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Breast Cancer Tests: Weighing The Risks

August 24, 2010
Written by: , Filed in: Breast Imaging, Diagnostic Imaging
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Risk management can be devilishly tricky. For example, is a better breast-cancer imaging method worth the increased radiation dosage for the patient?

A new report in the journal Radiology, being published in the October issue and in advance online today, raises that issue. “A single breast-specific gamma imaging (BSGI) or positron emission mammography (PEM) examination carries a lifetime risk of inducing fatal cancer greater than or comparable to a lifetime of annual screening mammography starting at age 40,” said the study’s author, R. Edward Hendrick, PhD, as quoted in a Radiological Society of North America press release. Dr. Hendrick is clinical professor of radiology at the University of Colorado Denver School of Medicine in Aurora, Colorado.

Such tests are generally used only when a mammography or ultrasound screening uncovers a possible problem—not for routine screening themselves. Dr. Hendrick told the New York Times that he’s not suggesting that the tests not be used, just that their added risk be taken into account before they are ordered.

“I would go to the international breast meeting and the big radiology meetings, and nobody had a clue what the doses and risks were,” he said. “They’re treating the tests as if they have the same radiation dose and risk as mammography, and the truth is that they have a much, much higher risk. The point of the paper was to say that not all the breast imaging procedures have comparable risks and doses.”

But what about other risk factors over which medical personnel have no control? A study published online this week in the Journal of the National Cancer Institute finds that nicotine may not only promote smoking addiction but also may directly promote the development of breast cancer.

In the same issue, another article suggests that alcohol consumption increases the risk of invasive lobular and hormone receptor-positive breast cancer, but not necessarily of invasive ductile carcinoma.

So patients depend on their health-care providers to inform them about the risks of medical procedures. But patients also need to know about other risk factors that crop up outside the clinical setting. And they’re continually being bombarded with “information” from TV commercials, their cousin whose niece once worked at a hospital, and, of course, the ever-reliable Internet.

There is one thing that just about everyone can agree on: mammograms save lives. “The primary tool for breast cancer screening is still mammography, which has a very low radiation dose and a very low lifetime risk of cancer induction,” Dr. Hendrick said. “The risk of missing a breast cancer because mammography is not done far outweighs the tiny risk of mammography causing a breast cancer.”

Related seminar: Pittsburgh Breast Imaging Seminar

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