The Latest in Breast Cancer Detection

New breast screening technologies are offering women more individualized care -- and a better chance at survival.

From the WebMD Archives

There is more hope for better diagnosing breast cancer thanks to new technologies.

Advances in screening technologies -- including digital mammograms -- combined with a better understanding of who is at highest risk means doctors are able to find cancers earlier -- and prevent more women from dying.

"The fact that you cannot argue with is that breastcancercancer mortality has declined by 24% in the past 10 years -- and a lot of that is due to early detection," says Carol Lee, MD, chairwoman of the Commission on Breast Imaging for the American College of Radiology and professor of diagnostic radiology at Yale University School of Medicine.

But it's not just screening advances helping to save lives. Experts say what also matters is learning more about the disease itself and who is at greatest risk.

"We are broadening our scope of the factors leading to the development of breast cancer, so we can now determine with far more accuracy not only who is at risk for this disease, but who is best served by various screening techniques, including the newest advances," says Julia A. Smith, MD, director of Breast Cancer Screening and Prevention at the NYU Cancer Institute in New York City.

Risk and Screening: The New Links

Experts say that most women are familiar with at least some of the common risk factors for breast cancer: A first-degree relative who has the disease, for example, or excessive use of alcohol.

But now new research is shedding light on many more individual factors, and in doing so driving both screening and treatment toward a more individualized approach.

"I think one of the biggest advances we are seeing now is this move towards individualized care, particularly when it comes to screening -- we are getting better at determining which options are right for which women, and that's a huge step forward," says Therese B. Bevers, MD, associate professor in the department of clinical cancer prevention and medical director of the Cancer Prevention Center and Prevention Outreach Programs at the University of Texas M.D. Anderson Cancer Center in Houston.

One curriculum pioneering this approach is the Lynne Cohen Breast and Ovarian Cancer Preventive Care Program. Currently available in four major cancer centers across the United States, including Los Angeles, Houston, Birmingham, Ala., and New York City, the goal is to identify more personal risk factors for breast cancer and use that information to create individualized programs of defense and prevention.

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Smith, who directs the program at the NYU Cancer Institute, tells WebMD that knowing your risk factors is one way to ensure you get the appropriate screenings at the correct stages of your life.

"Thanks to programs like this, we have begun to understand family history in a much better way -- what is really relevant, what needs to be included and considered, what points to a specific genetic mutation or inherited syndrome -- and most importantly, what other types of cancer in the family put a woman at risk for breast cancer and what we can do to monitor those risks appropriately," says Smith.

Getting Screened

Of course proper screening is crucial in detecting breast cancer. Though mammogram remains the most recommended choice, there are a number of newer options out there.

When it comes to advances in screening technology itself, some experts say digital mammography is at the top of the list.

In much the way digital cameras changed the face of our family photo album, doctors say that so, too, does digital mammography have the potential to reshape the face of breast imaging.

"The experience for the woman -- and the machine itself -- are largely the same; but what the digital does is allow contrast manipulations and other types of computerized enhancements to give us a better, clearer picture of what is going on in the breast," says Lee.

Experts like Etta Pisano, MD, who directed the largest clinical trail to date on digital mammography, says this clearer picture will help doctors discover many more cancers at an earlier, more easily treated stage.

"We did both digital and film mammograms with a year follow-up on 42,760 women -- and we found that digital mammography was better at finding cancers in women under age 50, in women with dense breasts, and in pre- and perimenopausal women," says Pisano, director of breast imaging at the University of North Carolina School of Medicine.

Though there are no studies showing digital mammography saves lives, Pisano tells WebMD that "the kind of cancers we found are the kind that kill women, so we're pretty sure digital mammography has lifesaving potential."

On the downside, it doesn't provide any advantage for postmenopausal women -- those with the highest rate of breast cancercancer. And it is expensive, with equipment costing up to five times that of traditional mammography. That said, Lee explains that for the right woman, it can make an enormous difference.

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Computers and Breast Screening

Further expanding on computer imaging is an advance known as CAD. Lee says CAD uses information stored in a database to highlight areas on any breast image that may require a second look -- including those taken by standard mammography.

"It has been shown that using CAD will increase cancercancer detection rate; it will cause a few more false positives, but it also picks up more cancers," says Lee.

While not all facilities use CAD, Lee suggests women ask before they make their appointment, adding that "it could be especially important if you are at high risk."

A Bigger Slice of Life

Among the very newest screening techniques undergoing testing is "tomosynthesis." Using a form of digital mammography, it works to create a three-dimensional picture of the breast, allowing doctors to see between layers of tissue.

"Not only does this appear to yield improved detection, but it will hopefully reduce the number of 'false callbacks' -- and that can help reduce a lot of anxiety," says Lee.

Digital tomosynthesis is currently being tested at several major medical centers including NYU, Yale, and Duke. It may become more widely available for testing in the near future.

Another up-and-coming advance, says Lee, is positron emission mammography, or PEM. It involves injecting the body with a small amount of radioactive tracer dye, which is used by the PEM scan to image the breast.

"All these extra imaging techniques are not meant to replace mammogram but rather act as extra tools for women at increased risk, and in some instances, to help avoid unnecessary biopsies," says Lee.

What's in, Out, and in Question

Among screening procedures once considered important but now out of favor is ductal lavage. Here, doctors flushed fluid into the milk ducts and analyzed it for presence of abnormal cells to help determine risk of breast cancer.

The problem, says Lee, is that a negative result didn't always mean you were OK. "We realized this test is pretty pointless, and it's rarely done anymore," says Lee.

Also sharing some doubt is breast ultrasound. Although it's a safe and gentle way of imaging tissue without radiation, because it was found to miss at least some of what is seen on a mammogram it, too, fell out of favor as a breast cancercancer screening tool.

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But now new clinical trials are showing ultrasound may be effective in detecting some abnormalities missed by a mammogram.

Bevers says it remains an especially important diagnostic tool for breast cystscysts (fluid-filled sacs) -- and may help some women avoid a biopsy.

Still, experts say it can result in false positives when imaging other types of breast lesions, and in these instances, may increase the risk of unnecessary biopsies.

Meanwhile, all the experts we talked to told WebMD that right now, nothing beats a mammogram as an initial screening tool.

Says Lee: "Even if your facility does not offer digital mammography or any new advances, get a mammogram -- this is still the best method we have for breast cancer screening."

WebMD Feature Reviewed by Louise Chang, MD on October 03, 2007

Sources

SOURCES: Carol Lee, MD, chairwoman, Commission on Breast Imaging, American College of Radiology; professor of diagnostic radiology, Yale University School of Medicine, New Haven, Conn. Julia A. Smith, MD, PhD, director, Breast Cancer Screening and Prevention; director, Lynne Cohen Breast Cancer Preventive Care Program, NYU Cancer Institute, and Bellevue Medical Center, New York City. Therese B. Bevers, MD, associate professor, department of clinical cancer prevention; medical director, Cancer Prevention Center and Prevention Outreach Programs, University of Texas M.D. Anderson Cancer Center, Houston. Etta Pisano, MD, professor of radiology and biomedical engineering; chief of breast imaging, the University of North Carolina School of Medicine, Chapel Hill, N.C.

© 2006 WebMD, Inc. All rights reserved.

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