Doctors have long known that breast cancer is most effectively treated when detected at an early stage, years before a tumor can be palpated either by a woman or her doctor. Since the 1980s, mammography has dramatically aided in pinpointing these tiny tumors, which usually are contained within the milk ducts of the breast.
Yet even with improvements in mammography over the years, many tiny tumors are still barely visible. As mentioned, part of the answer relates to the density of the breast tissue being imaged.
In pre-menopausal women, the tissue of milk production pervades the breasts and appears opaque, or white, on a mammogram. Unfortunately, so do tumors. In post-menopausal women, breast tissue gives way to fat, which mammographically appears grayish. Thus, tumors — no matter their size in post-menopausal women — show up in sharp contrast to fatty tissue, making the tumors much more visible to the diagnostic radiologist.
CAD, its developers say, helps ensure against human error by directing radiologists’ attention to obscure tumors and microcalcifications, the potentially pre-cancerous deposits that sometimes can be overlooked.
“The next challenge for CAD is diagnosis,” Doi said. “We have already developed algorithms that guide our system in distinguishing benign from malignant lesions. I believe that in time, as we fine-tune these algorithms, CAD will also become an important tool in helping women avoid unnecessary biopsies.”
Even with computer-enhanced detection of tiny tumors on mammograms, doctors say there is still a need for tests that focus on biomarkers. With respect to breast cancer, a biomarker would be any chemical or cells in the blood, tissue or other fluid that would signal impending cancer development. Such tests, doctors say, could potentially be far more precise than mammography in revealing evidence of cancer’s building blocks. The hope is that these building blocks would be detected years before a tumor ever begins to develop.
Researchers at the University of Nebraska in Omaha, for example, are working on a potential biomarker test for breast cancer that targets metabolites of estrogen. Lifelong exposure to estrogen is a long established link to increased breast cancer risk. While scientists are still uncertain exactly why estrogen exposure boosts the risk for breast cancer, some scientists hypothesize that metabolites — breakdown products of estrogen — might trigger DNA mutations, leading to tumor formation.
Dr. Douglas E. Stack and colleagues at the University of Nebraska are studying ways to detect these metabolites. Though the research is still in its early stages, if the scientists are successful, an effective biomarker for the early detection of breast cancer will be created. Screening could eventually become as simple as any standard blood test.
Ideas for new methods of screening and early detection abound.
Another potential test is minimally invasive and involves sampling cells from the same breast ducts over time in women who are at high risk for breast cancer, either as a result of personal history of breast cancer or inheritance. For years scientists have known that most breast cancers begin in the ducts. However, there was no way of sampling cells within the ductal system.
Famed breast surgeon and author Dr. Susan M. Love may have found a way. She is leading a study at the University of California, Los Angeles that has mapped the ductal system of the breast and has also developed a device that is minimally invasive and capable of retrieving ductal cells.
“With this device we can find cells that are just thinking about becoming cancer,” said Love, author of “The Breast Book,” an international bestseller.
Despite all of the work-in-progress, Visco sounds a note of reality. Though she and others would like to see the use of biomarker-testing and minimally invasive diagnostics, “mammography is the best we have right now,” she said.
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Tags: breast, mammography, menopausal women