Three different aspects of breast cancer were discussed April 24 at a women's health forum sponsored by Avera Sacred Heart Hospital.

Radiologist Lawrence Leon, breast cancer survivor Celia Miner and surgeon Mary Milroy each spoke about their experiences with breast cancer.

As a radiologist Leon, talked about mammography's role in early detection.

"Mammograms are a very important part of a three-pronged approach -- self breast exams, routine doctor exams and mammograms," he said. "The goal of mammograms is to get a detailed x-ray of the breast in order to detect cancer at the earliest stage."

Avera Sacred Heart Hospital recently purchased digital mammography equipment in a quest to provide the best technology to the region's women.

"As far as digital mammography goes, the exam is performed the same," Leon said. "It's the same compression, positioning and views. You still have to be very still and compression (of the breast tissue) is the key. The better the compression the clearer the images."

Leon said the only difference between digital and film mammography is that digital mammography is electronically stored in a computer and the images can be enhanced.

The National Cancer Institute and the American College of Radiologists recruited 49,528 women to have both a digital mammogram and a film mammogram, Leon said.

"They compared the results and found 335 breast cancers," he said. "The diagnostic accuracy of the exams were similar, but they did find that for certain groups of women digital mammography can find cancer earlier."

Digital mammography is better for women under 50, women who are pre-menopausal and women with dense breast tissue, Leon said.

"Although digital mammography is better for certain women, it does not replace film screen mammography," he said. "Any mammogram is better than none."

Celia Miner, a local attorney, shared the story of her family's battle with breast cancer. Not only is Miner a breast cancer survivor, but her mother, who is now deceased, and one of her daughters have battled the disease.

"Myself, my mother and my daughter were all in that sisterhood we didn't want to join," she said.

Miner said her mother was diagnosed with breast cancer at the of 81 after she had her first mammogram.

"My mother was one of those women who thought that the mammogram caused breast cancer," Miner said. "She never had one until I insisted when she was 81, and they found something."

Miner's mother, who was suffering from dementia, was too fragile for aggressive treatment, so Miner decided her mother would have a biopsy and then follow up with tamoxifen.

"After her biopsy she had no recurrence," Miner said. "She died seven year later, but not of breast cancer."

Miner realized she was at an increased risk for breast cancer when her extended family gathered for her mother's funeral and she found out how many of her female relatives had battled the disease.

"I was also at an increased risk just because I was a woman and because I was getting older," she said. "At this point I was 58 years old and I was religiously having regular mammograms and doing regular breast self exams. Then I got that call that every woman dreads. They had found 'something of interest' on my mammogram."

Because Miner had been diligent about mammograms, her cancer was caught very early.

"It was an early catch. I was really lucky and I am thankful I did those regular mammograms," she said. "I chose to have a mastectomy with no reconstruction. I had no other treatment except for tamoxifen for five years and I am now in that group of women that have moved on to femora for five years."

Miner said her battle with breast cancer was rough, but dealing with her daughter's diagnosis was much harder.

"I'm not one of those women who stand up and say having breast cancer was wonderful," she said. "It wasn't the best but it certainly wasn't the worst. The worst was my daughter."

Miner's daughter, Amy was diagnosed with breast cancer when she was 37 years old.

"Amy was preparing to attend the University of Hawaii, before she left she had a mammogram," Miner said. "They found 'something of interest' and she had a follow-up mammogram in Hawaii and never thinking she had cancer went in to have a biopsy. It was cancer and she came home and had a mastectomy on her right side."

Amy's cancer, like her mother's was caught early and she followed up with tamoxifen. Amy returned to Hawaii and when she had her follow-up exam and mammogram they found cancer in her left breast.

"Amy had a second mastectomy," Miner said. "She basically had a double mastectomy, just at two different times."

Although Miner had trouble dealing with her daughter's cancer ordeal, she said Amy took it all in stride.

"Dr. Milroy is very good but when you do two mastectomies at two different times it is hard to line up the scars," she said. "Amy's (scars) were a little lopsided so she connected the scars with a little tattoo to balance them out. She is very active in young survivors groups and has a very positive attitude."

Amy is an identical twin and her sister is currently enrolled in a high surveillance program through the Mayo Clinic.

"She is scheduled for a prophylactic double mastectomy with reconstruction," Miner said. "They calculate her risk at 1 in 3 and that is just too high."

Dr. Milroy discussed how the treatment of breast cancer has evolved in the last 20 years.

"I started my career as a resident in Michigan in 1985," she said. "In the 1980s breast cancer was not found by screening. The women we saw then had all found a lump. They were brought in and it was customary for them to sign a consent that said they were having a biopsy with the possibility of mastectomy. We would put them under general anesthetic, take the lump out and send it to pathology. They would look at it under a microscope and if it didn't look like cancer they'd call down to the operating room and that would be it. If they called and said it was cancer we would do a mastectomy.

"As a young resident I remember seeing women wake up from anesthesia, groggy and nauseated groping at their chest asking, 'Do I have cancer?' 'Do I have a breast?' It was not a very good way to treat breast cancer."

Thankfully, Milroy said treatment has changed drastically in the past 25 years.

"Women now have a say in their treatment," she said. "They can save their breast, and in most cases they never have to spend the night in the hospital."

Milroy said women make all the choices and they are offered a wide array of treatment options.

"They can have a mastectomy, a mastectomy with reconstruction, a lumpectomy, a lumpectomy with radiation," she said. "Although it is a tough decision, all women know in their hearts which is best for them."

Another major improvement concerns the removal of lymph nodes.

"They used to just take out all the lymph nodes, which can lead to lymphoedema or swelling of the arms," Milroy said. "We don't make anyone better by taking out normal lymph nodes, but we can make you worse.

"Technology now allows us to do lymph node mapping and find the sentinel or key node. Once we find the key node we can do a node biopsy, if it's negative we don't have to take the rest out."

Through regular mammograms and self breast exams women are finding tumors sooner.

"Tumor sizes are getting smaller and smaller," she said. "The smaller the tumor the less likely it is to have spread. Early detection allows for more options. The breast cancer mortality rate was flat-lined from 1930-1990, but in the last decade we have seen it steadily going down. We are seeing better cure rates, better options and fortunately, better outcomes."