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:
- Women in their 40s should have mammograms every one to two years.
- Women 50 and older should be screened every one to two years.
- 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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