Better Odds Against Breast Cancer

 However vigilant women are in watching for early signs of breast cancer, there are always those heart-stopping moments when everything goes awry. A dear friend of mine in her 40s who had gone with great discipline for a mammogram each year, who had no family history of the disease, and who kept herself astonishingly healthy and fit just called to tell me she’s been diagnosed with a malignant breast tumor that will have to be removed. Lumpectomy or mastectomy, it’s not clear yet, but the doctors have said she will need radiation and chemotherapy, as well as follow-up scans over the years. Two things are true -- her prognosis is fairly good, and her life is forever changed. Every time I hear a story like this, any of us hear a story like this, the question is asked, Why isn’t there some way to detect the presence of cancer earlier? Well, however frustrating the timing is given my friend’s diagnosis, it seems that there finally is some new and better technology on its way.

If you’re a health-conscious woman age 40 or over, chances are you, like my friend, make a yearly pilgrimage to your doctor’s office to have your breasts squashed between two plastic plates. It’s not fun, it’s a little uncomfortable, but it only takes a few minutes, and 40 million of these mammograms are performed in the US each year -- resulting in the detection of 80% to 90% of all breast cancers.

Now, there is promising new technology that was approved by the FDA in February of this year called breast tomosynthesis -- or, more commonly, "3D" mammography, and while there are still questions to be resolved, there is also great hope that this new development will help physicians diagnose breast cancer with even greater accuracy. I’ll explain how they hope to do that.

7% GREATER IMPROVEMENT IN DETECTION

FDA approval was based on two studies that asked radiologists to review more than 300 mammograms using traditional 2D mammography alone or a combination of 2D and 3D imaging. The radiologists who viewed both 2D and 3D images were 7% more accurate in their diagnoses than those who viewed only 2D. Doctors get a greater sense of depth with 3D mammography, explains Ellen B. Mendelson, MD, a professor of radiology at Northwestern University Feinberg School of Medicine and section chief of breast imaging at Northwestern Memorial Hospital in Chicago.

Regular 2D technology captures a compressed image of the breast. In contrast, 3D mammography images a series of thin "slices" of the breast from different angles, which a computer processes into a 3D image that the radiologist can manipulate. 3D mammography is performed along with regular mammograms, at the same time on the same scanning machine. Resulting advantages are...

• Better detection. 3D mammograms can help radiologists pin down the size, shape and precise location of abnormalities... compressed 2D images tend to obscure these details.
• Increased accuracy.There are fewer false-positive diagnoses with 3D mammography. The technology can help distinguish harmless growths from cancerous tumors by revealing more detail about irregularities. Some subtle changes are more easily observed in the thin slices that comprise the tomosynthesis exam.
• Reduced recalls and less anxiety. Improved accuracy spares many women the anxiety of being called back for further testing (for more scans or biopsies) when results are uncertain. The test still requires the flattening of the breasts so many women object to, but what a small price to pay for your health and your life!

A LINGERING CONCERN: RADIATION EXPOSURE

On the negative side, 3D mammograms expose women to additional radiation due to the dual 2D and 3D test. The amount is low, but all radiation exposure is cumulative, and we should always be aware of it, notes Dr. Mendelson. That said, the dose of the combined imaging is under the FDA limit for mammography, and the agency ruled that the benefits of the additional diagnostic information to radiologists outweigh the potential health risks from additional radiation exposure. Dr. Mendelson says that 3D mammography is currently most useful for women with dense breast tissue and for those who have already had breast cancer, but eventually it may be used by all women.

At present, 3D mammography is available at a limited number of medical centers -- Mass General in Boston, which spearheaded the research, is one, and more hospitals will be offering the procedure soon. Right now, many of the sites offering the procedure are doing so only in clinical trials... and pricing and insurance coverage is being worked out at this moment also.

While questions remain, Dr. Mendelson believes that when 3D mammograms are available in your area and your doctor recommends one, you should go ahead and have it. Keep in mind, however, that at this time 3D mammography is meant to complement -- not replace -- standard 2D digital mammography.

Anything that improves chances of detecting breast cancer by another 7% is reason for hope. That 7% might have given my friend the edge she needed to catch her tumor while it was still tiny and much more easily removed.

Source: Ellen B. Mendelson, MD, FACR, chief, section of breast imaging, Northwestern Memorial Hospital, and professor of radiology, Northwestern University Feinberg School of Medicine, Chicago.

 

 

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Publication                               Daily Health News

Original publication date                  May 24, 2011

 http://www.bottomlinepublications.com/content/article/health-a-healing/better-odds-against-breast-cancer