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Researchers at the Moffitt Cancer Center in Tampa, Fla., predict that advances in breast cancer screening will need a personalized touch because mammography is not a “one strategy fits all” technology. Their report appears in the American Journal of Medicine.
“Although mammography remains the gold standard for breast cancer screening, there is increasing awareness that there are subpopulations of women for whom mammography is limited because of its reduced sensitivity based on an individual’s breast density and other factors,” said lead author Jennifer S. Druktenis, MD.
The new study refers to a controversial disagreement on mammography screening issues. In 2009, the U.S. Preventive Services Task Force — a panel of health care professionals charged with reviewing published research and with making health care policy recommendations — issued guidelines that women should receive mammograms every 2 years starting at age 50. They recommended against screening before age 50. Their recommendation generated controversy because of a well-established convention, which recommends that mammography screening begin at age 40 and that, for those with a first-degree relative with breast cancer, screening should start a decade before that relative’s age at diagnosis.
As effective as mammography has been, the authors consider it an imperfect screening tool. The effectiveness for women with fatty breast tissue is as high as 98%, but the effectiveness for women with dense breasts can be as low as 36%. Women who undergo annual mammography may still present with cancers found only on physical examination, according to the authors. Moreover, some studies suggest that radiation exposure may contribute to an increase in breast cancer incidence in high-risk populations.
The authors suggested that optimal patient care will require a new screening paradigm with patient-specific strategies tailored to risk based on family history, age, genetic profile, and breast density.
“The sensitivity of mammography is inversely proportional to breast density,” explained Mooney. “Owing to decreased sensitivity in women with dense breast tissue, but with attention to radiation concerns and a high rate of false positives, breast imagers are adapting with new technologies.”
According to the authors, those new technologies include low-dose mammography; contrast-enhanced mammography (which evaluates blood flow in the breast); automated whole-breast ultrasound; molecular imaging; magnetic resonance imaging (MRI); and tomosynthesis (multiple mammographic “slices” through the breast, similar to a CT scan).
“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,” Druktenis said.
The authors agree that new technologies will be increasingly personalized, integrating patient-specific and age-dependent factors of cancer risk “with selective application of specific screening technologies best suited to the woman’s age, risk, and breast density.”