Gaining Ground on Breast Cancer

We have more options for detection, diagnosis, and treatment than ever, and still more are on the way: therapies that target the cancer without torturing you, so you can focus on getting better. Here, an overview.

By Amanda Gardner

Breast Cancer DetectionTHEN…Until about the mid-20th century, the only way to know something was wrong was to find a lump in a woman’s breast. By then it was often too late to save her breast — or her life. NOW…Mammography Screening: This remains the standard for finding tumors at their earliest, most treatable stage. But while mammography cuts the risk of dying by as much as a third, it still misses 15 to 20 percent of cancers. Experts have their hopes set on the following methods. Digital Mammography: Currently available in fewer than 15 percent of mammography facilities, digital mammography may one day be the detection method of choice, especially for women with dense breasts. (A new, less expensive device, Fuji’s Computed Radiography Mammography Suite, won FDA approval this year, so digital screening may soon become more widely accessible.) Instead of capturing an image on film, digital mammography stores an electronic picture of the breast on a computer, where contrasts can be altered for better viewing.Magnetic Resonance Imaging (MRI): MRI picks up changes in blood supply, which can indicate the presence of an early cancer, since tumors need blood to grow. "In very high-risk women, we can use MRI as a screening tool to pick up cancers while they’re still noninvasive and there is less potential that they have spread," says Alexandra Heerdt, MD, a breast surgeon at Memorial Sloan-Kettering Cancer Center in New York City. The technology is still in clinical trials for use in breast cancer.Halo Breast Pap Test: Approved by the FDA last year, this device uses suction to collect nipple fluid; the process is called ductal lavage. Because breast cancer often starts in the milk ducts, the fluid can be analyzed for abnormal cells before any other signs of cancer (such as a lump) are found.NEXT…Computer-Assisted Detection (CAD): This method highlights suspicious areas on a mammogram, picking up subtle changes the eye might miss and compensating for human error. Further research is needed to assess its benefit.Magnetic Resonance Spectroscopy: Performed as part of an MRI, this method graphs breast composition and reveals how much of the cancer marker choline is in the tissue. It may reduce the need for biopsies by 58 percent. Researchers anticipate that the technology, combined with mammography, will one day become the standard of care for high-risk women. "It’s already being used in the detection of brain and prostate cancers," says researcher Lia Bartella, MD, of Memorial Sloan-Kettering Cancer Center. iFind Home Detection Device: A handheld imaging tool that uses near-infrared light to measure blood volume, iFind lights up when it detects a possible tumor. The device stores information on a microchip so a woman can track changes over time and download the exams for her physician. The iFind will generate results that will help improve mammogram accuracy when it becomes available in about two years.Biomarkers: These are the holy grail of cancer detection and still at least 10 years away from hitting the market, but the promise is that a single molecule in the blood or urine will show that an individual has cancer or may develop it. "The hope is that molecular detection will be earlier detection," says Therese Bevers, MD, of the University of Texas M.D. Anderson Cancer Center. Breast Cancer Breath Test: While this test is still in the theoretical phase, researchers at the University of Michigan at Ann Arbor anticipate that one day an over-the-counter device can detect molecules generated by breast cancer in the breath. Breast Cancer Diagnosis THEN…Biopsy: "A biopsy is the only definitive way to know if it’s cancer," says Jay Brooks, MD, of Ochsner Health System, in Baton Rouge, Louisiana. Classic techniques range from surgery to remove suspicious tissue to a core-needle biopsy (an in-office procedure in which tissue is removed with a hollow needle) to fine-needle aspiration, in which a smaller needle removes sample fluid or cells from the breast. Axillary Node Dissection: In the past, surgeons removed up to 80 lymph nodes from under the arm to see if the cancer had spread beyond the breast. By the end of the twentieth century, the procedure had been refined so that only 20 or 30 were removed. But only about 30 percent of procedures revealed cancer in the nodes, meaning that for the majority of patients the surgery was unnecessary.

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