New Frontiers in Breast Cancer Screening

For years, the detection of breast cancer has relied on traditional film (X-ray) mammography, clinical breast examinations (CBE), and monthly self-breast examinations. X-ray mammography is currently considered the “gold standard”. However, in recent years, there have been significant advances in screening tools, which may detect cancer in patients for whom mammography is not successful. Several procedures under investigation are briefly reviewed here.

Digital Mammography

Digital mammography produces images that can be used for the screening and diagnosis of breast cancer. In clinical studies, digital mammography was comparable in clinical performance to traditional X-ray mammography and may eventually replace traditional X-ray mammography. From the patient’s perspective, a digital mammogram uses the same technique as the traditional X-ray mammogram. However, digital mammography does offer some advantages. For example, rather than subjecting the patient to another mammogram, digital images can be manipulated to correct for under- or overexposure. In addition, digital images can be saved and transferred electronically. Digital mammography also has a large range for examination of all areas of the breast, including areas that traditional X-ray mammograms have difficulty viewing.

Ultrasound

Ultrasound is thought to be useful in detecting breast cancer in women with dense breast tissue. This imaging technique transmits sound waves through the breast tissue, which create pictures called sonograms used to distinguish fluid-filled cysts from potentially cancerous solid masses. Ultrasounds may also be beneficial for examining lumps that can be felt but may be difficult to see on a mammogram. Perhaps the most famous case is that of actress Suzanne Somers, whose breast cancer was detected using ultrasound after going undetected using the traditional X-ray mammogram and clinical breast examination. Ultrasound’s relatively low cost and lack of radiation exposure leads to higher patient acceptance.

Magnetic Resonance Imaging (MRI)

MRI uses radio waves and magnetic fields to produce images of the internal structure of the breast. It is suggested that the MRI may be more effective than X-ray mammography in distinguishing between malignant and benign breast lumps. It may be used when the findings from a mammogram, sonogram, and physical examination are inconclusive. It is considered particularly useful in women with dense breasts. In addition, because MRI is not limited by scarring from surgery or breast implants, it may be beneficial for women who have had breast implants or previous lumpectomies.

Ductal Lavage (Nipple Aspiration)

This is a new procedure that allows a clinician to evaluate the milk ducts in the breast. By inserting a tiny catheter or needle into the nipple of the breast, the clinician obtains cells from the lining of the milk ducts that are then examined for irregularities. Abnormal cells may be an indication of an increased likelihood of developing breast cancer.

Philana Chen, MPH

Tara Friebel, MPH