Exercise and Maintaining Healthy Weight Most Important Lifestyle Factors for Reducing Recurrence Risk

Many studies have found a link between regular exercise and a lower risk of being diagnosed with breast cancer or breast cancer coming back (recurrence). At the same time, much research has shown that being overweight increases the risk of breast and other cancers, as well as increasing the risk of recurrence.

A review study suggests that exercising regularly and maintaining a healthy weight are the two most important lifestyle choices a woman diagnosed with breast cancer can make to reduce her risk of recurrence.

The research was published in the Feb. 21, 2017 issue of the Canadian Medical Association Journal. The researchers summarized their results in six main points:

  • Exercise: Women who’ve been diagnosed with breast cancer should exercise moderately at least 30 minutes per day, 5 days a week, or do 75 minutes of vigorous exercise per week. Women should also do two to three sessions of strength training for large muscle groups (glutes, back, chest, and hamstrings) per week.
  • Avoid weight gain: Weight gain during or after breast cancer treatment is linked to worse outcomes. Women who are overweight or obese at diagnosis also have poorer outcomes.
  • Stop smoking: While it’s unclear if stopping smoking after a breast cancer diagnosis affects the risk of recurrence, smoking causes a number of other health problems.
  • Limit alcohol: Limiting drinking to one or zero alcoholic drinks per day may help reduce the risk of recurrence.
  • Vitamin supplementation: Moderate consumption of vitamin C may be helpful, although more research is needed. Vitamin D supplements can help maintain bone strength.
  • Diet: No specific type of diet has been shown to reduce the risk of breast cancer recurrence. Research suggests that patients do not need to avoid soy, and that soy products may help women maintain a healthy weight if they’re used to replace higher-calorie meat protein.

Overall, the researchers found that exercise had the most potential to reduce the risk of recurrence and improve survival — exercise reduced the risk of dying from breast cancer by about 40%.

Along with a healthy diet and lifestyle choices, regular exercise is one of the best things women can do to keep the risk of recurrence as low as it can be. This study adds to other research suggesting that regular exercise reduces recurrence risk. Regular exercise also helps keep your physical and mental health in top shape. No matter how old you are, it’s never too late or too soon to get moving. And once you do start, keep at it!

Bottom line: Regular exercise reduces recurrence risk of breast cancer.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.


Many Women at High Risk of Genetic Mutation Don’t Get Testing

A study has found that after being diagnosed with breast cancer, most women want genetic testing but don’t get it, and only about half of women at high risk of a genetic mutation are tested. The study was published as a Research Letter in the Feb. 7, 2017 issue of the journal JAMA.

Most inherited cases of breast cancer are associated with one of two abnormal genes: BRCA1 (Breast Cancer gene one) or BRCA2 (Breast Cancer gene two).

Women with an abnormal BRCA1 or BRCA2 gene:

  • have up to an 85% lifetime risk of developing breast cancer
  • have a much higher-than-average lifetime risk of ovarian cancer; estimates range from 15% to 60%

U.S. guidelines say that BRCA testing should be considered when:

  • many women in a family have been diagnosed with breast and/or ovarian cancer, particularly if the women were younger than 50 when diagnosed
  • some women in a family have been diagnosed with cancer in both breasts
  • there is both breast and ovarian cancer in a family
  • men in a family have been diagnosed with breast cancer
  • there is breast cancer in a family and either male relatives on the same side of the family have been diagnosed with prostate cancer at a young age or relatives on the same side of the family have been diagnosed with gastrointestinal cancers, such as pancreas, gall bladder, or stomach cancer
  • a family is of Ashkenazi (Eastern European) Jewish descent

To do the study the researchers sent a survey on genetic testing to 2,529 women who had been diagnosed with stage 0 to stage II breast cancer between July 2013 and September 2014. The women were between 20 and 79 years old and lived in Georgia and Los Angeles, Calif.

The survey found that 66% of the women said they wanted genetic testing, but only 29% actually had genetic testing. In addition, only 60% of high-risk women who had genetic testing met with a genetic counselor.

