For Breast Cancer Screening, One Size Doesn’t Fit All
New findings reported in The American Journal of Medicine
Although mammography, the gold standard of breast cancer screening, reduces breast cancer mortality, it has important limitations. Critics point to reduced sensitivity for women with dense breasts, a high rate of false positives leading to excessive biopsies, and concerns about long-term effects of repeated radiation. With greater understanding of risk stratification, the authors of this review envision a re-thinking of the typical breast cancer paradigm to include new technologies that allow a more individualized approach that integrates patient-specific metrics, such as age, breast density, and personal preference. The review is published in the June issue of The American Journal of Medicine.
The authors discuss the pros and cons of new technologies for breast cancer screening. For instance, “digital breast tomosynthesis is an imaging technique aimed at eliminating the pitfalls of overlapping breast tissue. It has the potential to lower recall rates on screening mammography and reduce false negative examinations due to dense breast tissue,” says lead author Jennifer S. Drukteinis, MD, of the H. Lee Moffitt Cancer Center and Research Institute in Tampa. MRI, which offers improved sensitivity but reduced specificity, is appropriate for high-risk patients. Other technologies outlined are contrast-enhanced mammography, low-dose mammography, automated whole breast ultrasound, and positron emission mammography.
“Given the heterogeneity of the human population, a ‘perfect’ imaging technology for breast cancer screening will likely never be found. In fact, because of this heterogeneity, the very concept of ‘one strategy fits all’ may be outmoded,” says Dr. Drukteinis.
“The development of a personalized, individual patient-centered approach to breast cancer screening mirrors the evolution of similar strategies in other aspects of medicine,” writes Robert G. Stern, MD, a radiologist affiliated with the University of Arizona College of Medicine, in an accompanying editorial. “There will likely be no new whiz-bang technology to replace mammography; rather, innovative patient-specific approaches that incorporate new adjunctive and complementary technologies into overall breast cancer screening will improve specificity and sensitivity, reduce radiation exposure, and remove a significant amount of anxiety from the lives of our patients.”
Citing the intricacies of each modality, Dr. Stern brings up a very critical point: the need for a much closer working relationship between breast imagers and clinicians to make sure each woman undergoes breast cancer screening tailored to her.
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Notes for Editors
"Beyond Mammography: New Frontiers in Breast Cancer Screening,” by J.S. Drukteinis, B.P. Mooney, C.I. Flowers, and R.A. Gatenby (DOI: http://dx.doi.org/10.1016/j.amjmed.2012.11.025).
“Breast Cancer Screening: The Paradigm Shifts (Finally),” by R.G. Stern (DOI: http://dx.doi.org/10.1016/j.amjmed.2013.01.016).
They appear online ahead of print in The American Journal of Medicine, Volume 126, Issue 6 (June 2013) published by Elsevier.
Full text of the articles is available to credentialed journalists upon request. Contact Jane Grochowski at + 1 406 542 8397 or firstname.lastname@example.org to obtain copies. To schedule an interview with Dr. Drukteinis contact Kim Polacek, Media Relations Coordinator, at Moffitt Cancer Center at +1 813 745 7408, +1 813 507 3173 (cell) or email@example.com. Contact Dr. Stern directly at +1 520 326 0406, firstname.lastname@example.org or email@example.com.
About The American Journal of Medicine
The American Journal of Medicine (http://www.amjmed.com), known as the “Green Journal,” is one of the oldest and most prestigious general internal medicine journals published in the United States. It has an Impact Factor of 5.43, which ranks it 13 out of 153 General and Internal Medicine titles according to the 2011 Journal Citation Reports® published by Thomson Reuters.
AJM, the official journal of The Association of Professors of Medicine, a group comprised of chairs of departments of internal medicine at 125-plus U.S. medical schools, publishes peer-reviewed, original scientific studies that have direct clinical significance. The information contained in this article in The American Journal of Medicine is not a substitute for medical advice or treatment, and the Journal recommends consultation with your physician or healthcare professional. AJM is published by Elsevier.
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