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Will Breast Cancer Screening Be Personalized?

April 5, 2013
Written by: , Filed in: Breast Imaging
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Mammography will remain the major breast cancer screening tool for the foreseeable future, predict researchers at Moffitt Cancer Center, but supplementary technologies will get more use as screening gets increasingly customized to fit individual women.

Jennifer S. Drukteinis, MD, an assistant member in Moffitt’s diagnostic imaging department, explained:

Although mammography remains the gold standard for breast cancer screening, there is increasing awareness that there are subpopulations of women for whom mammography is limited because of its reduced sensitivity based on an individual’s breast density and other factors.

Dr. Drukteinis was quoted in a Moffitt news release. She is lead author of an article assessing the state of breast cancer screening and suggesting ways it might be improved. Three other staff members at Tampa-based Moffitt co-authored the article, published online Thursday in The American Journal of Medicine.

The authors are fans of mammography and not, apparently, of the U.S. Preventive Services Task Force’s still-controversial 2009 recommendation that women younger than 50 not routinely be screened but instead consult their doctors about whether screening is appropriate for them.

“At present, the task force is the only group or consensus panel in the United States recommending breast cancer screenings to begin at age 50,” said co-author Blaise P. Mooney, MD, another Moffitt diagnostic imaging assistant member. “There is, however, clear evidence that mammography detects early breast cancers in this population. Data suggest that large-scale screening reduces mortality.”

It’s not precisely accurate to say the USPSTF recommends that screenings begin at 50. The task force’s Web site says, “The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.”

The Moffitt researchers’ recommendations actually seem in line with that emphasis on what’s best for the individual. “Given the heterogeneity of the human population,” Dr. Drukteinis said, “a perfect imaging technology for breast cancer screening will likely never be found. In fact, because of this heterogeneity, the very concept of ‘one strategy fits all’ may be outmoded.”

Instead, the researchers suggest in their article, such technologies as low-dose or contrast-enhanced mammography, automated whole-breast ultrasound, molecular imaging, MRI, and tomosynthesis will increasingly be used to supplement conventional mammography, “with selective application of specific screening technologies best suited to the woman’s age, risk and breast density.”

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A UCLA program seeks out immigrants who were doctors in their home countries but are, out of necessity, working at other jobs. The program helps them get licensed to practice medicine in the United States. For details, see our Facebook page.

Related seminar: UCSF Breast Imaging and Digital Mammography (free domestic shipping)

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