By Jeffrey B. Roth
Early detection of breast abnormalities saves lives, said Dr. Douglas Yee, director of the Masonic Cancer Center at the University of Minnesota and spokesperson for the American Association for Cancer Research. Breast cancer diagnostic tools available more than five years ago included manual breast exams, traditional mammograms, manual ultrasound examinations and MRI. With the recent addition of Automated Breast Ultrasound (ABUS) imaging, especially for women with dense breasts, physicians can access another sophisticated weapon in the arsenal used in early detection of breast cancer.
Prior to the introduction of ABUS, manual ultrasound breast examinations offered a noninvasive, non-radiological imaging system that provided a better opportunity to identify breast abnormalities in women with dense breasts, Dr. Yee said. The tool’s efficiency, while better than mammography when examining dense breast tissue, was dependent upon the imaging technician.
“The major challenge around technology relates to its reliability,” Dr. Yee said. “While the hand-held guided ultrasound was good, it was very operator-dependent. The automated machine has the potential to get around the problem.”
Where we are
Ultrasound imaging technology is radiation-free; it does not require breast compression and it provides 3D imaging, compared to mammograms, which are 2D images, Dr. Yee said. ABUS offers physicians “a fabulous opportunity to identify breast cancer in early screenings.”
Last May, Evangelical Community Hospital’s Thyra M. Humprheys Center for Breast Health announced the acquisition of the GE Healthcare somo-vTM ABUS Platinum system, considered to be one the best devices for imaging of women with dense breasts, said Dr. John F. Turner, FACS, clinical co-manager of the center. The technology has been around more than five years, but it has been refined since first introduced as a diagnostic imaging tool.
“Before this, we did not have a clear indication for the breast density issue,” Dr. Turner said. “The reality is that when a mammogram has better than 50-percent background density, there is a risk of missing a cancer on that study. We're talking about 50-percent of women, 40 and over, who have significant density; specifically heterogeneous density of 50 to 75 percent; or severe density of 75 percent and over.”
What we know
Dr. Turner noted that a 2007 study reported in the New England Journal of Medicine found that “mammographic density is associated with an increased risk of breast cancer and makes the detection of cancer by mammography difficult;” and “mammography sensitivity is significantly reduced in women with dense breasts, as density masks the appearance of tumors. As breast density goes up, the accuracy of mammograms goes down. Studies have shown that automated breast ultrasound is clinically proven to increase cancer detection by 35.7 percent over mammography alone for women with dense breasts.”
In 2013, Pa. Gov. Tom Corbett signed the Pa. Breast Cancer Coalition, PBCC’s Breast Density Notification Act. The law requires that mammography centers notify women and their primary care physicians of their breast density and, when indicated, patients may be referred for additional screening options, such as ABUS, Dr. Turner said. The center not only notifies patients they have this type of tissue, but they take the next step by providing them with educational materials and consultation to help them understand and make the best decisions possible for their health.
“We realize there are other options in our local healthcare arena for breast care services including Breast Tomosynthesis, but we specifically chose this new 3D ultrasound technology for its superior ability to capture images of abnormalities through lower compression, without additional radiation exposure,” said Kenneth Jusko, DO, medical director of imaging services for Evangelical Community Hospital. “At the end of the day, our goal is to help every woman who has an abnormality detect it, find it early and take whatever means necessary to resolve it.”
Where we are going
While some physicians argue that breast self-examination is not effective, Dr. Turner believes it is a first-step in an increasing range of diagnostic options. An annual clinical examination offers a more sophisticated inspection than self-exams; followed by mammograms, ultrasounds and MRI scans, when necessary.
Dr. Jusko said ABUS provides 3D capabilities to reconstruct breast images. The resulting images can be manipulated by software, allowing diagnosticians multiple views of the interior of the breast. The actual procedure generally takes less than 30 minutes for the scan. When completed, ABUS provides about 1,000 images.
Use of MRI scans, the most expensive procedure, is indicated with high-risk patients, Dr. Jusko said. A hand-held 2D ultrasound provides better image resolution, but is not as thorough as an ABUS scan.
If an ABUS scan indicates the presence of an abnormality, the hand-held ultrasound scan may be employed for confirmation purposes to determine if it’s benign and should be left alone or if a biopsy is indicated, Dr. Jusko said.
“Our goal is to identify cancers before they reach one centimeter in size,” Dr. Jusko said. “We are trying to find 5, 6 or 7-millimeter cancers. The treatment is a lot simpler and more straightforward.”
Using proprietary technology to automate the ultrasound imaging process, the somo∙v ABUS Platinum system was developed specifically for imaging of the dense breast, Dr. Jusko said. The somo∙VIEWer™ Advanced 3D Workstation enables fast, accurate review and archiving of patient exams.
What to do?
Ask your physician if your breasts can be classified as dense. If so, and you are at a high risk for developing breast cancer, it makes sense to investigate diagnostic tools with the potential to detect breast cancer earlier.
Jeffrey Roth, a resident of Adams County, Pa., is a correspondent for Reuters and writes for numerous magazines and publications, including the New York Times.
New England Journal of Medicine – Nejm.org