Radiologists are Most Qualified to Evaluate Breast Health
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Dr. Wende Young, a pioneer in breast imaging, discusses the roles of technology and patient-centricity in breast imaging.
Editor’s note: the Elizabeth Wende Breast Clinic (EWBC) in Rochester, NY, is highly regarded as being on the cutting edge of technology in its quest to identify breast cancer at its earliest stages. In this issue of Everything Rad, we interview its founder, Dr. Wende Young, who set standards for breast cancer treatment worldwide, on why radiologists are most qualified to evaluate breast health.
Q: What challenges did you face in developing a specialty clinic for breast imaging?
A: In 1975 when I opened my clinic, the diagnosis of breast cancer was very different from what it is today. If a patient had a breast problem, she was referred to a surgeon who, after evaluating the patient, decided whether to perform a breast biopsy.
In 1975, as a radiologist on the faculty of University of Rochester, my only job was to interpret the mammogram we performed on the patient and send the report to the surgeon.
Q: What led you to believe that radiologists are the most qualified to evaluate breast health?
A: It was obvious to me that if the radiologist clinically examined the patient’s breast and correlated it with the mammogram, that the diagnosis would be more accurate than the surgeon’s clinical examination alone; hence my decision to leave the University of Rochester to open my clinic.
In 1975, because the concept of a clinic for breast cancer detection only was new, we saw very few patients in the first few years. But once our government recommended screening mammograms, our office practice grew to its present size.
Other studies like CAT scans, Magnetic Resonance Imaging, and ductography also increased radiologic accuracy. These tests helped determine the size of cancers and helped determine the best course of therapy.
Pioneering biopsies versus surgical lumpectomies
Q: What role did technology play between 1975-1990?
A: In 1975, breast ultrasonography (analyzing sound waves bouncing into the breast) had recently been developed. We purchased one of the first ultrasound units in the United States which enabled us to determine whether a lump was caused by a tumor, or a cyst (fluid collection in the breast) that could be removed with a needle to make the lump disappear.
One of the first patients on whom I performed ultrasound was a 67-year-old woman who had been sent to me from her surgeon because she found a lump in her breast. Her mother had recently died of breast cancer. She came to her clinic on the way to her hospital to have a breast biopsy. She had her suitcase with her. Ultrasonography showed a cyst. The lump disappeared when I removed the fluid with a needle. You can’t imagine her relief when I told her she didn’t need surgery.
In the 80’s and 90’s, new types of breast diagnostic tests also were developed for radiologists to use. Our needle core biopsies were performed under ultrasound or mammogram guidance. These began to replace surgical biopsies, which removed more tissue and which were more expensive. We published a paper in the 90’s which showed that in Rochester our needle core biopsies were four times more likely to discover cancer than surgical biopsies.
Putting patients at the center of healthcare
Q. How does patient advocacy fit into the picture? Does adopting this approach help radiologists?
A: Most doctors’ offices are not a place where people want to go, and most people are not in a good mood when they come to a doctor’s office. Anything you can do to make it a nicer place is going to encourage people to come. We do everything we can think of to make the place seem more like home.
Since the day the clinic opened, we have always given the patient the option of receiving the results of our examination before she leaves the clinic. Women wait for their results in comfortable robes and sit in a living room-like setting where a fireplace glows. We offer them tea or coffee and chair massages. They can distract themselves by reading, conversing, or shopping the handmade jewelry that is offered for sale at a nominal fee.
For radiologists, doctors, or anyone that runs a business involving patients, the ones that are going to be the most successful and help the most people are the ones who are empathetic. That’s really all you need if you are well-trained.
Today, Dr. Young is retired at a young 83. Her legacy is the EWBC and the thousands of women she helped throughout her career as an internist and radiologist.