A Publication of WTVP

Following in her father’s footsteps, Dr. Jessica Alameda Guingrich became interested in practicing medicine at an early age. After attending Purdue University and the University of Illinois College of Medicine at Peoria, Dr. Guingrich fulfilled her residency at the University of Wisconsin Hospital and Clinics and completed her fellowship at the Susan G. Komen Breast Center in Peoria.

As Medical Director for the Breast Imaging section of the Susan G. Komen Breast Center, Program Director for the Center’s Breast Imaging Fellowship, active staff of OSF Saint Francis Medical Center and Clinical Assistant Professor at her alma mater—the University of Illinois College of Medicine at Peoria, Dr. Guingrich always stays busy. Aside from her many professional positions, she also holds membership in numerous medical societies and serves on several professional committees. Her continued work in the advancement of breast health has helped her attain the position of Medical Advisor for U-Systems in San Jose, California, specifically for the SomoVu Automated Breast Ultrasound equipment.

While practicing medicine in Peoria, Dr. Guingrich resides in Peoria Heights with her husband, Rich, and four children: Ashley, Richie, Chelsea and Maggie.

Tell about your background, family and education, including who or what influenced you to go to medical school.

I was born and raised in Peoria by my parents, Dr. Jay and Jeannine Alameda, and grew up with three other siblings. I attended Mossville Grade School and Bergan High School, and with strong family roots in Peoria, I always felt that no matter where I moved for college and other higher education, I would eventually return to Peoria to be near family. I moved back to Peoria in 1999 after completing college, medical school and residence. Since then, I have been working as a full-time radiologist with Central Illinois Radiological Associates, Ltd. I completed a Breast Imaging Fellowship in 2000, and have been the medical director of the Breast Imaging section at the Susan G. Komen Breast Center and OSF Saint Francis Centers for Breast Health since June 2005. I am married to a fantastic, supportive husband, Richard M. Guingrich (Rich), who is a stay-at-home dad for our four children.

During both grade school and high school I developed an interest in medicine, as my father, Jay C. Alameda, M.D., was a practicing orthopedic surgeon in Peoria. With family background in medicine and a strong personal interest in science, I decided to pursue biomedical engineering with plans to obtain a Bachelor of Science in engineering followed by a Doctorate of Medicine. I attended Purdue University in West Lafayette, Ind., where I completed my bachelor’s degree in chemical engineering. I had summer internships at Caterpillar in Peoria and at Kimberly Clark in Neenah, Wis. during my undergraduate years. While at Purdue, I participated in research within the chemical engineering department, working with polymers and drug release systems which spurred my interest in biomedical engineering research.

I then attended medical school at the University of Illinois College of Medicine at Peoria. During those years, my interest swayed from biomedical engineering research to clinical medicine. After medical school, I attended residency at the University of Wisconsin in Madison, at which time I completed an internship in surgery followed by four years in radiology. My ultimate decision to pursue radiology was due to my strong technical background in engineering.

During my last year of medical school, I met my future husband, Rich, on a blind date. He was also born and raised in Peoria and was currently working at Caterpillar. A year later we were married, and he moved to Madison to be with me as I completed my radiology residency. During our five years in Madison we had two children, Ashley (now 11) and Richie (now 8). With both of us having family in Peoria, we knew that we ultimately wanted to raise our family back home after my residency.

After completing my radiology residency, we moved back to Peoria in 1999. At this time, I joined Peoria Radiology Associates, P.C. (now Central Illinois Radiological Associated, Ltd.) and also pursued a fellowship in breast imaging at the Susan G. Komen Breast Center in Peoria. With two children and plans for more, Rich and I decided that it would be best for him to be a stay-at-home dad. We then had two more children, Chelsea (now 5) and Maggie (now 3).

Tell about your current position as medical director for the Breast Imaging section of the Susan G. Komen Breast Center.

