Healthbeat Report: Mammogram alternatives

July 29, 2010 8:39:56 PM PDT
To screen or not to screen? That is the question many women are now asking as confusion swirls around the issue of mammograms.

When the US Preventative Services Task Force recommend women get mammograms later and less often it left many women shocked and confused. Screening saves lives but are there better ways to detect breast cancer? Researchers are working to make these tests even better and 3-D technology could make a difference.

It looks like a typical mammogram. But Rosali Papelera's scan is different. She's helping test tomosynthesis 3-D mammography. It's a beefed up mammogram that uses special software to view the breast tissue from many angles.

"So there are 30-40 images per breast per angle. So it ends up being 100 images per exam where on," said Dr. Sarah Friedewald, radiologist, Advocate Lutheran General Hospital.

Advocate Lutheran General Hospital is taking part in a national study of 3-D mammograms.

The question is whether the 3-D images can reduce the confusion between benign and cancerous tissues with clearer, more accurate images. The goal is fewer false alarms and unnecessary biopsies. Also, several doctors say it's a little more comfortable because there isn't a need for as much pressure. But this 3-D approach is not yet FDA approved.

"We hope we are better able to improve the detection of breast cancer," said Dr. Friedewald.

Right now conventional mammography is still considered the best way to look for breast cancer in women without symptoms. But mammograms are not perfect and that's why researchers are studying new approaches. Many women have heard about ultrasound or MRI and they wonder why not those tests instead of mammograms? Doctors say they make sense as additional screens for women at high risk or those with very dense breasts. But in most cases they're not ready to replace routine mammograms.

A breast ultrasound, also known as sonography, uses high frequency sound waves that bounce off tissues and fluid to create pictures inside the body.

"Ultrasound sees different things from what mammography can see," said Dr. Ellen Mendelson, radiologist, Northwestern Memorial Hospital.

A recent study determined that more breast cancers were found when ultrasound was combined with a mammogram. Ultrasound is also used to take a better look at breast masses already detected. It's painless and does not involve radiation. At Northwestern Memorial Hospital researchers are now studying a 3-D version of this technology.

"It's women whose breast tissue is dense and those women who really are at high risk of breast cancer will benefit most from this additional study," said Dr. Mendelson.

Magnetic resonance imaging or MRI uses magnetic fields and radio waves to create precise images of organs and tissues. Annual MRI's are recommended for women considered at high risk. But the test is expensive, time consuming and can involve an injection of dye. It also tends to give a lot of false alarms.

The upside of MRI is that it can detect cancers when they are very small. Loyola radiologist kathleen ward.

"Breast MR is used as a screen in women that have a greater than 20 percent risk of developing breast cancer," said Dr. Kathleen Ward, radiologist, Loyola University Medical Center.

Rosali Papelera knows breast cancer runs in her family but she's comfortable sticking with yearly mammograms for now.

"Early detection is the best way to prevent breast cancer," said Papelera.

The American Cancer Society and the American College of Radiology still recommend mammography screening beginning at age 40. But women should talk to their healthcare provider first to determine what is best for them.

3-D Mammogram Study
Advocate Lutheran General Hospital

Women interested in participating in the research study should call Advocate's HealthAdvisor at 1.800.3.ADVOCATE (1.800.323.8622) for more information, and mention Code 8W35 when calling about the study. There is no cost to study participants.

3-D Ultrasound Research
Northwestern Memorial Hospital

Anyone who would like more information on the 3-D ultrasound research can email Dr. Mendelson at emendelson@nmff.org or her research assistant, Marysia Kalata, at m-kalata@northwestern.edu.

American Cancer Society
www.cancer.org

American College of Radiology Imaging Network
ACRIN
www.acrin.org

American College of Radiology
www.acr.org


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