Tuesday, December 15, 2015
- Finding and removing what appear to be precancerous breast lesions saves lives.
- Advances in imaging technologies make clearer and safer visualization of breast tissue possible. Several new approaches are being adopted at MSK and elsewhere.
- Women at average as well as high risk for breast cancer can benefit from these advances.
For early detection of breast cancer, being able to visualize what’s going on inside a woman’s breasts makes a crucial difference. The greater the detail, the more likely it is that doctors can spot tissue thickening or other unwanted changes at an early stage, when the area can be removed completely and efficiently. Catching these problems early, before potentially cancerous cells have a chance to grow or spread, is critical.
“This is a time of rapid and exciting change in breast cancer screening,” explains Memorial Sloan Kettering Breast Imaging Service Chief Elizabeth Morris, who also serves as President of the Society of Breast Imaging. “New technologies are generating images that are clearer and more detailed than ever before. This means we’re more likely to make decisions that are right for our patients.”
Major enhancements to digital mammograms are under way for women at average, increased, or high risk for breast cancer and are now available across much of the country. MSK has pioneered the development of a number of these new screening technologies, Dr. Morris explains.
Major Advance: Screening with Contrast-Enhanced Digital Mammography
MSK was one of the first institutions in the United States to investigate contrast-enhanced digital mammography (CEDM). By injecting a harmless dye into certain areas of the breast during a digital mammogram, doctors can view more detail than would otherwise be possible.
“CEDM is a potentially low-cost way to screen women at average risk for breast cancer,” says Dr. Morris. “It also appears to produce fewer of the false-positive readings that can be so distressing for patients.”
Time and research will tell the fuller story, she adds, as the technology is still relatively new and we don’t yet know which patients it should routinely be used for. “For example, it might have a role in screening the average-risk woman with dense breast tissue that can obscure a cancer.”
For women at increased risk for breast cancer, initial findings indicate that CEDM can help doctors identify cancer as accurately as more expensive — and less widely available — MRI technology. For women already diagnosed with breast cancer, CEDM is recognized as equal to MRI in producing accurate, high-quality results.
Someday soon, she adds, “there may be a role for CEDM in replacing the MRI screening we currently use in women at high risk for breast cancer. Clinical trials are under way to figure this out.”Back to top
Another Key Development: Screening with Digital Breast Tomosynthesis
According to Dr. Morris, one of the most promising breast cancer screening technologies is digital breast tomosynthesis. This approach, already embraced by MSK and adopted in more than half of imaging centers nationwide, looks and feels similar to digital mammography in many ways. But the images it produces are dramatically better.
Instead of capturing a picture of the entire breast at once, tomosynthesis generates an image using multiple very thin pictures or slices of tissue that build the view of the breast. The approach is so effective because it avoids clouding the image with overlapping tissue.
Studies indicate the technique is 30% more accurate in finding early breast changes than digital mammography, and also greatly reduces the number of distressing false-positive readings. It’s effective for people at all levels of risk, regardless of the density of the breast tissue. If an area of abnormality is identified, doctors can use tomosynthesis to perform a needle biopsy either right away or once a woman has had a chance to process the information that something was found.
The downside to digital tomography is that it’s usually more expensive for patients, and not all insurers currently cover the cost.
Dr. Morris adds that “the holy grail is the combination of these two technologies in a format called contrast tomosynthesis. MSK hopes to start studying this approach through clinical trials in 2016.”Back to top
Other Notable Developments for Women at Increased Risk
In MSK’s Risk Assessment, Imaging, Surveillance, and Education Program, our experts create a personalized, long-term surveillance plan for women at increased risk for breast cancer that takes multiple factors into account. These include any hereditary predisposition to breast cancer and whether you’ve ever received radiation to the chest area.
Read about screening guidelines that Memorial Sloan Kettering researchers have developed and find out if you are at an average or increased risk.
Also at MSK, breast radiologist Chris Comstock is leading a clinical trial investigating ways to slash the time it takes to do an MRI of the breast from approximately 30 minutes to 5 to 7 minutes. “If the results are favorable,” Dr. Morris says, “we’ll have a screening test that’s more tolerable — and cheaper — for women undergoing this test for screening or even diagnostic purposes.”
Lastly, as researchers discover new procedures that reduce the amount of radiation women are exposed to, nuclear imaging of the breast may soon be possible as a screening tool for women at elevated breast cancer risk, according to Dr. Morris.Back to top