After completing my Breast Imaging fellowship in June 2000, I became one of three breast imagers at the Susan G. Komen Breast Center. I then became medical director for the Breast Imaging section in June 2005. As such, I coordinate with OSF Saint Francis Medical Center administration, staff at the Susan G. Komen Breast Center and OSF Saint Francis Centers for Breast Health and other radiologists and breast imagers within Central Illinois Radiological Associates. I am also the program director for the Breast Imaging Fellowship and have been since July 2001.

It is very rewarding to direct such an all-inclusive breast center with a staff who has experience and passion for what they do. Our Breast Center has years of expertise, as it began in 1990 with many of the staff pioneers of our center. In 2001, the Breast Center moved to its current location within OSF Saint Francis Center for Health off Route 91 in north Peoria. With this facility and our four additional mammography screening sites, we are able to provide this comprehensive service to patients throughout the area. We were the first facility in central Illinois to have full-field digital mammography, a service we have been providing since 2001. It has given us years of experience above our competitors. We are also the first in Illinois to offer a comprehensive breast center program, which began in 2003. This program provides a service in which patients who have been diagnosed with breast cancer meet at the center with a breast surgeon, radiation oncologist and/or medical oncologist, plastic surgeon and other breast experts to discuss their breast cancer management. In addition, we are also the first to offer a High Risk for Breast Cancer screening program—a program through which patients who have a high risk of developing breast cancer are provided closer monitoring and education.

Our comprehensive facility at the Susan G. Komen Breast Center also provides computer-aided detection, diagnostic mammography, breast ultrasound, SomoVu Automated Breast Ultrasound System, breast MRI, image-guided breast interventional procedures (which include ultrasound-guided core biopsy, stereotactic core biopsy, MRI-guided core biopsy, ductography, cyst aspiration and fine needle aspiration procedures) and bone densitometry. Fellowship-trained breast imaging radiologists are on hand to interpret studies and perform interventional procedures. Our dedicated nurses and clinical breast care coordinators have years of expertise in providing patient education and support services for those diagnosed with breast cancer. As an experienced team, we feel fortunate to provide this service and are driven to provide the best in patient care and to remain on the cutting edge of technology.

How has early diagnosis affected the outcome for women in the past ten years?

Early detection and treatment of breast cancer have undergone significant changes over the past decade. More women are aware of the importance of annual mammograms in early detection of breast cancer, with an increase in percentage of women age 40 and over having annual mammograms. Earlier detection has allowed more breast conservation surgeries and fewer mastectomies with increased benefit from adjuvant chemotherapy for breast cancer treatment and prevention.

Over the past ten years there has been a decrease nationally in the number of deaths resulting from breast cancer, from approximately 44,000 in 1997 to 41,000 in 2006. This decline in breast cancer mortality is felt to be due to early detection and improvements in treatment. Likewise, the number of diagnoses of breast cancer has increased from approximately 182,000 new invasive cases in 1997 to approximately 215,000 new invasive cases in 2006. The breast cancer incidence rate increased more rapidly in the 1980s due to increased utilization of mammography. The increased number of diagnoses since that time has been primarily in women age 50 and older.

Mammography remains the gold-standard imaging tool for early detection of breast cancer. Recently, breast MRI has also become a useful tool in breast cancer detection. The American Cancer Society now recommends that women with a particularly high risk of developing breast cancer should get annual breast MRI scans with their yearly mammograms. Recent studies have shown that breast MRI appears to be more sensitive than mammography in detecting breast cancers. However, these scans also show more spots in the breast which may or may not be cancerous, leading to a higher false-positive rate. Therefore, these annual scans are only being recommended for certain high-risk patients. Patients at high risk or those concerned that they might be at high risk should talk to their physician or call the Breast Center and inquire about our High Risk for Breast Cancer Screening Program.

How closely do the radiologist, oncologist and surgeon work together to help a woman choose her treatment plan?

It is of utmost importance to have a multidisciplinary approach in managing patients with breast problems or abnormal mammograms, in assessing patients who are at a high risk for breast cancer and in diagnosing and treating those with breast cancer. In general, this approach utilizes a team of medical professionals including breast imaging radiologists, breast surgeons, pathologists, medical and radiation oncologists, plastic surgeons and clinical breast care coordinators/nurses to optimize patient care.

