center, all breast imaging studies (mammograms, breast ultrasounds and breast MRI) are interpreted by board-certified radiologists who are sub specialized in breast imaging. Our specialists have more than 30 years of combined experience in interpreting these studies, and this is all that they do. Some studies have suggested that the use of sub specialized radiologists, and the greater experience of radiologists who interpret higher numbers of these exams, improves diagnostic accuracy.

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If something suspicious is found on a mammogram, what is the chance that it might be breast cancer?

Approximately 10% of screening mammograms are called back for additional imaging evaluation, which involves diagnostic mammography views and/or ultrasound. Of those that are called back, only about 10% of those require biopsy (90% are either explained as benign findings or simply require short-term follow-up). Of those that are biopsied, only about 30% actually are cancer. Another way to put this is that out of 1,000 screening mammograms performed, approximately 5 patients will be found to have cancer.

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What happens if something suspicious is found on my mammogram?

If there is a suspicious finding on your mammogram, you will typically need to have additional views and/or ultrasound performed. The radiologist will consult with you in person and will recommend additional evaluation to make a diagnosis. This might be ultrasound-guided core biopsy, stereotactic breast biopsy, cyst aspiration, needle localization and surgical consultation, or MRI-guided biopsy. We will make every attempt to schedule and perform these procedures as soon as possible, so that our patients do not have to endure a long wait to find out whether or not they have breast cancer.

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When is an ultrasound recommended, and how does it differ from a mammogram?

Ultrasound is used:

  • to evaluate any palpable breast lesion
  • to evaluate masses, distortions, or asymmetries found on mammography
  • to evaluate findings identified on breast MRI

Ultrasound forms images of the breast utilizing sound waves, not X-rays. No compression is required; a warm gel is placed on the skin and an ultrasound probe is rubbed over the skin to obtain the image.

Ultrasound can often show abnormalities which might go undetected on mammography due to extremely dense breast tissue. Ultrasound is used most commonly in conjunction with mammography, not as a replacement for mammography.

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When is breast MRI recommended for breast cancer screening?

These are the recommendations for screening breast MRI, according to the new American Cancer Society guidelines:

  • BRCA1 or BRCA2 gene mutation
  • first-degree relative (parent, sibling, child) with a BRCA1 or BRCA2 mutation, even if the patient has yet to be tested herself
  • lifetime risk of breast cancer scored at 20%-25% or greater, based on one of several accepted risk assessment tools that look at family history and other factors
  • radiation to the chest between the ages of 10 and 30
  • Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or one of these syndromes based on a history in a first-degree relative

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If MRI is better, why not have an MRI right away instead of a mammogram?

MRI is the most highly sensitive imaging study for the detection of invasive breast cancer and recent studies indicate it may also be highly sensitive for the detection of intraductal breast cancer. Although it is highly sensitive, it is not highly specific. This means that it also finds lesions which are not cancerous and leads to false positive results and subsequent biopsies. Because of its high false positive rate, high cost and the fact that it benefits from specialized expertise for interpretation, general screening of the population with breast MRI is not ready for prime time. It should be used only for specific indications, as an adjunct to mammography and breast ultrasound.

At this point, MRI should be used in screening only for high risk patients.
 
Other indications for the use of breast MRI are:

  • evaluation of the extent of disease in patients newly diagnosed with breast cancer, including screening of the contralateral breast
  • evaluation of breast implant integrity
  • evaluation of patients with metastatic axillary adenopathy with no known primary cancer
  • patients with breast cancer who had surgery with close or positive surgical margins (MRI is done before repeat surgery.)
  • evaluation of the response of breast cancer to chemotherapy
  • distinguishing post-operative scar from recurrent cancer
  • problem-solving in certain cases (patients with difficult to interpret mammograms or breast ultrasounds to help clarify equivocal findings)

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Are there new techniques being studied to improve the accuracy of breast screening?

There are many exciting technologies being investigated in the field of breast imaging. All of this work is in the hopes of detecting breast cancer at the earliest stage possible to allow patients the best chance for a cure.