The most common reasons high-risk women gave for not having genetic testing were:

  • my doctor didn’t recommend it (56.1%)
  • too expensive (13.7%)
  • didn’t want it (10.7%)
  • my family didn’t want me to have it (0.2%)

“We found that genetic counseling and testing are not well-matched to medical need,” said Allison Kurian, M.D., associate professor of medicine and of health research and policy at Stanford, who is the study’s lead author. “Women are very interested in genetic testing but many fail to receive it. This is particularly worrisome because it means that doctors are missing the opportunity to prevent cancers in mutation carriers and their family members.”

“Genetic testing results can affect what sort of surgery a woman may choose to treat her existing breast cancer, as well as what treatments she should pursue to reduce the risk of forming new cancers in the future,” said Reshma Jagsi, M.D., professor and deputy chair of radiation oncology at the University of Michigan and one of the study’s senior authors. “We don’t have a crystal ball, but genetic testing can be a powerful tool for certain women. It is worrisome to see so many of those women at highest risk for mutations failing even to have a visit focused on genetic counseling.”

Bottom line: Many high-risk women who should have genetic testing aren’t having the screening done. Women with a genetic mutation linked to breast cancer have a number of options to reduce breast cancer risk and the risk of breast cancer recurrence.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.


Low-Dose Aspirin May Lower Breast Cancer Risk

Taking low-dose aspirin at least three times per week may reduce women’s risk of breast cancer by up to 20 percent, a new study suggests. Many people take low-dose aspirin (also called baby aspirin) to reduce the risk of heart disease. A low dose of aspirin is 81 mg per day. Aspirin reduces inflammation and is also a weak aromatase inhibitor. Aromatase inhibitor medicines — Arimidex, Aromasin, and Femara — are used to treat hormone-receptor-positive breast cancer.

Earlier studies have suggested that people who regularly take low-dose aspirin may have a lower risk of breast and some other cancers. Still, these studies didn’t look at whether any possible risk reduction was linked to the characteristics of the breast cancer.

A preliminary study suggests that women who take low-dose aspirin 3 or more times per week have a lower risk of hormone-receptor-positive, HER2-negative breast cancer. The study used data from more than 57,000 women who were part of the California Teachers Study.

In the 23% of women who reported using low-dose aspirin regularly, researchers saw a 20% reduction in the risk of developing HR-positive/HER2 negative breast cancer, some of the most common forms of the disease.

The risk was inversely associated with taking a low-dose aspirin three or more times a week, compared with those women who had no regular low-dose aspirin use. Women who took other nonsteroidal anti-inflammatory medications such as ibuprofen did not see as much of a difference, nor did those taking a regular high-dose aspirin. Previous studies have showed mixed results in breast cancer impact among women who took a regular high-dose aspirin.

The new study did not look at why there might be an association between lower cancer risk and aspirin, but author Leslie Bernstein, a professor in the Division of Cancer Etiology in the Department of Population Sciences at the Beckman Research Institute of the City of Hope Comprehensive Cancer Center, said one reason may be because aspirin can lower inflammation.

“Simply things like obesity or inflammatory conditions are a risk factor for breast cancer, so this may be one reason it could help,” Bernstein said.

Yet, it’s too soon to suggest taking baby aspirin to reduce breast cancer risk.

If more study bears out the link between baby aspirin and breast cancer prevention, Bernstein said low-dose aspirin may also help prevent recurrence.

The study was published online May 1 in the Breast Cancer Research journal. It was funded by the U.S. National Cancer Institute and the California Breast Cancer Research Fund.

Bottom line: People who regularly take low-dose aspirin may have a lower risk of breast cancer and some other cancers.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.


3D Mammography Improves Cancer Detection in Women Under Age 50

The addition of tomosynthesis to mammography provided better screening performance and lower recall rates, as well as higher invasive cancer detection in younger women, based on a recent study.

In women under age 50, recall rates for those undergoing conventional mammography was 115 per 1,000 cases compared with 108 per 1,000 cases for tomosynthesis (3D mammography), for a 6% reduction in recalls reported Stephen Rose, MD, chief medical officer of Solis Mammography, a group of 30 clinics headquartered in Addison, Texas.

Also, cancer detection rates were 2.1 for mammography compared with 3.1 with the addition of tomosynthesis, while invasive cancer detection rates improved from 1.2 to 1.8 with the addition of tomosynthesis, he said in a presentation at the Radiological Society of North America (RSNA) annual meeting.

