3D mammographies, cold caps changing breast cancer treatment

MORRISTOWN – Two new technologies are helping breast cancer patients at Morristown Medical Center save their hair and even their life.

The first, 3D mammographies, is one of the biggest changes in mammography in the past two decades.

"The standard mammography consists of four views—two views of each breast," said Dr. Paul Friedman, medical director of the Rippel Breast Center. "The new 3D mammography takes between 80 and 100 images of each breast in different views.

"We used to have just a single image, with all the images piled on top of it," he added, "but we can now slice through the breast and move apart tissue to see things we never could see before."

A year ago, Morristown Medical Center was the first hospital in the state to convert all its equipment to what is also called 3D tomosynthesis. In the past few months, Overlook Medical Center in Summit and Chilton Medical Center in Pequannock, both in the Atlantic Health System, also acquired some 3D equipment though they do not offer 3D mammographies exclusively.

Jennifer Zambri, 41, of Denville, says the shift to 3D in Morristown saved her life. On May 30 this year, her birthday, she went for her second ever mammography.

"We saw a subtle area of distortion, which is one of the areas that the tomo has been helping with," Friedman said. "It revealed an early invasive lobular cancer that, in my opinion, would not have been found until it was perhaps palpable many years from now."

On Aug. 4, Zambri had a double mastectomy, with reconstruction. She opted to remove both breasts, she said, because lobular cancer tends to spread.

"When people find lumps in their breasts, that's usually cancer in the ducts," Zambri explained. "Lobular cancer doesn't create lumps, so it's much harder to find than the ductal kind. Lobules are milk-producing glands whereas ducts are what carries the milk.

"To find the cancer this early was a huge thing," she added. "Typically, it's so hard to find that, by the time it starts manifesting itself, it's already metastasized into your system."

Zambri said she was doubly happy with the early diagnosis because it meant she didn't need the typical 18-month treatment regimen of chemotherapy and radiation. Instead, she's taking tamoxifen to block the production of estrogen in her breast tissue even though she doesn't have much tissue anymore.

With tamoxifen, the likelihood of recurrence is less than 5 percent, she explained.

On Oct. 2, a PET scan confirmed she was cancer free.

"3D mammo saved my life and it made this whole process so much easier," Zambri said. "Chemo can give you leukemia, heart problems, neuropathy, depending on the strength of what they need to do and how much they need to get rid of. It's a whole different level of treatment I never had to worry about."

Detects 30 percent more cancers

A study by the Hospital of the University of Pennsylvania shows 3D mammographies detect 30 percent more cancers and decrease false positives by 15 percent.

For that reason, Friedman said, 3D mammos decrease the need for calling women back for additional images and, therefore, patient anxiety.

It's true that 3D mammographies use a little less than twice the radiation than 2D digital mammographies. On the other hand, he pointed out, women who are called back to have additional 2D digital views taken also are subject to higher radiation.

"If a woman had to come back for even two more pictures after her standard mammogram," he said, "that would put her over the amount of radiation she's having with the tomosynthesis."

Cold caps

The other technology — cold caps — allows breast cancer patients undergoing certain chemos to keep their hair.

Patients getting chemo at the Carol G. Simon Cancer Center can rent or buy their own—either Penguin Cold Caps or Elasto-Gel Caps—from the manufacturers and bring them to chemo. If they're patients of Regional Cancer Care Associates, a private practice, they also can, if eligible, participate in a new US Oncology clinical trial testing the Orbis Paxman Hair Loss Prevention System.

Morristown is one of three sites in the nation where the trial is taking place. In the trial, a patient's cap is hooked up to a Paxman machine that constantly pumps cold water through it.

"This Paxman Scalp Cooling System, a self-contained machine that's hoping to get FDA approval, is already being used in Europe and Australia," said Dr. Steven Papish of Regional Cancer Care Associates."Basically, a cold cap is inhibiting blood supply to the scalp so the hair follicles are not receiving the dose of chemotherapy that the rest of the body is receiving.

