As medical science advances and the methodologies for the treatment of breast cancer continue to evolve, one fact remains clear: the prognosis of a patient diagnosed with breast cancer is better if the cancer is diagnosed at an early stage. Unfortunately, despite all of our advanced technology, we still fail to properly diagnose breast cancers an estimated 10% of the time. A recent article in the Wall Street Journal highlighted one of the chief difficulties in the early diagnosis of breast cancer, dense breast tissue. Typically, a woman’s breast is made up of a combination of fatty and glandular tissue. However, in approximately 50% of women under the age of 50 years, and in more than 30% of older women, this glandular tissue can be dense enough to interfere with the interpretation of mammograms, making the successful detection of breast cancer problematic. Currently, there is a movement underway to urge officials at both the State and Federal levels to require physicians to inform patients who have dense breast tissue and to educate them about the issues and diagnostic options available to them. Several advanced diagnostic methods exist that can aid in the diagnosis of breast cancer in women who are experiencing this issue.
Ultrasound technology, an imaging system that uses high-frequency sound waves to produce images of structures within the body, can help identify areas in the breast than may be missed by a traditional mammogram. Unfortunately, although ultrasound imaging has been shown to find more cancers, it also generates approximately four times as many false positives. Still, many doctors favor this approach, arguing that the false positives are a small price to pay for the increased ability to detect and treat breast cancers in the early stages.
Many hospitals and imaging centers are now also offering a new form of mammogram called 3-D tomosynthesis. Like a traditional mammogram, this diagnostic technique begins by taking an X-ray of the breast. However, the X-ray arm then rotates around the patient in an arc, taking additional images at different angles that can be assembled into a three-dimensional view. By creating, in essence, a 3D mammogram, tomosynthesis improves the diagnostic rate of conventional mammography considerably, but can be more expensive than a conventional mammogram and can expose the patient to higher levels of radiation.
Magnetic resonance imaging (MRI) technology uses magnetic and radio waves to scan breast tissue, detecting masses not detectable by mammogram or ultrasound. The MRI has become the standard to aid in the evaluation of dense breasts and also to help further the evaluation of breasts in which a cancer has already been identified. The additional information gathered from an MRI can also provide assistance in developing a specific treatment plan for approaching breast cancer surgery. A “fast MRI” device, that is less costly and takes less time than the conventional MRI, is currently being tested and evaluated for future use.
Finally, a new diagnostic technique called molecular breast imaging, or MBI, uses a radioactive tracer to make tumor cells highly visible with a special camera. MBI is currently only in the initial stages of evaluation, but it may potentially find more cancers with fewer false positives than MRI technology, all at a significantly lower cost. Further trials need to be carried out to determine the practicality of this diagnostic test.
It is encouraging that we are making progress in the management of breast cancer. Our efforts are resulting in diagnosis at an earlier stage and increased survival rates. If you have any questions about breast reconstruction or any of the other procedures that I perform, please feel free to contact me, Dr. Philip Beegle. Some reconstructive plastic surgery procedures can be covered by insurance and we provide a variety of options for financing, including Alphaeon® and CareCreditSM in order to assist you. You can also stay connected by following my team on Facebook and we look forward to sharing more exciting news and updates over the upcoming months.