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The Future of Breast Cancer Screening

An array of high-tech detection techniques and devices is on the scientific horizon.

Digitial Mammography

Digital mammography, which takes the X-ray image on computer rather than on film, is gradually becoming available. There are now about 300 such units in use around the country, according to the American Cancer Society.

The instrument "offers enormous potential" because the pictures can be manipulated, says Robert A. Smith, PhD, head of screening at the American Cancer Society.

Much like digital photographs currently taken by consumer digital cameras, breast images taken by digital mammography can be magnified, and the resolution can be adjusted to get a clearer picture.

While easier to use, digital mammography is not more successful at finding cancers than traditional mammograms -- and the cost of each machine tends to be prohibitive.

Computer-Aided Detection Devices (CAD)

Smith says the digital imaging technology could especially improve with better-programmed computer-aided detection (CAD) devices, which are now used by some labs to analyze standard mammograms and act as second-opinion readers for radiologists.

Early tests show CAD can help point out cancers otherwise missed by experts. Yet there is an ongoing debate about whether a machine can sufficiently replace a second radiologist in reviewing test results.

Ultrasound

Medical experts who want to evaluate problems first found during a mammogram or a physical exam often turn to ultrasound technology. An ultrasound device releases sound waves into the body, and creates a picture of the breast from the bouncing back of the waves. The idea is that sound echoes differently of off masses of various consistencies, such as fluid-filled cysts, solid tumors, or normal tissue.

Ultrasound has been around for decades, but improvements to the technology promise to make it more helpful in looking for cancer. One advance of note is still in the experimental stages: an ultrasound that takes 3-D images of the breast as opposed to 2-D ones.

MRI

Another breast detection technique that scientists have gradually enhanced over the years is magnetic resonance imaging (MRI). In this method, a large magnet, radio waves, and a computer work together to produce what experts consider a very clear, cross-sectional picture of the breast. Furthermore, experts can examine specific areas by injecting a dye in the veins, which collects in problematic tissues, making them more visible in the MRI picture.

Similar techniques are now under investigation, such as magnetic resonance elastography (MRE), which draws an image of the breast based on the elasticity of vibrating tissue.

Toward a Better Image (of Breasts)

Many methods to check for breast cancer are still experimental right now. Often, women at high risk of developing the disease turn to clinical trials of these imaging devices in an effort to ease their concerns.

Some of these experimental methods are:

  • Positron emission tomography (PET). This technology makes use of the notion that a tumor has a higher metabolism than normal tissue. When a radioactive substance is injected into a patient's vein, it travels to rapidly dividing cancerous cells, which have greater nutrient needs. Ideally, a PET scanner would detect the activity and produce an image of it.

     

  • Ductal lavage and ductoscopy. The idea behind these two methods is that certain cancers begin in the milk ducts of the breasts. In ductal lavage, a catheter is inserted through the nipple and into the milk ducts. A saline solution is emptied into the ducts, and then withdrawn. Then the cells washed out from the ducts are checked under a microscope. In ductoscopy, a catheter with a light at the tip is inserted through the nipple into the ducts and a dye is injected. The dye outlines the shape of the duct and an X-ray ideally shows whether there is an abnormal growth in the area.

     

  • Electrical impedance spectral imaging (EIS). Low-frequency electrical currents are applied to the breast, and an image is formed based on the theory that normal tissue and cancerous masses conduct electricity in different ways.

     

  • Microwave imaging spectroscopy (MIS). This device uses microwave energy that is similar to cell phone frequencies (but at a much lower level). The technique is particularly sensitive to water, and can detect areas where there is more of it. Tumors are thought to have more water and blood than regular tissue.

     

  • Near infrared (NIR) spectral imaging. This method is based on the idea that infrared light is sensitive to blood, creating an image of hemoglobin inside the breast. Knowledge of vascular activity is believed to help spot early tumor growth, and determine its stage.

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