Q & A with Dr. Morris Browman, Director of Radiology at VMmed

  1.  What services do you find important or unique that VMmed offers?

The multidisciplinary, team approach to breast cancer screening and treatment is truly cutting edge. We are also unique in terms of how much expertise and state of the art technology we focus in a single, pleasant setting outside of a hospital, allowing us a to provide a considerable array of top quality medical services very rapidly. It’s an outstanding team, from the front-line surgeons all the way up to the clerical staff. I am proud to be a part of it.

  1.  What is the newest technology to screen breasts?

There are new technologies developed continuously, but the most sensitive (ie the one that misses the fewest cancers) is MRI. Overall, the newest concept is the idea that different women require a different mix of screening techniques, depending upon the actual, calculated biological risk and the individual’s subjective risk tolerance. Recently it has become clear that women with dense breast tissue can benefit significantly from added ultrasound and/or MRI examinations.

  1.  In which area(s) of breast cancer treatment have you seen the greatest progress in the years that you have been practicing?

The specific analysis of individual tumors to determine what stimulates their growth, and therefore how best to treat them, has helped us make great strides in treatment success.

  1.  How has VMmed kept up with these advances?

In whatever field an advance occurs (detection, surgical treatment, radiotherapy, genetic analysis, etc), our team has expertise in place to implement the new approach. We were the 1st clinic in Canada to implement full field digital mammography and are always on the alert for the next step forward.

  1.  Is mammography enough?

Mammography is enough for some women of relatively low lifetime risk. However, an individual may still choose to lower her risk by supplementing mammography with other imaging (e.g. ultrasound or MRI)

  1.  As a breast imager, what is the question you are most asked by patients?

The most frequent question I am asked, both by patients and female relatives, friends and acquaintances, is “what should I be doing in terms of breast cancer screening?” We would all like a simple answer, but this is truly a complex question. The answer is: “It depends. There is no ‘correct’ answer. Any screening plan is a set of compromises. Screening, by definition, is looking for disease in patients who have no symptoms.

Questions that need to be answered include: Will earlier diagnosis help save lives? What is the cost of screening (this includes false positives that may require more imaging or biopsy, as well as financial costs)?

The answer to the first question is easy, as screening for breast cancer has been shown to decrease mortality in large, randomized, controlled trials. The cost/benefit analysis, however, is subjective. For example, from the perspective of a government or insurance company, the cost of doing further imaging and false positive biopsies (for things that turn out not to be cancer) has to be weighed against where else this money could be spent for the public good (for example anti-smoking publicity). However, from the perspective of an individual woman, the cost analysis changes. One woman may find that an ultrasound-guided needle sample from a breast is a small price to pay to confidently exclude the possibility of a cancer, while another may prefer to simply have follow-up ultrasound examinations in order to make sure the lump doesn’t grow. Some women may prefer to follow the American Cancer Society guideline of screening annually after the age of 40, and others may be content with screening mammography every 2 years only after the age of 50. The differences between these options are as much matters of philosophy as they are of biology and cost.

At VMmed, we take an aggressive approach to finding breast cancers at the earliest possible stage.