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Wednesday, November 14, 2012

New breast test is twice as good as mammograms

The Beginning of the End for Mammography
and Other Invasive Treatments
By Mindy Tyson McHorse, Contributing Editor

    Recent progress on the breast cancer front tells me we're moving closer to more effective, gentler cancer tests and treatments. It may even be the beginning of a movement away from radiation-heavy screening tests and invasive techniques like biopsies.

    Here's the first round of good news: In September, the FDA officially approved use of ABUS — the Automated Breast Ultrasound System. What's that? If you're a woman you need to know, because it can DOUBLE your chance of finding breast cancer early. So keep reading. . .

Continued below. . .

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    We first told you about ABUS in Issue #198 of this newsletter, pointing out it's a lifesaver for women with dense breast tissue (that's about 40 percent of women in the U.S.).

    Mammograms are useless for detecting tumors in dense tissue, and women with dense breast tissue are four to six times more likely to develop breast cancer. So the test is of little use to the women who need it most. Mammograms aren't even that useful for screening normal tissue, missing up to 15 percent of all cancerous lumps.

    ABUS is important because it doubles the rate of early detection for women with dense breast tissue and triples the rate of detection for cancers smaller than 10 mm.And since early detection means a survival rate of 96%, ABUS just makes sense.

    Now of course, the FDA only approved use of ABUS for women with dense breasts. And they haven't completely kicked mammograms to the curb. The first sentence of their official approval statement is that they support ABUS "in combination with a standard mammography." Even then, they say ABUS should be for women with dense breast tissues who've had a "negative" mammogram.

    It's a little ridiculous because ABUS can screen tissue of any type. The best information we have indicates it's a better solution for almost any woman, because ABUS means no painful breast compression, no radiation exposure, and a more thorough exam than a mammogram.

    Still, the FDA's new stance represents progress. It even gives me hope the FDA will someday sever its ties with the radiology industry. At least we can hope.

    Just note that ABUS approval doesn't override the longstanding best way to find breast lumps: consistent breast exams from competent physicians. It's been proven that the more time a physician spends conducting the exam, the more thorough the results.

    In fact, one study showed that OB/GYN physicians found fewer lumps when compared to family practitioners, internists, and other physicians who conduct longer exams (and by "long" I only mean 10-15 minutes).

    But lumps smaller than 1 cm across are tough for physicians to feel, no matter how long the exam lasts. That's why the ABUS news is important. Plus, it takes a physician about five seconds to examine a woman's breasts and tell her if the tissue is dense. And if that's the case, an ABUS test is crucial.
The mechanical palpation that "reads" tumors
    Another technique to keep your eye on: Elastography. It's used by ultrasound technicians to spot malignant tumors. That translates into fewer biopsies, because it means you're dealing with fewer false positives.

    This is good news. Biopsies are invasive, cost as much as $1,000, and getting back results can take as long as two weeks. Worse, the pathway through the skin created by the needle makes it potentially easier for diseased cells to spread.

    Elastography avoids all that. It's one step up from traditional ultrasound because it actually takes two ultrasound images and combines them. The first image uses basic ultrasound techniques to penetrate the body with sound waves. The result is a fuzzy image (called a sonogram) of what's inside your body.

    Step two is where the ultrasound technician takes what's called a compression image. If a breast tumor is suspected, the tech pushes slightly on the breast with the ultrasound emitter. This compresses the breast tissue while sound waves go through it. Because healthy breast tissue and benign tumors are more elastic, or softer, than malignancies, they'll depress easily. Malignant tumors don't depress at all. They can be anywhere from five to 100 times stiffer than a benign growth.

    It's the equivalent of a mechanical "palpation," providing information on the flexibility of a tumor.

    Once the two images are combined, the resulting two-part computer-generated picture tells us a lot more than a basic sonogram.

    But here's where it gets interesting — in 2006, an elastography study correctly differentiated between benign and malignant tumors with nearly a 100 percent success rate.

    On top of that, doctors can read the results right away instead of making you wait weeks to learn whether a tumor is cancerous or not. The cost is only $100 or $200 per procedure and doesn't require a pricey follow-up visit. And given that it's non-invasive ... there's not really a good reason not to use it.

    Elastography also shows incredible promise for diagnosing prostate cancer and a few other diseases, like cirrhosis of the liver (a disease where the liver hardens).
Cryogenics kill cancer cells
    Elastography isn't the only way to avoid biopsies. IceCure Medical, a company in Israel, is now marketing what it calls "IceSense3" to kill breast cancer tumors.

    The procedure is like a nearly non-invasive biopsy. It uses ultrasound imaging to guide a hollow, extremely thin needle into a tumor. Liquid nitrogen is then used to inject radically cold temperatures through the needle to destroy the tumor.

    The method only works on tumors that are detected early, but if you pass that hurdle it has several other advantages. It requires just a local anesthetic and can be done in 10-15 minutes. More importantly, it doesn't leave women disfigured and with insanely large hospital bills.

    It remains to be seen whether this method can prevent widespread metastases, since there's always the risk a cancer has spread by the time it's visible on a scan. But it's better than a lot of the procedures out there.
Cancer recovery now in reach
    It's enough to make future breast cancer regimens look appealing: Easy tumor detection with ABUS. Clarification on whether a tumor is benign or cancerous through elastography. And then non-invasive cryogenic treatment on the tumors with cancer cells.

    My advice? Ask about these treatments. Push for them. Demand them. The FDA is cumbersome in getting anything done, but who knows? Maybe the ABUS opinion is a sign that this beast of an organization will someday get on board with the future of cancer treatment.

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