This represented a relative increase in invasive cancer detection of 67%, he noted.

For the study, Rose examined the results of 65,457 screening examinations among women under age 50 — 45,320 had conventional mammography and 20,137 underwent mammography plus tomosynthesis. The studies were done from Jan. 1, 2015 to Dec 31, 2015. Women screened with tomosynthesis plus mammography paid an out-of-pocket fee, Rose explained.

He also noted that “with tomosynthesis, we were able to find more cancers in women with dense breast tissue. In fact, using digital mammography we were unable to find any cancers in women with dense breast tissue.”

Overall, the addition of tomosynthesis increased the positive predictive value (PPV) of the screening by more than 56%, Rose said. The debate over screening women in their 40’s for breast cancer is still an issue, with the U.S. Preventive Services Task Force suggesting that mammography screening should begin at age 50, and the American Cancer Society recommending that annual screening begin at age 45, but women can opt for screening starting at age 40.

But Rose noted that as many as 20% of invasive cancers are found in women under the age of 50, and breast cancer in these women are the cause of more life-years lost to the disease. “More aggressive, rapidly developing cancers are more likely in women diagnosed under the age of 50,” he told MedPage Today.

Bottom line: 3D tomosynthesis mammography improves cancer detection in women under the age of 50. Tomosynthesis is more effective in dense breast tissue which is more prevalent in women under the age of 50.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.


Breast Tomosynthesis Technique May Help Reduce Breast Cancer Screening Recall Rate

A new digital breast tomosynthesis technique has the potential to reduce the rate at which women are called back for additional examinations without sacrificing cancer detection, according to a study published in Radiology.

Digital breast tomosynthesis (DBT) in conjunction with full-field digital mammography (FFDM) has been shown to improve cancer detection and reduce callbacks for additional examinations. However, the combination of the two methods requires a second radiation exposure to the breast and also slightly more time for women in breast compression. Researchers at Christiana Care Health System developed a DBT technique that may eliminate the need for FFDM.

Researchers have been exploring a relatively new approach in which the DBT images are used to create a synthesized 2-D (s2D) compilation image. The method has the potential to render FFDM unnecessary. Investigators compared the clinical performance of DBT-s2D with that of DBT-FFDM and FFDM alone. They studied 78,810 screening mammograms performed from 2011 to 2016. In the study group, 32,076 women were screened with FFDM, 30,561 women were screened using DBT-FFDM, and 16,173 women were screened using DBT-s2D.

The study demonstrated that DBT-s2D’s recall rate was only 4.3% compared with 5.8% for DBT-FFDM. Overall cancer detection rates were similar. However, DBT-s2D detected 76.5% of invasive cancers compared with 61.3% for DBT-FFDM. At 3.6%, the false ̶positive rate for DBT-s2D was significantly lower than the 5.2% rate for DBT-FFDM. The positive predictive value of biopsy for DBT-s2D was 40.8% compared to 28.5% for DBT-FFDM.

Dr Jacqueline Holt, director of Breast Imaging at Christiana Care Health System said: “The adoption of s2D mammography combined with DBT into screening programs would limit radiation exposure to the patient, and, on the basis of our results, may improve clinical performance.”

Bottom line: Advanced imaging techniques such as 3D tomosynthesis with synthesized 2D images have the potential to reduce radiation exposure and improve breast cancer detection when compared to stand-alone 2D full field digital mammography or the combination of 2D full field digital mammography with 3D tomosnthesis mammography.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.


Exercise is an Important Key to Preventing Breast Cancer Recurrence

For women who have recovered from breast cancer, exercise appears to be the most important lifestyle choice to reduce the risk of death from a relapse. The research involved a review of 67 published articles and recently published in the Canadian Medical Association Journal.

“Of all lifestyle factors, physical activity has the most robust effect on breast cancer outcomes,” co-author Ellen Warner, of Sunnybrook Health Sciences Center in Toronto, said in a press release. “Weight gain of more than 10% body weight after a breast cancer diagnosis increases breast cancer mortality and all-cause mortality. However, there are good reasons to discourage even moderate weight gain because of its negative effects on mood and body image.”

The authors looked at lifestyle factors such as exercise, weight, diet, and smoking to determine what behaviors women can change to improve their chances of surviving a recurrence of breast cancer.

