High-Tech Mammograms Improving Breast Cancer Care
The mammogram is changing for the better, say experts trained in breast imaging.
New computer-driven technologies should make the yearly exam more accurate and easier on patients than ever before.
High-tech computer-based digital mammography is already available at about 10 percent of diagnostic centers in the country and growing steadily, says Priscilla F. Butler of the American College of Radiology Breast Imaging Accreditation Programs.
While filmless mammography does not feel any different to women while they are being screened, physicians are discovering that there are benefits for particular patients.
A study of more than 40,000 women published last fall found that compared with standard mammograms, computer-based digital "pictures" were more beneficial for over half the women.
The study is called the American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial.
The findings note that younger women with dense breast tissue, those under 50, and those who are premenopausal would benefit most from digital mammograms.
The range was so large that some physicians have since concluded that dense breast tissue in all groups is better seen with the help of a computer.
"In other situations, it is probably no different [than film]," says Dr. Carl D'Orsi, co-chairman of the American College of Radiology Breast Imaging Commission.
Other technologies are on the horizon. Researchers say a new technology called Cone Beam Breast Computed Tomography (CBBCT) promises to equal or surpass mammography in detecting breast cancer.
The CBBCT scanner takes a number of pictures of the breast from various angles then merges them into one three-dimensional image.
This pilot study used the CBBCT scanner to image 20 volunteers who had had normal mammograms, as well as a group of women who had had abnormalities detected during a physical exam or who had had suspicious mammograms.
The goal of the study was simply to see how well the CBBCT could image the breast.
The CBBCT proved itself at least as good as conventional mammogram in imaging the breast, say the report’s authors.
The system also has the advantage of being more comfortable. The woman lies on her stomach on a cushioned exam table with a cutout in the middle.
She suspends her breasts one at a time through the cutout while the CBBCT takes 300 images in the space of about 10 seconds. The radiation dose is comparable to that of mammography.
Unlike conventional mammography, the CBBCT system clearly displays tissue around the ribs and outer breast near the armpits.
The pilot study will continue until 60 participants have been imaged. A larger trial is planned for next year.
Dr. Joshua Kalowitz, chief of breast imaging at Maimonides Cancer Center in Brooklyn, New York, says there are hopeful technologies on the horizon.
"Five years from now, we'll be in a lot better shape, but right now, we have to see which ones will end up being the best," he notes.
Computerized mammography does have its drawbacks - at least for now. Dr. D'Orsi says there are so many options for setting up and reading the computer images that physicians are somewhat slower at determining their results.
"There's a learning curve to it because it's new, but you get faster and faster," explains Dr. D’Orsi, who is director of the Breast Imaging Center at Emory University in Atlanta.
But Dr. D'Orsi cautions that the most important thing is not the technology itself, but the person reading the results.
And, the National Cancer Institute (NCI) warns women not to wait for the new technology. The guidelines in place for several years still apply:
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Women in their 40s should have mammograms every one to two years.
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Women 50 and older should be screened every one to two years.
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Women who are at higher than average risk of breast cancer should seek expert medical advice about whether they should begin screening before age 40 and the frequency of screening.
Always consult your physician for more information.
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A screening mammogram is an x-ray of the breast used to detect breast changes in women who have no signs of breast cancer.
It usually involves two x-rays of each breast. Using a mammogram, it is possible to detect a tumor that cannot be felt.
A diagnostic mammogram is an x-ray of the breast used to diagnose unusual breast changes, such as a lump, pain, nipple thickening or discharge, or a change in breast size or shape.
A diagnostic mammogram is also used to evaluate abnormalities detected on a screening mammogram.
It is a basic medical tool and is appropriate in the work-up of breast changes, regardless of a woman's age.
Mammography has been used for about 30 years, and in the past 15 years technical advancements have greatly improved both the technique and results.
Today, specialized equipment, used only for breast x-rays, produces studies that are high in quality but low in radiation dose.
Mammography may be used either for screening or to make a diagnosis.
Women older than 25 years should undergo diagnostic mammography if they have symptoms such as a palpable lump, breast skin thickening or indentation, nipple discharge or retraction, erosive sore of the nipple, or breast pain.
A mammogram may be used to evaluate breast pain when physical examination and history are not conclusive.
Women with breasts that are dense, "lumpy," and/or very large may be screened with mammography, as physical examination may be difficult to perform.
Women who are at high risk for breast cancer or with a history of breast cancer may be routinely screened with mammography.
Always consult your physician for more information.
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