Sonography
Superior for Some Breast Cancers
Sonography
is more accurate than mammography for women under 45 with symptoms
Mammography
may be the standard screening test for breast cancer, but if you are
a woman under 45 with symptoms of the disease, an ultrasound (also called
sonogram) is more likely to find malignancies.
That
is the conclusion of a new study published in a recent issue of the
American Journal of Roentgenology.
"Sonography
was significantly more accurate than mammography in diagnosing breast
cancer in women with breast symptoms who are 45 years and younger,"
says study author Dr. Nehmat Houssami, a senior lecturer at the School
of Public Health at the University of Sydney, Australia. Houssami was
the director of the MBF Sydney-Square Breast Clinic at the time the
study was conducted.
Study
Did Not Look at General-Population Screening
Houssami
is quick to point out, however, that the study did not look at general-population
screening for breast cancer, and he says he is definitely not suggesting
that ultrasound replace mammography for screening.
Breast cancer is
the most common cancer among women, excluding non-melanoma skin cancer.
Currently, approximately three million women in the US are living with
the disease, including two million who have already been diagnosed,
and another one million who do not yet know they have the disease.
The American Cancer
Society (ACS) estimates for 2002 include 205,000 new cases of invasive
breast cancer being diagnosed in the US. In addition, ductal carcinoma
in situ will be responsible for 54,300 new cases this year.
Always
consult your physician for more information.
Symptoms
of Breast Cancer
Symptoms
of the disease include:
- lump or thickening
(a mass, swelling, skin irritation, or distortion) in or near the
breast or in the underarm area
- a change in the
size or shape of the breast
- a change in the
color or feel of the skin of the breast, areola, or nipple (dimpled,
puckered, or scaly)
- nipple discharge,
erosion, inversion, or tenderness
The symptoms of
breast cancer may resemble other conditions or medical problems. Always
consult your physician for a diagnosis.
Mammography
Guidelines
A mammogram is an
x-ray examination of the breast. It is used to detect and diagnose breast
disease in women who either have breast problems such as a lump, pain,
or nipple discharge, as well as for women who have no breast complaints.
The American Cancer Society recommends that every woman over 40 have
a mammogram annually. The National Cancer Institute recommends women
in their 40s and older should have a screening mammogram on a regular
basis, every one to two years. Ultrasound is a diagnostic imaging technique
that uses high-frequency sound waves to create an image of the internal
organs.
For this study,
radiologists examined the mammograms and sonograms of 480 women between
the ages of 25 and 55. All of the women had symptoms of breast cancer.
Half of the women actually had breast cancer. The 240 women without
cancer were age-matched to those in the breast cancer group.
Overall, there was
not a statistically significant difference in the detection of cancer
between the two tests, they found. However, in younger women—those
under 45—sonography correctly identified 84.9 percent of breast
cancers, while mammography was only able to pick up 71.7 percent of
the cancers.
The reason for the
difference, Houssami says, is simple. Younger women's breasts are generally
more dense than older women's breasts, and sonography is better able
than mammography to capture images through that density.
In most cases, a
woman with breast cancer symptoms is referred for both mammography and
sonography, regardless of her age, according to the study.
For all the age
groups combined, researchers in this study found that 96 percent of
the cancers were detected using both tests together, versus 81.7 percent
for ultrasound alone or 75.8 percent for mammography alone.
Dr. Diane Palladino,
a breast surgeon at Exeter Hospital in Exeter, N.H., says she always
orders both tests for a woman who has symptoms of cancer, explaining
that both tests have their strengths and weaknesses.
Ultrasound
Better For Images of Denser Breast Tissue
"Ultrasound
helps us judge the size of the lesion and can give us some idea of whether
the tumor is benign or malignant," she says, adding that ultrasound
provides better images of denser breast tissue than mammography does.
But, she says, ultrasound
cannot see microcalcifications, which are signs of very early breast
cancer.
Eventually, both
Houssami and Palladino think ultrasound may become the main imaging
test for detecting breast cancer in younger women after further research
is done.
Palladino says it
is important for women to realize "that mammography is not 100
percent, especially in younger women. If you have a lump and a negative
mammogram, you still need to address that lump in your breast."
Always consult your
physician for more information.
Breast
Cancer Patients Not Heeding Exercise Advice
Study finds
many decrease activity, despite its benefits
Breast cancer patients
are not sticking to prescribed diet and exercise routines, even though
working out and controlling weight gain might help them avoid future
bouts with the disease.
That is the observation
of a new study by researchers from the Fred Hutchinson Cancer Center
in Seattle, along with colleagues at the National Cancer Institute,
the University of New Mexico, and the University of Southern California.
Their report appears in a recent issue of Cancer.
The new research
explores how even women who were diligent about working out before they
were diagnosed with breast cancer appear to let their routines slide
after the disease strikes.
"Most notable
were the decreases in activity among women who underwent surgery as
well as chemotherapy and radiation therapy, as well as the women who
were obese or overweight prior to diagnosis," says study author
Melinda Irwin, currently an assistant professor in the department of
epidemiology and public health at Yale School of Medicine.
The findings are
important, says Irwin, because previous studies show a lack of activity
leads to weight gain, which then increases the risk of cancer recurrence.
This is particularly true if women are overweight when they are diagnosed.
"If a woman
is already overweight or obese when diagnosed with breast cancer, the
chance of having a recurrence within five years is twofold over lean
women, and the chance of dying from breast cancer, over a 10-year period,
is 60 percent greater than lean women," Irwin says.
For breast cancer
surgeon Dr. Jeanne Petrek, the study offers an interesting observation.
However, its real value may not be realized until the women are followed
and their cancer prognosis can be linked to activity levels, she says.
"This is an
early result, and it just tells us what happened in the early months
following diagnosis and treatment. But what it doesn't tell us is whether
these women were able to lose the weight they gained, whether they regained
physical activity in one or two years, and if they did, what would that
mean to their prognosis," says Petrek, director of the surgical
program at Memorial Sloan-Kettering Cancer Center in New York City.
"These are
the kinds of questions that must be answered before this finding has
true relevance," she adds.
"Any exercise
intervention after a cancer diagnosis shows significant improvement
in fatigue and nausea and overall quality of life, including depression,"
Irwin says. "If a woman didn't exercise before being diagnosed,
she should be counseled on the importance of starting an exercise program
after treatment; if she exercised before, it's important that levels
don't decrease after cancer."
Always consult your
physician for more information.
Online
Resources
American
Cancer Society
American
Journal of Roentgenology
Breast
Cancer Prevention Trial
Cancer,
Interdisciplinary International Journal of the American Cancer Society
Journal
of the National Cancer Institute
National
Cancer Institute
National
Institutes of Health (NIH)
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