They conclude that physical activity can reduce the chance of death from a breast cancer relapse by up to 40 percent. Specifically, researchers recommended engaging in at least 30 minutes of moderate exercise five days a week or 75 minutes of vigorous exercise per week, as well as core muscle strength training. Another suggestion was eating a healthy and nutritious diet. The research team noted that no diet is known to reduce the risk of breast cancer, so patients should follow general diet recommendations.

It is hard to isolate why exercise confers such benefits, says Warner, but one possible explanation is that it suppresses inflammation that could otherwise damage cells and increase the risk of cancer spreading. A key recommendation was avoiding weight gain, since it is linked to decreased chance of survival. Another important recommendation was exercising more. As for taking vitamin supplements, researchers recommended vitamin C because it helps maintain bone strength. Chemotherapy and hormone treatments are known to reduce bone density. Breast cancer patients should also stop smoking immediately, and limit their alcohol intake to one drink a day.

“Because it is common for patients to reduce their level of physical activity after a breast cancer diagnosis, it is important for health care professionals to promote and encourage exercise in this patient population,” the authors added. “Simply receiving advice from an oncologist to exercise more has been shown to increase patients’ level of activity.”

It is important to note that patients included in these studies were not only changing their behaviors, they were also receiving conventional anti-cancer therapy. Lifestyle changes alone should not be used in place of adequate treatment under the supervision of a breast cancer specialist.

The authors stressed that their recommendations may not work for everyone with a breast cancer diagnosis because some cancers are more aggressive and may recur despite the most carefully followed lifestyle regimen.

Bottom line: An active lifestyle combined with a healthy diet can reduce the risk of breast cancer recurrence. The combination of a healthy diet and physical activity have been linked to a reduction in mortality from numerous diseases.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.


Don’t Skip Your Mammogram After A False-Positive Result

The emotional trauma of receiving a false-positive result from a mammogram may lead many women to delay or skip their next screening, a new study finds. A false-positive result means that an aberration on a mammogram looks like it might be cancer. But after tests — such as added imaging or biopsy — it turns out to be benign.

The finding, from a study of more than 261,000 Chicago-area women, highlights an unintended consequence of false positive results on screening mammography. The new study was led by Firas Dabbous, manager of patient-centered outcomes research at Advocate Lutheran General Hospital in Park Ridge, Ill. His team examined data on more than 741,000 screening mammograms conducted on nearly 262,000 women in the Chicago area. The study found that slightly more than 12 percent of the mammograms ended up yielding a false-positive result.

In cases where a mammogram was recommended every year, women who had an unfounded scare tended to delay their next test by an additional 13 months compared to a three- to six-month delay for women whose tests had come out negative.

That, in turn, can affect a woman’s chances of survival if breast cancer is subsequently diagnosed. Some women never showed up at all, but the researchers couldn’t determine whether they gave up on the breast cancer screening or simply had it done elsewhere.

“It’s a delicate balance,” chief author Firas Dabbous of Advocate Lutheran General Hospital in Park Ridge, Illinois, told Reuters Health. “We want to detect tumors when they are present but we don’t want to overburden women with a lot of false positives and a workup that is not needed.”

The study appeared online February 9th in the journal Cancer Epidemiology, Biomarkers and Prevention.

Debates over how often women should get mammograms often focus on whether false positives – which can cause women to experience anxiety as well as painful and expensive extra testing, including biopsies – represent a harm that outweighs the benefits of screening.

“Unfortunately, for women over age 50, just skipping a mammogram every other year would miss up to 30 percent of cancers,” said Dr. Stefanie Zalasin, a breast imaging specialist in New York who reviewed the new findings. She said that prior research has shown that “women who have had a false-positive mammogram are actually at greater risk for subsequently developing breast cancer. This is why it is extremely important that women continue annual screening mammography, even if they have had the experience of having a false-positive mammogram in the past.”

“Most U.S. studies have shown either greater adherence to screening recommendations after a false positive, or no difference, whereas studies done in Europe have shown screening rates somewhat lower than women who have true negative results,” Smith said.

Bottom line: Screening mammography has some limitations, but it’s increasing the survivability of the woman through early detection.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area


Dense Breasts May be Leading Risk Factor For Breast Cancer

Women whose breasts are composed mainly of dense glandular tissue rather than fat may have higher odds of developing breast cancer, a recent study suggests.

