Where Can Breast Imaging Utilize Complementary Technology?
Mammography is the current gold-standard for breast cancer detection. However, it has known limitations. These limitations pose problems especially for women with unclear or abnormal imaging findings. Below you will find explanations of mammography's limitations and explanations of how breast imaging can utilize complementary technology :
False Negative Results:
A false negative mammogram looks normal even though breast cancer is present. A false negative result can delay a woman's diagnosis, which could lead to a later stage diagnosis and necessitate more aggressive treatment. This also reduces the chance of survival for a woman thus proving early detection is vital.
False Positive Results:
A false-positive mammogram looks abnormal but no cancer is actually present. This causes patients to have unnecessary costs of further treatment, unnecessary procedures and unnecessary anxiety. False positive results increase the cancer-to-biopsy yield, meaning more women undergo unnecessary biopsies as a result.
Over-diagnosis and Over-treatment:
An over-diagnosis of breast cancer refers to a tumor detected on screening that never would have led to clinical symptoms. A study in the New England Journal of Medicine (NEJM), "Breast-tumor size, over-diagnosis, and screening" looks at the introduction of screening mammography and the possibility over-diagnosis of small tumors that may not progress to clinically significant tumors. This issue leads to increased costs to patients and the health care system as a whole.
Dense Breast Patients:
Breast density can considerably influence the precision of routine methods of detection, such as mammography. Approximately 50 percent of women have dense breasts. All imaging modalities rely on visual interpretations of a woman's breasts, and for dense breast patients that visual interpretation can be confounded by glandular tissue, cloaking cancers. This occurs because distinguishing between healthy and dense breast tissue and cancer is difficult, as both appear white on imaging––often likened to trying to spot a polar bear in a snowstorm.
The Gray Zone:
When a woman falls into the“gray zone” it can be very difficult to visually interpret results and thus mammography can fall short. This is because it can be challenging to determine whether a patient should be classified as a BI-RADS 3 versus a BI-RADS 4A. The likelihood of a breast cancer is between zero and two percent in a BI-RADS 3 patient. For BI-RADS 4 patients, the variation is between two and 95 percent, with some centers using the BI-RADS 4A (2 - 10 percent), 4B (10 - 50 percent) and 4C (50 - 95 percent) stratification of results. Since a woman with a BI-RADS 4A has a two to 10 percent likelihood of breast cancer, the difference between a BI-RADS 3 and BI-RADS 4A is minor however, management of the patients’ care in each category is drastically different, with BI-RADS 4A patients all being biopsied and BI-RADS 3 patients given a “watch and wait approach”.
What Can Be Done:
Though mammography has its limitations, there is still a strong need for the detection method in the breast cancer space. However, we need to find a way to counter the limitations mentioned above. If a blood-based approach, such as a liquid biopsy tool was added to the standard of care, we would be able to improve the timing and accuracy or detection. If a women obtained a mammogram with difficult-to-interpret results, a liquid biopsy could be taken to gain a definitive response, giving the patient more clarity. Adding a test that would be based on physiology rather than anatomy to the current standard-of-care would ease patient anxiety, reduce false positive and negative results, as well as give dense breasts patients a conclusive detection status.