Digital Mammography Boosts Chances of Spotting Malignancies

It's the next big advance in breast cancer detection, doctors say

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By Dennis Thompson
HealthDay Reporter

SUNDAY, Oct. 22, 2006 (HealthDay News) -- The advent of technologies like digital mammography means even the toughest patients to diagnose for breast cancer can receive a life-saving screening.

And these advances help to explain why breast cancer mortality rates continue to drop year after year in the United States, thanks to improvements in early detection and in treatment.

Still, nearly half of women 40 and older don't receive annual mammograms, as recommended by the American Cancer Society.

"Breast cancer is a very treatable disease, particularly when it's caught early," said Dr. Carol Lee, a professor of diagnostic radiology at Yale University School of Medicine and head of the American College of Radiology's breast imaging commission.

Between 1990 and 2002, the death rate for breast cancer declined by 2.3 percent annually, according to the American Cancer Society (ACS).

Despite that good news, doctors will diagnose an estimated 212,920 new cases of breast cancer in 2006, and about 41,000 women are expected to die from the disease. Only lung cancer accounts for more cancer deaths in women, according to the ACS.

Digital mammography is expected to help further lower the death rate.

The computer-based technique allows for more digital manipulation of a breast X-ray exam than was possible with film mammography, Lee said. "It's exactly analogous to digital photography versus film photography," she said.

A recent study involving 42,760 women nationwide found that digital mammograms were more accurate for more than half the women who get breast-cancer screenings. Younger women with dense breast tissue, which makes it harder to detect tumors, particularly benefited from use of the new technology, the study found.

"It just may be more useful in those younger women," said Susan Brown, a registered nurse and manager of health education for the Susan G. Komen Breast Cancer Foundation. "It makes it possible for women to have useful mammograms prior to the age of 40, if they are at greater risk of breast cancer or if they have some clinical signs or symptoms that require examination."

Other advantages offered by digital mammography include the ease of storing and retrieving images, and making them part of a patient's electronic medical record.

However, Lee noted that even regular mammography offers benefits that are undeniable and urged women to use the less expensive option if cost is a factor.

"It's important for women to remember that the studies showing a decline in breast cancer death rates have been based on plain-old film mammography," Lee said.

Mammograms can often detect a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium, called microcalcifications. These lumps or specks can be from cancer, precancerous cells, or other conditions, according to the National Cancer Institute.

If an abnormal area shows up on a woman's mammogram, her doctor may ask her to undergo a biopsy, which is the only way to tell for sure if cancer is present.

Women older than 40 are urged to get an annual mammogram and clinical breast examination, according to the American Cancer Society. Some younger women also can benefit from regular mammograms, Brown said.

"She should have that conversation with that clinician, particularly if she's at a higher risk for breast cancer due to family history," Brown said.

Women ages 20 to 39 are urged to receive a clinical breast examination every three years, as well as giving themselves a monthly breast self-examination.

Clinical exams are important because doctors are able to pick up on signs and signals not necessarily obvious to the average woman.

"They have a certain amount of expertise," Brown said. "They would be able to use further forms of examination if an abnormality is seen, or pick up on abnormalities the woman might not have seen."

Self-examination still is important, Brown said, both by feeling the breasts for lumps and by looking them over carefully.

"We are looking for lumps, but also visual changes as well," Brown said. "It could be dimpling, puckering of the skin, or a pulling-in of the nipple. There's a rare form of breast cancer where the breast enlarges and becomes red, hot and tender."

However, the American Cancer Society considers self-examinations optional and urges women instead to stick to a regular clinical screening schedule.

"I would encourage breast self-exams, but they're not a replacement for a breast exam by a professional health provider," Lee said.

Treatment of breast cancer also has improved, with therapies becoming more and more targeted to patients and their specific tumors, Brown said.

"In general, the broad ranges of treatment have remained the same," she said. "But more and more, the therapy is being targeted to a woman's individual tumor. Doctors study it, understand it, and craft a very targeted and individualized therapy. The goal is to provide a therapy that is effective with as few side effects as possible."

More information

To learn more about digital mammography, visit the U.S. National Cancer Institute.

SOURCES: Carol Lee, M.D., professor of diagnostic radiology at Yale University School of Medicine, New Haven, Conn., and head of the Breast Imaging Commission, the Amercian College of Radiology; Susan Brown, registered nurse and manager of health education for the Susan G. Komen Breast Cancer Foundation, Dallas; American Cancer Society; National Cancer Institute

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