I wish I’d known: A Lancaster County woman’s powerful story about 3D mammography

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Gloria Denlinger is determined to help other women in Lancaster County avoid her experience with breast cancer by sharing her story.

“My biggest regret is not knowing that I could have chosen 3D mammography for my annual screening. I knew I had dense breast tissue but was unaware that 3D mammography would have been better for early detection in my case than traditional 2D digital mammography,” Gloria explained.

An unexpected diagnosis
Nitin K. Tanna, MD, is a radiologist with Lancaster Radiology Associates and serves as chief of mammography and breast-imaging services at Lancaster General Health (LG Health). He recalls meeting Gloria in September 2016 when she came to the Suzanne H. Arnold Center for Breast Health at LG Health’s Suburban Pavilion.

“Gloria had recently noticed that one breast was smaller than the other. A surgeon at the facility where she normally had her mammograms (not affiliated with LG Health) did a biopsy and diagnosed her with breast cancer, which had spread to her lymph nodes,” he said. “Gloria came to our center for a second opinion, and I confirmed the diagnosis but was saddened to see the large extent of her disease in the breast and with many abnormal lymph nodes.”

What was most upsetting to Gloria was that she had gotten annual screening mammograms and her tumor was never detected—even as recently as May 2016.

Dr. Tanna performed a full diagnostic workup, including a 3D mammogram and ultrasound of the breast and lymph nodes, and he reviewed her outside 2D images from many previous years.

“I could see that the cancer had been growing for years but was partially obscured on prior mammograms due to her dense breast tissue,” Dr. Tanna added.

Had Gloria been referred for 3D mammography, her cancer would likely have been detected and treated sooner—possibly up to three years prior, at a much smaller size and stage.

The 3D advantage
3D/Tomosynthesis technology allows doctors to see masses and distortions associated with cancers and precancerous lesions more clearly and with greater confidence. Images of the breast are captured from multiple angles and reconstructed in thin slices that can be examined individually or combined to create a 3D image of your breast. This makes it easier to detect abnormalities such as cancer, which show up as white areas. And because we are looking at very thin sections one at a time, those white areas are less likely to be obscured by dense breast tissue, which also appears white on the images. Dr. Tanna points out that 50 percent of women in the U.S. who get mammograms are identified as having dense breast tissue.

A better alternative
When 3D technology was introduced, there was concern that the few extra seconds of radiation would expose women to a higher than acceptable dose. At LG Health, the radiation for 3D screening mammography is now the same low dose as 2D, but with the added benefits of better detection and fewer false positives.

Treating an aggressive cancer
Gloria chose to treat her breast cancer at the Ann B. Barshinger Cancer Institute. Because of the advanced size and stage, her team recommended a highly aggressive approach to her therapy and surgery. Gloria completed eight sessions of chemotherapy over 16 weeks to shrink the tumor. She then underwent a single mastectomy and removal of her affected lymph nodes.

As a member of Penn Medicine, LG Health was able to offer Gloria an innovative procedure for breast reconstruction called TRAM flap, which uses the patient’s own abdominal tissue. Dr. Joseph Serletti, chief of plastic surgery at Penn Medicine, performed the advanced surgery right here in Lancaster.

After she healed, Gloria underwent 28 sessions of radiation therapy—a necessary step to destroy any remaining cancer cells. Because the cancer had grown so large, clean surgical margins could not be achieved, even with a mastectomy. She happily completed radiation therapy this August.