Are Mammograms Safe? Other Options for Detecting Breast Cancer

by Charyn Pfeuffer

The American Cancer Society and the National Cancer Institute have led women to believe that "early detection is your best protection." In reality, early detection does not prevent women from breast cancer. This is why we desperately need better breast cancer diagnostics, such as a saliva or blood test, that will be more accurate and effective for women of all ages, as well as less painful and less expensive. Such advances may one day make standard mammograms and invasive diagnostic tests obsolete. More than 75% of breast cancer cases occur in women who have no identifiable risk factors (family history, early menarche, late menopause, delayed or no childbearing, no breastfeeding, obesity). Mammography is a flawed test. Mammograms miss at least 20% of all breast cancers and more than 40% of breast cancers in pre-menopausal women. By the time breast cancer is detected in a mammogram, a woman will have already had the disease for an average of 6-8 years. Mammography is ionizing radiation -- a known cancer-causing agent.

So, what can you do to take an active role in your breast health? Be aware of preventative measures. Researchers have developed a computerized formula known as the Gail model that can evaluate your personal risk factors and predict your five-year and lifetime risk for developing breast cancer. Women who may have an inherited risk for breast cancer or test positive for the BRCA1 or BRCA2 mutations may want to talk to their physicians about genetic testing and/or beginning annual screening mammograms earlier than age 40. Changes in these genes increase the risk of breast cancer. A new class of drugs, aromatase inhibitors, may prevent breast cancer in earlier stages, by inhibiting the development of estrogen, which some tumors need to thrive.

New and improved screening techniques aim to offer better alternatives to standard mammography. It's important to remember that, whichever screening method you choose, that the quality of the scan is only as good as the skill of the person reading it. Digital mammography electronically collects images and incorporates computer-aided detection systems to help flag suspicious areas in the breast. The images can be stored on the computer and manipulated to improve brightness and contrast. A large trial is under way to compare digital and conventional mammography. Computerized Thermal Imaging (CTI) utilizes a highly sensitive, high-speed infrared camera that captures thermal images of the breast (infrared heat given off by the body). Once the radiologist has acquired the images, sophisticated software and algorithms reconstruct individual heat patterns. These can be analyzed to help doctors differentiate healthy tissue from possibly diseased tissue. This exam is not without limitations since CTI is based on the principles of thermography, there is a possibility for a false positive result. CTI also cannot detect microcalcifications (tiny calcium deposits that may indicate the presence of cancer) and the technique is costly. CTI is currently under FDA review and available only to patients in clinical studies. Researchers are working on a new saliva test to help detect breast cancer. The test measures the amount of HER2 (a genetic material that, when present in large amounts, has been associated with breast cancer) found in a sample of a patient's saliva. There are obvious advantages of saliva testing of steroid hormones--saliva collection is easy, can be done anywhere, any time and testing is expected to be inexpensive. MedicGroup, the company that developed the saliva test, hopes to apply for FDA approval by the end of this year.

Most women, sometime in their lives, develop lumps in their breasts. Most lumps (about 8 in 10) are not breast cancer. However, a biopsy is often recommended to be sure. Many women are opting for new minimally invasive and non surgical biopsy techniques, instead of still being sent to the operating room for an open surgical biopsy. Ductal lavage is a minimally invasive method of collecting samples of milk ductal cells (where most breast cancers are believed to begin). Once the ductal fluid has been collected, s sent to a laboratory where a cytopathologist determines whether the cells are normal, atypical, or malignant. Ductal lavage should only be used as an adjunct to standard breast cancer detection tools, such as mammography or physical exam. Non-surgical biopsies make recovery easier for patients whose results are benign. In core needle or vacuum assisted biopsies, doctors can place a biopsy needle through the patients skin into the breast using use x- rays or ultrasound (image guided biopsies) to guide the sampling device and obtain tissue without having to resort to surgery. Tumor Ablation combines the imaging technology of MRI machinery with ultrasound waves to localize and destroy cancer cells with extreme temperatures; either cold (cryoablation) or heat (radiofrequency ablation), rather than removing the cancer via traditional surgery. Ablation techniques for cancerous breast tumors are in clinical trials now.

Charyn Pfeuffer is the author of a new book, Breast Cancer Q & A (Avery; June 2003).