"The more rapidly growing cells in your body—your hair, the lining of your mouth, your nail beds—are more affected by chemotherapy than normal cells," added Papish, who also is medical director of the Carol G. Simon Cancer Center. "That's why patients, to decrease some of the exposure, will suck on an ice pop so they don't get mouth soreness. They'll also use frozen peas for their fingernails to limit the amount of the drug that gets into the nails."

Jamie Moorehead, 48, of Long Valley, who finished her chemo in April, used the low-tech method.

She rented a kit of eight Penguin Cold Caps from Medical Specialties of California UK at a cost of $600 per month, and brought them to Morristown. She also brought the necessary equipment, including two coolers, each filled with 40 pounds of dry ice from Esposito's in Morris Plains; a heating pad; a blanket; and warm socks, all to help keep her as warm as possible while the caps were on her head.

"When a frozen cap is on your head, it weighs five pounds," Moorehead said. "Your head is really frozen. The cap is 32 degrees below zero, Celsius."

That's 26 degrees below zero, Fahrenheit.

Moorehead also brought her cold cap team—her husband Robert Moorhead, who was in charge of taking one cap off her head, and replacing it with a freshly frozen one, every 30 minutes, and her friend Tracey Bauer, who kneaded every cap so it sat evenly and perfectly flush with her scalp. If it isn't even, a bald spot could occur where there's less pressure.

Since the protocol includes the patient drinking a gallon of water, Bauer also helped Moorehead to the bathroom as she balanced the heavy cap on her increasingly tired neck.

Nancy Marshall, cofounder of The Rapunzel Project, dedicated to spreading awareness about cold caps, said two coolers are needed to keep the caps adequately frozen.

"You put a used cap in the cooler that you're not currently drawing from and you keep rotating caps," Marshall said. "The dry ice is so cold that, by the time you need that cap again, it's refrozen."

That's a lot of work, particularly since Moorehead and her team had to keep rotating the caps every half hour, for four hours, after each chemo treatment ended. Since Moorehead lives in Long Valley, that meant a stop in the parking lot of the Rockaway Townsquare mall, and then another stop, before she arrived home.

An empowering experience

Yet she'd do it all again. The experience was empowering, she said, and distracting in a positive way. She was always thinking about her hair instead of thinking less happy thoughts about chemo and its effects.

"Cold caps give patients some control," said Jeanne Silva, breast nurse navigator at the Carol G. Simon Cancer Center. "They can't control that they were diagnosed. They can't control that they need surgery. They can't control that they need chemotherapy. They might also need radiation. But they can try to save their hair. It gives them a little bit more power in a situation where they lose power."

Besides, Moorehead felt her black curly hair always has been one of her defining features and the thought of losing it, and possibly having it grow back straight, or even another color, upset her. She was ecstatic that she did keep all her hair, though it was slightly thinned and gray since, she said, no hair coloring, products, or cutting is allowed for the duration of the chemo treatments.

"I wanted my hair," she said. "I work with children and I was concerned about going to school and working with kids. My not having hair would upset them. They wouldn't know who I was. Also, my own children, who are teenagers, didn't want me looking different. They wanted me to look like everyone else's mom when I picked them up."

According to Silva, some patients decline using a cold cap because it's a lot of work and because they don't like the idea of potentially having breast cancer metastasizing to scalp cells that didn't receive as much chemo.

"There's always that fear that you're preventing chemotherapy drugs from getting to the scalp," Papish said, "but there has been a randomized trial showing it's safe. The likelihood of a scalp recurrence in breast cancer is extremely rare."

The patients chosen to participate in the clinical trial with the Orbis Paxman Hair Loss Prevention System machine, he said, are at particularly low risk for metastasis to the scalp.

Lorraine Ash: 973-428-6660; lash@njpressmedia.com

Learn more

• For more about Penguin Cold Caps, call Geralyn Pewarchie, 810-359-5257

• For financial assistance with Penguin Cold Caps, visit www.ccaps.org

• For general information on use of cold caps at the Carol G. Simon Cancer Center, contact Jeanne Silva, 973-971-6175 or Jeanne.Silva@atlantichealth.org

• For information on the Orbis Paxman Hair Loss Prevention System clinical trial in Morristown, contact Michelle Mackenzie, 973-538-3593, ext. 2338 or mmackenzie@regionalcancercare.org