And why early detection methods are so important for women with dense breasts.
If you’re a woman over 40, your doctor has probably recommended that you get a mammogram. Although these tests may be uncomfortable for some people, they are invaluable for detecting breast cancer early. This type of screening can reduce your risk of dying from breast cancer by up to 40% by identifying breast cancer before symptoms such as lumps appear. That’s commendable, but I often wonder how this process could be strengthened. What screening improvements will be needed to reduce deaths from metastatic breast cancer? 100 percent?
Early detection of breast cancer is essential. Metastatic breast cancer (stage 4) is treatable, but not curable, despite all the medical advances that have occurred. To cure breast cancer, doctors need to intervene before the breast cancer reaches stage 4, if not earlier. Ultimately, all breast cancers must be detected before they spread, or metastasize.
So why is mammography screening insufficient and undetectable? all Is breast cancer early enough? One of the main reasons, she says, is that 43 percent of those screened have dense breast tissue, so mammograms may not detect breast cancer. This masking effect is sometimes compared to the challenge of finding a white rabbit in a snowy field or finding WALL-E. where is wally Books — in the crowd. In addition, with dense breasts, there is no guarantee that breast cancer will not be visible at all. Cancer in dense breasts may be completely hidden and invisible.
This is a solemn question. How much cancer might go undetected in dense breasts? I recently estimated that a mammography test might not. 267,000 cancers in 2021 in the United States. This is a large number that likely accounts for many, if not most, cancers that spread before they are detected.
Honestly, mammography do Although it easily detects many cancers in non-dense breasts, it also identifies many cancers in dense breasts, although this is often more difficult. That’s why doctors continue to recommend mammography regardless of breast density. No one should miss the opportunity for early detection. However, it is important to convey that a negative mammogram with dense breasts does not mean breast cancer is not present. Additional screening may still be required.
The good news is that there are already plenty of additional screening options. Imaging tests such as contrast-enhanced breast MRI, molecular breast imaging, and contrast-enhanced mammography can identify cancers that would otherwise be hidden by dense breast tissue on a regular mammogram. (Full-breast ultrasound also improves cancer detection in dense breasts, but to a lesser extent; 3D mammography is a good option for initial screening, but 3D mammography detects very few additional cancers.) Because it is not a substitute for other options for additional screening in dense breasts) cancer in dense breasts. )
Liquid biopsies, such as blood draws that test for cancer DNA in the blood, have potential for breast cancer screening, but are still being refined for clinical use. But keep an eye out for these liquid biopsies, as they have the potential to revolutionize screening for breast cancer, including dense breasts.
Approximately 17 million people in the United States with dense breasts undergo a mammogram each year, and they may benefit from additional testing. Yes, the costs can be significant, including for the patient, especially if the additional tests are not covered by insurance. However, improving early detection of cancer can have significant benefits. If more cancers are detected at curable stages, patients can avoid chemotherapy and other costly interventions, including expensive end-of-life care.
In a sense, society is paying one way or the other. The current cost of late-stage treatment for breast cancer is high. Dense breasts also prevent many cancers from being detected early, increasing the mortality rate from this dreaded disease. Currently, approximately 40,000 people die from breast cancer each year in the United States, and far more worldwide. This social damage is enormous and tragic. I believe that strong additional screening in dense breasts will reduce metastatic breast cancer to the lowest levels ever seen. If this screening were made widely available, tens of thousands of breast cancer deaths could be avoided each year.
Critics of additional breast cancer tests like breast MRIs say they do more harm than good, raise false alarms and cause undue anxiety in those undergoing the test. However, the risk is do not have Performing additional screening, especially in the case of dense breasts, far outweighs these concerns. Overdiagnosis of some cancers, or the detection of cancers that do not cause lifelong harm, is also a concern. (For example, if you were diagnosed with breast cancer at age 75 and died from an unrelated heart attack that year, that could be considered an overdiagnosis of cancer). However, 40,000 people die from breast cancer each year in the United States. underdiagnosis. Early detection of cancer is a bigger and more urgent problem to solve.
Without additional screening, many people with dense breasts have worse outcomes. These people are more likely to be young and nonwhite, including black, Asian, and Hispanic women. Continuing to ignore disparities in screening outcomes is unethical and problematic, especially since there are already multiple technologies available to address this problem that have not been widely adopted. All we need is to make these technologies more available to those who need them. The time to act was yesterday. Well, what shall we do today?
The Find It Early Act is a national law that requires additional screening for dense breasts using ultrasound, breast MRI, and other recommended screening options. This ensures that additional screening for dense breasts is covered by private insurance and Medicare/Medicaid. If the Early Detection Act is enacted, it will reduce deaths from metastatic breast cancer and reduce disparities and inequalities in breast cancer screening. (In support of this action, click here.) Read on to learn more about the past, present, and potential future of supplemental breast cancer screening. here.
Matt Covington, MD, is an assistant professor of radiology at the University of Utah and Huntsman Cancer Institute. Dr. Covington provides comprehensive breast imaging and leads clinical trials on new imaging technologies for cancer detection. Dr. Covington has received compensation for consulting services from GE Healthcare and currently receives research funding for contrast mammography from Fujifilm.Follow Dr. Covington Twitter (X) and linkedin.
