Written by Bondozoglou Nikolaos MD,PhD, Radiologist, Clinical Director of CT, MRI, PET/CT Department, Athens Medical Center , Athens Medical Group
The Need for Better Presymptomatic Screening of the Breasts
Modern medicine requires individualized treatment, beyond therapy, both in the diagnosis and in the prevention of breast cancer. The treatment of breast cancer is determined by the individuality of each person and especially the degree of risk of that person for a specific disease. However, with regards to the early diagnosis of breast cancer, all women are treated to date in the same way: regular screening with mammography and ultrasound. The only thing that varies is the recommendation for the start and regularity of preventative screening for breast cancer. Although the benefit of mammography is proven, breast cancer remains the leading cause of cancer death in woman, and generally the first cause of death in women aged up to 50 years.
For this reason in recent years a public discussion has begun on the actual value of the method of early diagnosis of breast cancer. Although most experts agree that primarily mammography and to a lesser extent ultrasound saves lives from breast cancer, they do acknowledge the disadvantages of these tests. That they lose, that is, a significant number of early-stage cancers and lead some women to unnecessary treatments.
The Meaning of “Dense breast” in Mammography
The main reason why detection of an early cancer in mammography may be missed is the so-called dense breast. In mammography, dense breast appears as diffuse white. The tumor is also white, so it is difficult to detect.
In the US, at least 21 States apply today a specific law (Breast Density Notification Law), which states that women with dense breasts should be informed in writing of the reduced value of mammography and discuss with their doctor the benefits of a complementary examination for detection of breast cancer.
It is note that dense breast has no relation to the appearance or feel of the breast but is discovered only by specialists in mammography. It is important that women know the density of their breasts. In women with dense breasts, mammography may miss early-stage cancers. This is also evidenced by the fact that the highest percentage of cancers not detected in mammography are found in women aged 40-50 years, in whom dense breasts prevail. This category includes women that must be screened preventively for breast cancer, before undergoing IVF.
High Risk Groups for Breast Cancer
There are however other groups of women, for which existing traditional mammography and ultrasound screening do not suffice. This concerns women of high-risk for breast cancer based on family history or the presence of genes predisposed to the development of the disease. These women in particular should begin preventive screening earlier, since it has been established that breast cancer affects them earlier. Since 2009, it is recommended that screening of these women be supplemented with an annual MRI mammography, but in practice this is done only in a small number of women.
Another high risk group for breast cancer are women with breast prosthesis. The prostheses hide parts of the mammary gland on mammograms, leading to loss of significant pathologies through the application of conventional tests. However, these women may be also be effectively screened with MRI mammography.
Preventive Ultra-fast MRI Mammography
Today, a new application of MRI, preventive Ultra-fast MRI Mammography, aims to change the current preventive practice as it appears to be the test of maximum sensitivity in the early detection of breast cancer.
Aiming at the broader application of MRI mammography in the pre-symptomatic screening of breast cancer, in recent years Ultra-fast MRI Mammography has been tested, proposed and its application begun. Compared with mammography, with Preventive Ultra-fast MRI Mammography the detection of breast cancer is not based only on anatomical, but mainly on functional characteristics, and is not affected by the presence of dense breast. This results in the increased capacity of the detection of breast cancer and particularly in the early stages.
A publication in the Journal of Clinical Oncology, in 2014, showed that if 1000 women of moderate or slightly increased risk with a normal mammography and ultrasound of the breasts, are subjected to preventive Ultra-fast MRI Mammography 18 incipient, clinically significant breast cancers will be detected. If this additional preventive Ultra-fast MRI Mammography screening was not done the cancer would be detected later and probably in a more advanced stage.
A recent publication in the European Journal of Radiology, 2015, also showed significant sensitivity of detection of breast cancer with preventive Ultra-fast MRI Mammography. In the MRI department of the Athens Medical Centre we studied the effectiveness of this new Preventive Ultra-fast MRI Mammography examination, compared with conventional MRI mammography, in 100 women. The results were impressive as we proved that the Ultra-fast MRI Mammography examination detects breast cancer with the utmost sensitivity and there is consensus of the diagnosis between experienced specialists. Our results were announced at the 2015 European Congress of Radiology held in Vienna.
Bearing in mind our experience and the to date published data, we developed an examination that lasts for a few minutes, containing the sequences that detect breast cancer with the greatest sensitivity, but also limit recommendations for unnecessary biopsies.
Compared to conventional mammography, which is time consuming - it lasts for about half an hour - and requires, after it is done, analysis of hundreds of images by specialists, Preventive Ultra-fast MRI Mammography contains those sequences that detect breast cancer with maximum sensitivity in only three minutes. Essentially, we shorten the examination taking only the most important images that international experience has shown can reveal the image of breast cancer. Necessary, of course, conditions for the successful application of the new Preventive Ultra-fast MRI Mammography examination is the use of the latest MRI technology and, especially, medical experience in the field of MRI mammography.
Important advantages of Preventive Ultra-fast MRI Mammography is that it detects twice as many cancers compared to other tests, detecting breast cancer in the early stages, has no radiation, does not cause the unpleasant feeling of the pressure on the breasts, as is the case with classical mammography, while the huge reduction in examination time results in a significant reduction to its cost, which is at a similar level to other breast examinations.
In conclusion, Preventive Ultra-fast MRI Mammography has a much higher sensitivity of detection of breast cancer compared with other tests. The time and cost of Preventive Ultra-fast MRI Mammography is now at levels that allow for wider application. Preventive Ultra-fast MRI Mammography is the best complement to mammography in women with dense breasts, in woman with moderate and high-risk for breast cancer and in women with implants, while it is an examination of choice in younger women.
We can therefore say that we now have in our hands a new weapon to overcome the disadvantages of the past of regular monitoring for the treatment of breast cancer.