One new technology being developed is Tomosynthesis, an adjunct to digital mammography. In conventional mammography, a 3-D structure (the breast) is evaluated with a 2-D image. A major drawback of mammography is that structures can be superimposed on a single image. This can result in cancers being hidden on the image or can cause the false appearance of cancer, leading to unnecessary biopsies, etc. Tomosynthesis is a 3-D digital technique that removes the effect of superimposed structures by taking multiple low dose exposures of the breast and processing the information into 1 mm thick slices. This shows promise in improving detection of breast cancers by mammography and decreasing the rate of false positive studies.

Breast-specific gamma imaging (BSGI) and Positron emission mammography (PEM) are developing nuclear medicine techniques which also show promise in detecting breast cancer at early stages. Rather than depending on the shape or appearance of cancer, these techniques depend on the metabolism or biology of the lesion for detection.

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About Your Screening Mammogram

Description of the procedure

Mammography is a specific type of imaging that uses a low-dose X-ray system to examine breasts. A mammography exam, called a mammogram, is used to aid in the diagnosis of breast diseases in women.  This is an x-ray of the breast.

Who performs the procedure?

A certified Mammography Technologist will operate the machinery and a Board Certified Mammography Radiologist will interpret the exam after the images are taken.

Why is this procedure done?

Screening Mammography is done to identify women and men with breast abnormalities.

Where is the procedure performed?

The procedure is performed at The Ray W. Moody M.D. Breast Center which is on the first floor in the Westage Building of the Orange Regional Medical Pavilion located at 75 Crystal Run Road, Middletown, NY 10941.

Is there any prep for this procedure?

We ask that you do not wear any deodorant or antiperspirant, powders, body creams or perfume on the day of the exam. You will be asked to undress above the waist and put on a gown. Please wear a skirt or slacks to facilitate the change of clothes.

What can I expect before the procedure?

You will be asked to fill out a history form and take off your clothes from the waist up and put on a gown.

What can I expect during the procedure?

You will be escorted into an exam room by a technologist. The technologist will expose one breast and place it on the breast plate for compression. The technologist will then start compression of the breast and ask you to hold your breath while the pictures are being taken. Then the breast is released and the other breast is compressed, and then side views on each breast are performed. After four pictures are taken, the technologist might ask you to wait to ensure that all the correct images are taken and are superior quality.

What can I expect after the procedure?

You will be asked to change back into your clothes and resume all normal activities. You may experience some minor discomfort in the breast area, but this will pass.

Are there any risks to this procedure?

There is a risk of radiation as with all X-rays. The amount of radiation is very small, in fact less than a standard X-ray.

Are there any alternatives to this procedure?

Breast MRI

How do I schedule a procedure?

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Multidisciplinary Breast Care Team

The Breast Center is staffed by an exceptionally well-qualified group of breast health experts.  (insert credentials of physicians and staff, physicist, link to doctor list)

Experienced Mammographers (Breast Radiologist Physicians)

Interpreting mammograms is a very demanding and complex task. At the Ray W. Moody, M.D. Breast Center, every breast image is read by one of our highly trained mammographers. These are radiologists with advanced training in the sub-specialty of breast imaging. Their sole focus is reading breast images and they have more than 20 years of combined experience in interpreting breast imaging studies.

In addition, the Ray W. Moody, M.D. Breast Center's physicians and staff are actively involved in continual medical education to advance the state of women's imaging. 

Breast Evaluation and Treatment Program

The imaging specialists at the Ray W. Moody, M.D. Breast Center work closely with members of the Multi Disciplinary Breast Team to provide the most comprehensive, coordinated care possible.
 
For women who are diagnosed with breast cancer, the multidisciplinary breast cancer team includes an expert breast medical oncologist, breast surgeon and radiation oncologist, as well as specialists in breast tissue pathology, plastic and reconstructive surgery, genetic counseling and a wide variety of supportive services.


 

Breast Evaluation and Treatment

Prevention and Early Detection of Breast Cancer


Introduction  |  Three Step Plan for Preventive Care  |  How to Perform Breast Self-Examination  |  Mammography Screening  |  Myths about Breast Cancer  |  Breast Anatomy  |  Benign Breast Conditions  |  Breast Health Glossary

Introduction

Early detection is your best defense against breast cancer. Finding a breast lump or otherwise suspecting you have a breast problem is a frightening experience. You worry that it may be cancer, and you wonder what will happen if it is.
 