At the Susan G. Komen Breast Center and OSF Saint Francis Centers for Breast Health, we utilize a team approach in assessing patients with breast problems, abnormal mammograms or those who have already been diagnosed with breast cancer. We use state-of-the-art breast imaging technology and have the ability to perform necessary diagnostic procedures, including all forms of image-guided biopsies. We have a caring team of clerical staff, including schedulers who will try to expedite appointments and teams of experienced technologists who use compassion and are mindful of patient comfort. Our clinical breast care coordinators provide patient education, information about support groups, guidance for those in need of emotional support and many other important services for those undergoing biopsies and for those who have been diagnosed with breast cancer. We also have resources for those who are at high risk for developing breast cancer, including our High Risk for Breast Cancer Screening Program. Finally, we also work closely with referring physicians to ensure breast problems are managed as needed, both within our department and after patients leave our facility.

Once a patient has been diagnosed with breast cancer and referred to a surgeon, the radiologist works closely with the surgeon and pathologist to further diagnose the extent of cancer and provide any other diagnostic imaging tools as needed, such as breast ultrasound or breast MRI. The medical oncologist, radiation oncologist and plastic surgeon ultimately form a team with the breast surgeon to determine the best method of cancer treatment and breast reconstruction, if needed. This team approach can improve patient outcome by optimizing diagnosis, treatment and other management options needed to best serve those diagnosed with breast cancer.

You are a medical advisor for U-Systems in San Jose, Calif., for the SomoVu Automated Breast Ultrasound System. Tell about the effectiveness of this equipment in screening patients.

I was initially introduced to the Automated Breast Ultrasound System in 2003. Thanks to Operations Manager Vicki Cunningham, who has always been an advocate for pursuing technological advances in breast imaging, the Breast Center was able to move forward with this new technology. Our facility then became one of ten initial sites participating in the clinical trial for the system. This clinical trial began in October 2005 and continued until June 2007, during which time patients were enrolled and evaluated prospectively with this automated breast ultrasound system. I was then selected to present the results of the first phase of this trial at the Radiological Society of North America’s (RSNA) 2006 annual meeting held in Chicago.

The SomoVu Automated Breast Ultrasound is FDA-approved for diagnostic uses in breast imaging. It does not replace mammography but is currently being used as a diagnostic tool with mammography and may be particularly helpful in women with dense breast tissue. To obtain data, a screening is placed over the breast at different angles and a large transducer then moves over the breast, obtaining a three-dimensional volume of ultrasound data. Due to the automated manner in which data is collected, user variability which can occur with standard hand-held ultrasound units is removed. Because not all cancers are visible mammographically, particularly in women with denser breast tissue, it is hoped that this new technology will help to detect early cancers which might only be seen by ultrasound, ideally before they are felt on a breast examination. By serving as one of the medical advisors for U-Systems, I have been able to work with the company to optimize its features in hopes that this new technology might eventually serve as another important screening tool to detect early breast cancers.

This is a new technology which is just now entering clinical uses at different facilities worldwide. We are the first site in Illinois to have this new technology and are one of two sites in Illinois offering SomoVu Automated Breast Ultrasound, with the second site at Northwestern Hospital in Chicago. This new type of ultrasound technology may change the way breast ultrasound exams are performed, but more research is needed to investigate its utility in screening women with dense breast tissue.

Do you continue to do research here in central Illinois on imaging?

At this time I am not currently involved in any other breast imaging clinical trials. As medical advisor for U-Systems for the SomoVu Automated Breast Ultrasound System, our Breast Center has been involved in several on-site demonstrations for other facilities regarding this new technology. I am scheduled to present a second abstract for SomoVu at the RSNA 2007 conference in Chicago, which will discuss the use of the three-dimensional SomoVu ultrasound images for the identification and diagnosis of breast cancer. Our facility has also been selected to participate in an instructional seminar for the SomoVu Automated Breast Ultrasound System at this RSNA 2007 conference.

What are the most important changes a woman can make in her lifestyle to prevent breast cancer?

