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accessHealthNews.net PAGE 9 May 2019 In the summer of 2018, Patel moved back to Missouri, accepting positions at both Liberty Hospital and Ray County Memorial Hospital (RCMH). "I believe we are providing improved care to a quarter of the state, and I'm very proud of that," she said. In December 2018, RCMH spent nearly $400,000 on a state-of-the-art 3D mammography machine, the Hologic Selenia Dimensions 6000. "Most rural areas don't get access to this cutting-edge technology," Patel said. "The fact that Ray County had the foresight to budget for such an expensive piece of equipment and have 3D available for the women in this area, it's just unheard of. It's such a rare, special thing we're doing in this part of the country to provide breast care for women." "We do have clients from Ray County who can't afford imaging. We were just awarded a large grant from Susan G. Komen of Greater Kansas City, so if a woman can't afford a mammogram, we can use those funds." Funding also comes from organizations including Liberty Hospital Foundation, American Cancer Society and ShowMe Healthy Women. "You call us, and we will definitely take care of you." Risk Assessment When should you get your first mammogram? In April 2018, the American College of Radiology and the Society of Breast Imaging released new recommendations that every woman, regardless of color, by age 30 needs to be risk-assessed for breast cancer. "The most accurate risk assessment tool is called the Tyrer-Cuzick model," Patel said. Tyrer-Cuzick measures a long list of risk factors, including smoking, alcohol use, body mass index, breast density, hormone use, BRCA 1 and 2 genetic testing results, family history, previous cancers, and more. "If they are deemed to be high risk – which is 20 percent or greater lifetime risk after calculating all these factors – they need to start annual screening mammograms at age 30, with supplemental screening in the form of breast MRI or ultrasound, alternating every six months with mammography," she said. "We're coming down very hard on surveillance recommendations for young women because we feel we're underestimating breast cancer risk in this country. Also, young women tend to have more biologically aggressive cancers." Women who are not high risk should start annual mammograms at age 40. Future of Breast Imaging "Breast imaging is rapidly evolving, and it's exciting to see," Patel said. "It seems like every year, something new is coming down the pipeline." One example is abbreviated breast MRIs, which can do a scan in less than 10 minutes. "But really, I think the future of breast imaging is going to be in the hands of artificial intelligence (AI) and machine learning," she said. The radiologist will flag an area of interest. Then, based on an algorithm of hundreds of thousands of case studies integrated into the computer, and based on characteristics of the lesion (margins, shape, vascularity, etc.), AI will decide if it's suspicious or cancer, or if it's benign or probably benign. "Studies are showing that AI capabilities are just as accurate as a radiologist," Patel said. "That is amazing." But AI can't talk with or comfort patients, addressing the very human side of medicine. "AI is never going to replace us, but it will make us better at what we do, helping us with our diagnostic certainty." All women, including those who are postmenopausal, should perform monthly self- exams as indicated by the National Breast Cancer Foundation (nationalbreastcancer.org/breast-self-exam): In the shower: Using the pads of your fingers, move around your entire breast in a circular pattern moving from the outside to the center, checking the entire breast and armpit area. Check both breasts each month feeling for any lump, thickening, or hardened knot. Notice any changes and get lumps evaluated by your health care provider. In front of a mirror: Visually inspect your breasts with your arms at your sides. Next, raise your arms high overhead. Look for any changes in the contour, any swelling, or dimpling of the skin or changes in the nipples. Next, rest your palms on your hips and press firmly to flex your chest muscles. Left and right breasts will not exactly match—few women's breasts do, so look for any dimpling, puckering, or changes, particularly on one side. Lying down: When lying down, the breast tissue spreads out evenly along the chest wall. Place a pillow under your right shoulder and your right arm behind your head. Using your left hand, move the pads of your fingers around your right breast gently in small circular motions covering the entire breast area and armpit. Use light, medium and firm pressure. Squeeze the nipple; check for discharge and lumps. Repeat these steps for your left breast. Source: National Breast Cancer Foundation (nationalbreastcancerorg/breast-self-exam) How to Perform a Breast Self-Exam (© catinsyrup - stock.adobe.com)

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