Fall 2009

Expert Care for Breast Cancer: High-tech tool helps women at high risk. Early detection, better diagnostic techniques and advances in treatment options are helping more women to survive breast cancer each year. While breast cancer continues to afflict more women in this country than any other cancer, nearly 89 percent of women who are diagnosed will live for at least five years after treatment, 98 percent if the cancer is caught in its earliest stages.

This is why the American Cancer Society (ACS) recommends that all women, beginning at age 40, have regular mammograms, which have been shown to decrease the chances of dying from breast cancer. In addition, the ACS also recommends magnetic resonance screening beginning at age 30 for women at high risk of breast cancer. This includes women who are known to carry the BRCA 1 or BRCA 2 gene mutations (these mutations account for about 5 to 10 percent of all breast cancers), women with a strong family history of breast or ovarian cancer, and women who have had chest radiation treatments for another cancer before the age of 30.

What is magnetic resonance screening? 

Unlike a mammogram, which uses x-ray technology to evaluate the breast, magnetic resonance (MR) screening uses a powerful magnet and radio waves to produce detailed images of the internal structures of the breast on a monitor. MR imaging of the breast is not a replacement for a mammogram, but it does allow physicians valuable information about many breast conditions that cannot be obtained by x-ray screening alone.

Important functions of MR screening of the breast 

High risk screening

Evaluating abnormalities found during mammography

Locating additional cancers prior to breast surgery

Determining whether cancer has spread in the breast or into the chest wall

Assessing the effect of chemotherapy

Checking the integrity of breast implants for leaks or ruptures

MR imaging of the breast is not used for routine breast cancer screening, and high-quality mammography remains the most effective technology presently available. Please talk to your doctor about high risk assessment and screening options for breast cancer, including potential benefits, limitations and harms, and the amount of uncertainty for each strategy.

Sources: Mayo Foundation for Medical Education and Research, Radiological Society of North America, American Society of Radiologic Technologists

Simple treatment can help steady spinning sensations

Do you experience a spinning sensation when you lie down, roll over in bed, or look up? If so, you may be suffering from vertigo, also known as benign paroxysmal positional vertigo, or BPPV.

There are many causes of dizziness and one of the most common types is called benign paroxysmal positional vertigo. This form of dizziness is due to a disturbance of the vestibular system within the inner ear, which helps to control our balance and equilibrium.

Benign indicates that the condition is not life threatening

Paroxysmal means that it occurs abruptly and lasts only seconds to minutes

Positional implies that the symptoms are provoked with a change in position Vertigo is described as a spinning sensation

Vertigo is described as a spinning sensation

Causes of vertigo

The vestibular system coordinates what we see, hear and feel with movements from our head and body. The information is relayed to the brain and this is what helps to control our balance. BPPV is caused by free-floating calcium carbonate particles that become displaced within the inner ear and often affects our balance. Less common causes of vertigo may include stroke, blood pressure or heart problems, brain tumors, multiple sclerosis, and migraine headaches. Medications, including prescriptive and over-the-counter, may also cause vertigo.

Symptoms of vertigo

Symptoms of BPPV may include any or all of the following: dizziness, a sensation of spinning, imbalance or unsteadiness, blurred vision, difficulty concentrating, and nausea. Symptoms can be quite variable from person to person with regards to intensity, frequency and duration. These symptoms can be quite disruptive to social and work activities. Dizziness and imbalance can also create a fear of falling and potentially increase the risk for falls.

Diagnosis

Most cases of vertigo are harmless, however any signs or symptoms of vertigo warrant an evaluation by a physician. The diagnosis of BPPV is based upon a medical history and physical examination. The Dix-Hallpike maneuver is a test that provokes symptoms and can confirm a diagnosis of vertigo. Occasionally auditory tests, lab work and other diagnostic tests are performed to rule out other diagnoses. Once BPPV has been confirmed, vestibular rehabilitation is the hallmark treatment.

Treatment

BPPV is treated with a non-invasive maneuver called canalith repositioning. This involves a series of head positions to clear the calcium particles out of the canal within the inner ear. Since BPPV may affect your ability to maintain your balance, vestibular rehabilitation therapy can help you to become steadier on your feet. Vestibular therapy is an important part of treatment for vestibular disorders and is directed by a trained physical therapist. Treatment is guided through a program that is symptom-specific and individualized to each person’s needs. After a thorough evaluation of strength, coordination, balance reactions, and positional vertigo testing, a treatment plan will be developed and implemented.

If you suspect that you are suffering from vertigo, schedule an appointment with your primary care physician. Vertigo is not a disease but a symptom that can have many causes and is easily treated, in most cases.

- Cathy Van Lith, M.P.T., O.C.S., WVMC Physical Therapy