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 examination 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.

Dense Breast Tissue Easier to Image

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 normal mammograms, as well as a group of women who had abnormalities detected during a physical examination or who 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 examination 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, N.Y., 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.

Experts Looking at Images Important

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 1 to 2 years.
• Women 50 and older should be screened every 1 to 2 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.