Fear of the unknown may cause some women to delay seeking medical attention. But if you think you might have a problem, seeing a doctor immediately is the best thing you can do for yourself.

Prompt evaluation can relieve the stress that comes from uncertainty. Your doctor can determine whether your breast lump or other symptom indicates a problem or is benign, as many lumps are.

If you have breast cancer, early diagnosis can improve your chances of early detection and successful treatment.

In fact, the five-year survival rate for women whose breast cancer is diagnosed at an early stage is 97%.

Three Step Plan for Preventive Care

The thought of having breast cancer is frightening to everyone, and especially devastating to women. But ignoring the possibility that you may get breast cancer, or avoiding the processes to detect cancer, can be dangerous.

Although there are some women who are at higher risk, the fact is that all women are at risk for breast cancer. That is why it is so important to follow this three-step plan for preventive care. Although breast cancer cannot be prevented at the present time, early detection of problems provides the greatest possibility of successful treatment.
 

What is the three-step plan?

Routine care is the best way to keep you and your breasts healthy. Although detecting breast cancer at its earliest stages is the main goal of routine breast care, other benign conditions, such as fibrocystic breasts, are often discovered through routine care.

 Step 1:  Breast Self-Examination (BSE)

A woman should begin practicing breast self examinations by the age of 20 and continue the practice throughout her life - even during pregnancy and after menopause.  BSE should be done regularly at the same time every month.  Regular BSE teaches you to know how your breasts normally feel so that you can more readily detect any changes.  Changes may include:
  • a change in the shape/size of breast
  • development of a lump or swelling
  • skin irritation or dimpling
  • nipple pain or retraction (turning inward), redness or scaliness of the nipple or breast skin
  • a discharge other than breast milk

If you notice any of these, see your health care provider as soon as possible for evaluation.

 Step 2.  Clinical Breast Examination

A breast examination by a physician or nurse trained to evaluate breast problems should be part of a woman's physician examination.
  • Between the ages of 20 and 39, women should have a clinical breast examination by a health professional every 2 or 3 years.
  • After age 40, women should have a breast exam by a health professional ever year.

A physical breast examination by a physician or nurse is very similar to the procedures used for breast self examination.  Women who routinely practice BSE will be prepared to ask questions and have their concerns addressed during this time.

 Step 3.  Mammography

Mammography is a low-dose x-ray of the breasts to find changes that may occur.  It is the most common imaging technique.  Mammography can detect cancer, or other problems, before a lump becomes large enough to be felt, it can also assist in the diagnosis of other breast problems.  However, a biopsy is required to confirm the presence of cancer.

Because when to begin and how often to have mammograms is controversial, it is best to talk with your physician about a mammography schedule that is appropriate for you - based on your overall health and medical history, risk factors and personal opinion or preference.

According to the National Cancer Institute, women in their 40s and older should begin having a screening mammogram on a regular basis, every 1 to 3 years.  But, the American Cancer Society recommends (and we concur) that by age 40, women should have a screening mammogram ever year.  (A diagnostic mammogram may be required when a questionable area is found during a screening mammogram).

Both organizations suggest that women who may be at increased risk for breast cancer should talk with their physicians about whether to begin having mammograms at an earlier age.

Additional information:

 

How to Perform Breast Self Examination (BSE)


What is BSE?

 Breast self-examination is a procedure performed by an individual to physically and visually examine herself for any changes in the breasts and underarm areas of the body. A BSE alone cannot accurately determine the presence of breast cancer. So, BSE should not be used in place of, but in addition to, clinical breast examination and mammography.

When should BSE be done?

Women should begin practicing breast self-examination by age 20 and continue the practice throughout their lives -- even during pregnancy and after menopause.

Breast self-examination should be performed every month. Become familiar with how your breasts usually look and feel so that you may detect any change from what is normal for you.

  • If you still menstruate, the best time to do BSE is one week after your period starts. These are the days when your breasts are least likely to be tender or swollen.
  • If you no longer menstruate, pick a certain day -- such as the first day of each month -- to remind yourself to do BSE. 
  • If you are taking hormones, talk with your physician about when to do BSE.  

