New Technologies for Breast Cancer Screening

Although several new technologies on the horizon show promise for improving our ability to detect breast cancer, none have yet proved superior to traditional, X-ray film mammography in screening for breast cancer, says a new report from the Institute of Medicine (IOM) and National Research Council of the National Academies.

"With all of its limitations, film mammography remains the gold standard against which new imaging technologies will be measured," said the report's lead author, Joyce C. Lashof of the University of California, Berkeley. "To date, no quantum leap has been made in this area."

In fact, no single imaging technology is capable of accurately detecting all breast abnormalities, the report says. Ultimately, it concludes, the best detection may come from using several different tools. For example, ultrasound and magnetic resonance imaging have shown potential in conjunction with mammography in diagnosis and screening, especially in getting a clearer picture of dense breast tissue in certain women.

The report evaluated imaging tools currently available, examining film mammography and 17 other technologies. These included ones with FDA approval, such as full-field digital mammography, ultrasound, computer-aided detection systems, and magnetic resonance imaging; as well as those not yet approved, such as optical imaging.

Many appear to offer varying degrees of potential for screening or diagnosis-in some cases, both-but more research is needed, the report asserts. No studies have shown a new technology to be a replacement for film mammography, for either screening or diagnosis. For instance, while digital mammography has been lauded as a major technical advance-facilitating storage, retrieval, transmission and image adjustment for mammograms-it has not shown greater accuracy than its nondigital counterpart.

The report cites multiple reasons for the push to develop new imaging and diagnostic technologies. For example, among women in the United States, the death rate from breast cancer has been decreasing by about 2 percent annually over the past decade, suggesting that early detection and improved therapy are having an impact on the disease.

Despite these optimistic findings, the fact remains that film mammography does not detect all cancers, particularly among younger women, who often have denser breast tissue that is more difficult to view with X-ray technology.

Film mammography also cannot prevent all deaths from breast cancer because it may not detect fast-growing malignancies early enough to effect a cure. Routine screening in clinical trials resulted in only a 25 percent to 30 percent decrease in breast-cancer mortality among women between the ages of 50 and 70, and a lesser benefit was seen among women aged 40 to 49.

Finally, the report calls for greater public access to current technologies, particularly for women who lack health insurance. It calls on Congress to expand the Centers for Disease Control and Prevention breast-cancer screening program to reach more women-from the current 15 percent to 70 percent-and state legislatures to provide more Medicaid funds for the treatment of women with breast cancer identified through local screening programs.

SOURCE:
Institute of Medicine, The National Academies (http://www.nationalacademies.org)

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