Best Doctors 2013: New Dimensions

Armed with detailed 3-D mammograms, University Hospitals' Dr. Donna Plecha is taking the breast cancer fight to the next level.

For Donna Plecha, treating breast cancer isn't just part of her job — it's personal. Her mother and three of her aunts were all diagnosed with the disease.

"My mom was diagnosed the youngest, and caught it herself, but my aunts waited too long, and were in denial about it," says Plecha, the director of breast cancer imaging at University Hospitals Seidman Cancer Center. All three of her aunts ultimately died as a result of the cancer.

The memories of those experiences motivate Plecha daily. "It just makes me think about myself, my sister, my cousins, and my patients more," she explains. "I'm passionate about finding ways to improve detection."

A few years ago, Plecha learned about a burgeoning technology called tomosynthesis mammograms, which produces a 3-D image of the breast. A roving camera takes 15 consecutive images of the breast from different angles that are then used to produce a 3-D rendering. Doctors can then slice or expand a particular image to study it further, looking for cancer, lesions or suspicious shadows.

Plecha was so intrigued by the new technology she sought out the original designers of tomosynthesis mammograms, Hologic, based in Bedford, Mass., and volunteered University Hospitals to be one of the company's first testers in 2010.

The results spoke for themselves. Among University Hospitals patients, the tomosynthesis mammograms helped detect about 50 percent more cancers, and also resulted in a 15 percent decrease in the number of people who had to be called back for a second round of screening because of a shadowy or unclear first mammogram.

About 70 percent of all patients diagnosed with breast cancer have no family history of the disease.

"This is really a breakthrough," says Plecha. "We've been able to find small invasive cancers that we might not have found before. And we've found them early, so we're able to treat and cure them effectively."

While doctors throughout the country began gathering data on the effectiveness of 3-D mammograms in the fight against cancer, Plecha became involved in a different battle. In late 2009, the U.S. Preventive Services Task Force announced a new set of guidelines, calling for women to begin getting annual breast cancer screenings at age 50 — a full 10 years later than the American Cancer Society and many doctors recommended screenings begin.

According to the government panel, there were only "negligible" benefits of starting screenings at age 40, and the amount of false positives and unnecessary biopsies were not worth the anxiety and cost it caused women.

Plecha strongly disagreed with the group's assessment. So she and a group of specialists decided to look at statistics from 2008 to 2011 and compare the diagnoses between two groups of women ages 40 to 49 treated at University Hospitals Case Medical Center. One group had been screened for breast cancer and one had not. Plecha says those findings, which will be published in the American Journal of Roentgenology later this year, show that breast cancer patients who'd undergone mammography "were diagnosed at earlier stages with smaller tumors" than those who hadn't been screened.

"Our goal is to pick up cancers as early as we can to treat them," says Plecha. "I don't know how you could argue differently."

Plecha has moved on to her next area of study: determining whether the PET/MRI machine, which combines the anatomic detail of an MRI with the PET scan's measurements of metabolic changes in organs and tissues, could be used to diagnose breast cancer at earlier stages. Currently, PET/MRI scans are used mostly to diagnose heart problems and brain disorders. But Plecha thinks the test can be just as successful in catching breast cancer at its beginning stages, when it's most treatable.

"It's an area I'm really excited about," Plecha says. "There are very few people that have not known somebody with breast cancer. If I can find breast cancer early and save lives, that is what keeps me passionate about what I do."

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