Although there is no way to avoid breast cancer, some healthy lifestyle choices may help lower one’s risk. Along with these lifestyle modifications, it is also important to perform monthly breast self-exams, annual clinical breast exams by a healthcare professional and annual mammography (starting at age 40).

Research has identified areas which may affect one’s risk of breast cancer. These factors include the following:

By following these life-modifying behaviors, these choices may also lower one’s risk of cancer as well as other diseases including heart disease, diabetes and osteoporosis.

Breast cancer can affect young women and men. What is the youngest age at which a breast cancer diagnosis has been made? How do males usually discover they may have breast cancer?

Breast cancers more typically occur in women over age 40 than in young women or in men. However, both young women and men can be diagnosed with breast cancer. Statistically, only five percent of all breast cancer cases occur in women under age 40, and less than one percent of breast cancer cases occur in men. However, it is important for one to be aware of personal risk factors for breast cancer. These risk factors include but are not limited to:

However, among women diagnosed with breast cancer, the majority of women (76%) have no risk factors. The biggest risk factor is simply being female.

Breast cancers diagnosed in younger women (less than age 40) are generally more aggressive and can result in lower survival. Statistically, these cancers are less common in the early 20s or teenage years but can occur. Since I began working at the Breast Center, the youngest woman diagnosed with breast cancer at our facility was age 23, although we have cared for other women who were previously diagnosed as young as 20. Review of other records at our facility indicates that we previously diagnosed an 18-year-old with a less common type of breast cancer; however this was a sarcoma rather than a more typical breast cancer, such as milk duct cancer.

Breast cancer can also occur in men of all ages, although typically men are diagnosed between ages 60 and 70. Radiation exposure, high levels of estrogen and a family history of breast cancer can increase a man’s risk of developing breast cancer. Men with breast cancer typically present a breast lump which can be felt. The majority of breast lumps felt in men, however, are due to a benign condition called gynecomastia (breast tissue development in a male) rather than breast cancer. The majority of breast cancers detected in men have imaging features similar to those detected in women and are most typically milk duct cancers. Men more typically undergo surgical treatment with a mastectomy rather than breast conserving surgery, or lumpectomy. It is very important for men to contact their physician if they feel a lump or have other symptoms of the breast.

What would you like our readers to know in regards to breast cancer screening and early diagnosis?

It is important to start yearly screening mammograms at age 40, to undergo an annual clinical breast exam and to perform monthly self-breast examinations. Annual mammography may be recommended sooner than age 40 depending on one’s family history of breast cancer. For instance, if one has a family history of pre-menopausal breast cancer diagnosed in a first-degree relative (i.e., mother or sister), annual mammography is typically recommended ten years prior to the age at which that relative was diagnosed. However, this recommendation can vary depending on the age at which that relative was diagnosed. Patients with a strong family history of breast cancer should consult their physician regarding when to start annual mammograms.

It is important to perform monthly breast examinations and for patients to contact their physician if they notice a change in their breast exam. Although mammography often detects small cancers which are too small to be felt, approximately 10 to 15 percent of cancers may not be detected mammographically. Furthermore, some breast lumps that are felt may not be seen in mammography. Therefore, it is important that breast exams are performed in conjunction with mammography to help optimize detection of breast cancer.

It is also important to understand that breast cancers can have many different clinical presentations. For instance, although most breast cancers are not painful, approximately 11 percent of women with breast cancer can experience breast pain as a symptom. Therefore, breast pain should be evaluated by a physician. Women who might have symptoms of mastitis (redness, pain or bloody discharge) should be evaluated further if their symptoms do not resolve with antibiotic treatment, as certain cancers can cause similar symptoms as mastitis. Other breast symptoms which should be evaluated include breast thickening, swelling, distortion, skin irritation, dimpling and nipple symptoms (including pain, scaliness, ulceration, retraction or spontaneous nipple discharge). If you notice a change in your breast self-exam or are concerned about a breast problem, please contact your physician so you can be scheduled for a diagnostic breast examination. TPW