Researchers examined data on more than 18,000 women with breast malignancies and 184,000 women the same age without breast cancer. They found breast density appeared to be the biggest indicator of cancer risk, even more than other common risk factors like family history or waiting until after age 30 to have babies.

“Women with dense breasts have a roughly 2-fold higher breast cancer risk relative to women with non-dense breasts,” said lead study author Dr. Natalie Engmann of the University of California, San Francisco.

This is a problem because 60 percent of younger women have dense breasts and so do 40 percent of older women who have gone through menopause – and because dense breasts make tumors harder to detect on mammograms, Engmann said.

“Our findings suggest that because breast density is a strong, common risk factor that can be modified, reducing the number of women with dense breasts may prevent a substantial proportion of breast cancer cases,” Engmann.

In the study, online February 2 in JAMA Oncology, researchers examined data on women with four categories of breast density: almost entirely fat, mostly fat with some dense tissue, moderately dense and predominantly dense. Then, they looked at several known breast cancer risk factors: women’s weight, family history of the disease, personal history of benign biopsy results, breast density and having a first baby after age 30.

About 39 percent of breast cancer cases before menopause and 26 percent of cases afterwards might be prevented if women in the two highest breast-density categories had less dense breast tissue, the study team calculated.

It’s unclear that women can do anything to reduce breast density, but it may make sense for them to consider screening alternatives to mammograms, said Dr. Christine Berg, a NCI researcher who wasn’t involved in the study.

“I think it makes more sense for a woman with dense breasts, particularly with other risk factors, to discuss with her doctor and the radiologist whether or not she would benefit from other types of screening such as MRI,” Berg said by email. “Breast tomosynthesis is an emerging technology which I think is better than standard mammography.”

Berg also recommended a calculator (here: http://bit.ly/2knIYuH) developed by the Breast Cancer Surveillance Consortium for women to assess their individual risk.

Bottom line: For women with dense breasts, the addition of alternate screening such as 3D bilateral whole breast ultrasound or MRI can improve the early detection of breast cancer.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.


Adding 3-D Mammography or Ultrasound to Regular Screening Finds More Cancers in Dense Breasts

Dense breasts have less fatty tissue and more non-fatty tissue compared to breasts that aren’t dense.

One way to measure breast density is the thickness of tissue on a mammogram. The BI-RADS (Breast Imaging Reporting and Database System), which reports the findings of mammograms, also includes information on breast density. Still, no one method of measuring breast density has been agreed upon by doctors. Breast density is not based on how your breasts feel during your self-exam or your doctor’s physical exam. Dense breasts have more gland tissue that makes and drains milk and supportive tissue (also called stroma) that surrounds the gland. Breast density can be inherited, so if your mother has dense breasts, it’s likely you will, too.

Research has shown that dense breasts:

  • can be 6 times more likely to develop cancer
  • can make it harder for mammograms to detect breast cancer; breast cancers (which look white like breast gland tissue) are easier to see on a mammogram when they’re surrounded by fatty tissue (which looks dark).

About 43% of women ages 40 to 74 years old in the United States are classified as having dense breasts.

As of September 2015, 24 states have passed legislation requiring that women be notified of their breast density with mammography results.

Because mammograms don’t always find cancers in dense breasts, researchers have been studying the effectiveness other screening methods for dense breasts.

A study has found that adding 3-D mammography (also called digital tomosynthesis) or breast ultrasound to regular screening mammograms can detect more cancers in dense breasts. Ultrasound was slightly better at detecting cancers in dense breasts than 3-D mammography and both screening methods had similar false-positive rates.

The study was published online on March 9, 2016 by the Journal of Clinical Oncology. Read the abstract of “Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts: Interim Report of a Prospective Comparative Trial.”

The study also was presented on March 9, 2016 at the 2016 European Breast Cancer Conference. Read the abstract of “Interim results of the Adjunct Screening with Tomosynthesis or Ultrasound in Mammography-negative Dense Breasts (ASTOUND) trial.”

The ASTOUND study was started in December 2012 and included 3,231 women with breasts classified by BI-RADS as either consistently dense or extremely dense. The women were 44 to 78 years old, and screening mammograms had found no cancer in their breasts.

