Provista Blog > National Mammography Day and Advances in Early Breast Cancer Detection
When President Bill Clinton proclaimed the first National Mammography Day in 1993, no one would have believed what we are facing today in 2016 – the near-constant bashing of this important screening tool. In 1993, there was only one way to detect breast cancer, and mammography was on a roll. Ultrasound was emerging as a diagnostic tool, but few considered its potential in screening. As for breast MRI, it was still 10 years away from introduction to routine clinical practice.
And now, today, with multi-modality imaging offering a near-guarantee of early detection, we have an ever-increasing mob of anti-screening activists crying: “Foul!” “You’re overdiagnosing breast cancer.” “You’re doing permanent psychological harm with your unnecessary biopsies.” “You’re only going to make the problem of overdiagnosis worse if you start adding ultrasound and MRI in your screening strategies.”
My contention is this: mammograms may have been oversold from the earliest days with regard to sensitivity. Why? Not out of intent to deceive, but through the simple fact that there was no way to know how many cancers were missed. With only one form of imaging, the only way to guess at sensitivity was to count cancers as they emerged after a negative mammogram. But what should be the interval that translates to a “miss?” 6 months? 1 year? 2 years? This totally arbitrary approach to identifying missed cancers has now been replaced with multi-modality imaging where women undergo ultrasound and/or MRI on the same day as the mammogram. With 3-D tomosynthesis, ultrasound, contrast-enhanced mammography, MRI (and its kissing cousin Molecular Breast Imaging), we can find virtually all breast cancers at an early stage. Mammography might be marginally effective in the eyes of the critics, but “early detection” is more powerful than we ever imagined.
Amazingly, we do not need any more breakthroughs in imaging technology. The problem is that we are unable to use these new technologies efficiently, thus provoking the condemnation of the bean counters. Risk-based screening has been proposed as “precision medicine,” but this approach is doomed, given that you exclude the majority of eventual breast cancer patients right off the bat, and secondly, cancer yields are marginally cost-effective even when screening the patients at highest risk for breast cancer. Lifetime risks are a poor surrogate for what’s actually in the breast on screening day, and short-term risks are not much better. To me, the answer has been obvious for a long time. We need a blood test for the detection of breast cancer that tells us when to recommend adjunct imaging if mammograms are negative. Provista Diagnostics appears to have the lead in that department with the first blood test of its kind, Videssa® Breast.
To read more by Dr. Hollingsworth, visit his blog or pick up a copy of his latest book: Mammography and Early Breast Detection: How Screening Saves Lives How Screening Saves Lives
Alan B. Hollingsworth, MD, is currently the medical director of Mercy Breast Center, the director of the Risk Assessment & Genetic Testing Program and the director of the Multidisciplinary Breast Cancer Pre-treatment Conference at Mercy Hospital in Oklahoma City, OK. In addition, Dr. Hollingsworth is the recent author of the book "Mammography and Early Breast Cancer Detection: How Screening Saves Lives" published by McFarland & Co., Inc.