Changes to be aware of:

Check with your physician if you find any change in your breast(s) that causes you concern.  Changes in your breasts may include:

  • development of a lump or swelling
  • skin irritation or dimpling
  • nipple pain or retraction (turning inward)
  • redness or scaliness of the nipple or breast skin
  • a discharge other than breast milk

Monthly breast self-exams should always include: visual inspection (with and without a mirror) to note any changes in contour or texture; and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.

How to do BSE: 

  1. Stand in front of a mirror that is large enough for you to see your breasts clearly.  Check each breast for anythiing unusual.  Check the skiin for puckering, dimpling or scaliness.  Look for a discharge from the nipples. 
    Do steps 2 and 3 to check for any change in the shape or contour of your breasts. As you do these steps, you should feel your chest muscles tighten.
  2. Watching closely in the mirror, clasp your hands behind your head and press your hands forward.
  3. Next, press your hands firmly on your hips and bend slightly toward the mirror as you pull your shoulders and elbows forward
  4. Raise one arm. Use the pads of the fingers of your other hand to check the breast and the surrounding area firmly, carefully, and thoroughly. Some women like to use lotion or powder to help their fingers glide easily over the skin. Feel for any unusual lump or mass under the skin. Feel the tissue by pressing your fingers in small, overlapping areas about the size of a dime. To be sure you cover your whole breast, take your time and follow a definite pattern: lines, circles, or wedges.
    Some research suggests that many women do BSE more thoroughly when they use a pattern of up-and-down lines or strips. Other women feel more comfortable with another pattern. The American Cancer Society now advocates the vertical strip method as being the most thorough pattern of search. The important thing is to cover the whole breast and to pay special attention to the area between the breast and the underarm, including the underarm itself. Check the area above the breast, up to the collarbone and all the way over to your shoulder.
    Lines: Start in the underarm area and move your fingers downward little by little until they are below the breast. Then move your fingers slightly toward the middle and slowly move back up. Go up and down until you cover the whole area.
    Circles:
    Wedges:
  5. It is important to repeat step 4 while you are lying down. Lie flat on your back, with one arm over your head and a pillow or folded towel under the opposite shoulder. This position flattens the breast and makes it easier to check. Check each breast and the area around it very carefully using one of the patterns described above.
  6. Some women repeat step 4 in the shower. Your fingers will glide easily over soapy skin, so you can concentrate on feeling for changes underneath. However, the shower method should be used in addition to, not instead of, the lying down method.
    If you notice a lump, discharge, or any other change during the month -- whether or not it is during BSE -- contact your physician as soon as possible.


 

Physicians and Staff




 

Accreditation & Awards

Orange Regional's Ray W. Moody, M.D. Breast Center has been designated a Breast Imaging Center of Excellence by the American College of Radiology (ACR) for a second consecutive year, an achievement only obtained by approximately 177 of 9,000 breast imaging facilities in the United States. Additionally, the Center has been recognized as a certified participant of the National Quality Measures for Breast Centers Program (NQMBC).

Breast Imaging Center of Excellence Designation

By awarding facilities the status of a Breast Imaging Center of Excellence, the ACR recognizes breast imaging centers that have earned accreditation in all of the College's voluntary, breast-imaging accreditation programs and modules, in addition to the mandatory Mammography Accreditation Program.


National Quality Measures for Breast Centers Program Certified Participant

As a NQMBC Certified Participant, the Ray W. Moody M.D. Breast Center is currently the only certified participant in Orange County and only one of four in New York State. This distinguished honor represents a commitment to provide the highest quality breast healthcare to patients in the community. The NQMBC program identifies quality care measures, provides immediate access to information and allows breast centers to compare their performance with other centers across the United States. 

National Accreditation Program for Breast Centers

The Ray W. Moody, M.D. Breast Center has been granted a prestigious three-year, full accreditation designation by the National Accreditation Program for Breast Centers (NAPBC), a program administered by the American College of Surgeons. Accreditation by the NAPBC is only given to those centers that have voluntarily committed to provide the highest level of quality breast care and that undergo a rigorous evaluation process and review of their performance.


 

Orange Regional Medical Center
707 East Main Street
Middletown, NY 10940
845-333-1000

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Orange Regional Medical Pavilion
75 Crystal Run Road
Middletown, NY 10940
845-695-5800

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