After their last regular screening mammogram, the women also had a 3-D mammogram and breast ultrasound. The 3-D mammograms and ultrasounds were read by different radiologists who knew that the standard screening mammogram had found no cancer, but didn’t know the result of the other additional screening test.

The additional screening tests found 24 breast cancers:

  • 12 were detected by both 3-D mammogram and ultrasound
  • one was detected only by 3-D mammogram
  • 11 were detected only by ultrasound

“These results mean that tomosynthesis detected an additional four breast cancers per 1,000 women screened and ultrasound detected an additional seven breast cancers per 1,000,” said Dr. Nehmat Houssami, professor of public health at the University of Sydney, who presented the study at the European Breast Cancer Conference.

There were 107 false-positive results:

  • 53 for 3-D mammograms
  • 65 for ultrasound

This difference wasn’t statistically significant, which means that it was likely due to chance and not because of the difference in screening methods.

In an editorial in the Journal of Clinical Oncology that ran with the paper, Wendie Berg, M.D., of the Magee Women’s Hospital at the University of Pittsburgh Medical Center, wrote that a high false-positive rate is why many doctors have been reluctant to use ultrasound for breast cancer screening. The ASTOUND study may start to change that.

“Importantly, in preliminary results from the ASTOUND trial, false-positive recalls (2.0%) and biopsies (0.7%) were acceptably low,” Dr. Berg wrote.

“…Our study does not provide all the answers on this issue but provides the first critical piece of information on how these two tests compare,” Dr. Houssami added. “If a woman is concerned that her breasts are very dense on the mammogram (or has been told her breasts are very dense and would like more testing), I can use the data from ASTOUND to discuss with her the option of having the ultrasound or the tomosynthesis screen; I would discuss with her the pros and cons of adding another test to improve sensitivity for detecting cancer, but would also point out this could have additional harms such as more false alarms.”

Bottom line: For women with dense breasts, the addition of 3D mammography or bilateral whole breast ultrasound improves the early detection of breast cancer.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.


Adding 3-D Whole Breast Ultrasound to Mammography Improves Detection of Breast Cancer!

Women with dense (less fatty) breast tissue represent 40 percent of all U.S. women, and they are four to six times more likely to develop breast cancer than women with non-dense breast tissue. Cancers in these women are also more likely to go undetected after having a mammogram.

A recent study published in the American Journal of Roentgenology, conclude that for women with dense breast tissue, combining mammography with a 3-D automated breast ultrasound system can improve the detection of breast cancer by 29 percent.

The study analyzed the performance of 17 radiologists in their detection of breast cancer using full-field digital mammography only versus full-field digital mammography followed by 3-D automated breast ultrasound.

The radiologists looked at 185 cases collected from prior clinical studies in which both imaging methodologies had been used. Out of the 52 cases in which cancer was identified, 31 had been interpreted in the prior clinical studies as negative for cancer on the mammogram.

When comparing the mammogram and 3-D ultrasound results to results from the mammogram only, the radiologists enhanced their ability to detect cancer by what the study’s researchers termed a “statistically significant relative improvement.”

“The improved detection in nearly a third of women with dense breasts is significant because it means those are cancers that might not have been found until it became more apparent on a mammogram,” Giger said. “And by the time they were discovered, the cancer might have been at a more advanced stage.

“The takeaway here is women with dense breasts should augment traditional mammographic screening with another type of imaging modality, such as 3-D ultrasound (or MRI), in order to avoid missing cancerous lesions,” Giger added.

Giger is the A.N. Pritzker Professor of Radiology for the Committee on Medical Physics and the College at the University of Chicago, as well as the vice-chair for Basic Science Research in the Department of Radiology. She is a member of the National Academy of Engineering and is considered one of the pioneers in the development of computer-aided diagnosis, authoring or co-authoring more than 300 scientific manuscripts. She also is the inventor/co-inventor of 25 patents, and serves as a reviewer for various national and international granting agencies, including the National Institutes of Health and the U.S. Army. In the breast cancer study, she served as an independent evaluator for the Food and Drug Administration’s approval of the Automated Breast Ultrasound System from GE Healthcare.

Bottom line: For women with dense breasts, the addition of 3D bilateral whole breast ultrasound improves the early detection of breast cancer.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.