Radiology plays a critical role in detecting, diagnosing and treating breast cancer and other diseases of the breast. On November 8 – the International Day of Radiology – this role is being highlighted by radiology societies around the world.
Advances in technology are helping refine and improve the radiological methods used to screen for and diagnose breast diseases. With new machines and analytical techniques, breast cancers and other diseases can be spotted earlier, helping increase the likelihood of the patient being cured. When women are invited to breast screening, there is a 20 percent reduction in breast cancer mortality, according to recent research.
Organized annually by the European Society of Radiology, the American College of Radiology and the Radiological Society of North America, the International Day of Radiology aims to raise awareness of radiology in breast diseases, including the importance of using the correct doses of radiation in medical imaging.
To mark the day, we have collected 14 recent articles published in Elsevier’s radiology-related journals. They are free to access until February 2, 2017.
New technologies, better screening
Breast screening has been shown to reduce breast cancer deaths, but the standard method, called full-field digital mammography (FFDM), still misses 15-30 percent of cancers, particularly in dense breast tissue. A new technique for screening – digital breast tomosynthesis (DBT) –could improve the rate of cancer detection.
DBT uses x-ray radiation to produce multiple images across sections of the breast, rather than a single image from one angle. Because of this, it is more effective at revealing disease in dense breast tissue. A team of researchers from the University of York in the UK, Referenzzentrum Mammographie München in Germany and Johns Hopkins Medical Institute in the United States conducted a systematic review of the research on DBT, published in The Breast.
The team compared the performance of the standard technique FFDM with DBT alone, DBT with FFDM, and DBT with another technique (synthetic digital mammography) for detecting breast cancer lesions in women with no symptoms of disease. They analyzed five studies – two from Europe and one from the US. Both European studies revealed that DBT and FFDM together resulted in better detection rates and lower false positives. All three US studies showed lower false positives for DBT and FFDM together, but only the largest study showed a significant improvement in detection rates.
Challenges with new method
Writing in Clinical Radiology, researchers from the University of Cambridge in the UK explore some of the challenges associated with the method. Using DBT as a screening tool means radiologists need to spend more time reading the images, and the method requires additional IT storage and connectivity. It is also unclear whether the technology is cost effective. The authors of the study call for more trials to clarify whether this method could help improve screening outcomes and ultimately survival rates.
Helping patients deal with false positives
One of the most significant outcomes of a false positive diagnosis is that the patient can experience stress. As the people responsible for interpreting the images taken during screening, radiologists can help reduce the stress of over-diagnosis. In an article in Academic Radiology, researchers from the University of Washington School of Medicine, University of Washington School of Public Health, University of Pennsylvania and Hutchinson Institute for Cancer Outcomes Research, all in the US, explore ways the community is mitigating the potential harms associated with screening.
While there are still risks of over-diagnosis, helping patients understand this and take part actively in their own diagnosis and treatment can help reduce stress. One approach is to offer patients information and the opportunity to ask healthcare professionals questions. Researchers from New York University School of Medicine and the University of Colorado School of Medicine in the US assessed the impact of public lectures on 117 patients.
The results, published in the Journal of the American College of Radiology, show that those who attended the sessions reported decreased anxiety and increased knowledge about the screening process. This, they conclude, helps enable patients to make informed decisions and may also encourage more people to attend screening.
Special collection: Radiology in breast diseases
Read more about these studies and many others in our special collection to mark International Day of Radiology 2016. This collection of articles is free to access until February 2, 2017.
- The diagnostic accuracy of radiographers assessing screening mammograms: A systematic review, Radiography (May 2016)
- The relationship between cancer detection in mammography and image quality measurements, Physica Medica (April 2016)
- Direct Interactive Public Education by Breast Radiologists About Screening Mammography: Impact on Anxiety and Empowerment, Journal of the American College of Radiology (January 2016) – CME
- Adding 3D automated breast ultrasound to mammography screening in women with heterogeneously and extremely dense breasts: Report from a hospital-based, high-volume, single-center breast cancer screening program, European Journal of Radiology (September 2016) – open access
- Missed Breast Cancer: What Can We Learn? Current Problems in Diagnostic Radiology (November-December 2016)
- Analysis of the impact of digital watermarking on computer-aided diagnosis in medical imaging, Computers in Biology and Medicine (January 2016)
- Large scale deep learning for computer aided detection of mammographic lesions, Medical Imaging Analysis (January 2017)
- A new method of detecting micro-calcification clusters in mammograms using contourlet transform and non-linking simplified PCNN, Computer Methods and Programs in Biomedicine (July 2016)
- Breast cancer screening controversies: who, when, why, and how? Clinical Imaging (March-April 2016)
- Clinical Outcomes of Mammographic BI-RADS 3 Lesions in the Community Hospital Setting, Canadian Association of Radiologists Journal (November 2016)
- Systematic review of 3D mammography for breast cancer screening, The Breast (June 2016) – open access
- How Can Advanced Imaging Be Used to Mitigate Potential Breast Cancer Overdiagnosis? Academic Radiology (June 2016)
- Intramammary schwannoma: a palpable breast mass, Radiology Case Reports (September 2016) – open access
- Digital breast tomosynthesis (DBT): a review of the evidence for use as a screening tool, Clinical Radiology (February 2016)