New technologies in screening dense breast tissue

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Dr Jessie Jacob was in Australia during July to speak about dense breast tissue and the new technology developed by GE Healthcare which improves invasive breast cancer detection by up to 55% percent over mammography alone in dense breasts. This new ultrasound system is about to hit Australian shores, with Adelaide based Benson Radiology the first group to purchase the technology.

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The major issues currently faced in breast cancer screening can be divided into five areas:

1. Compliance: There is still a lack of awareness on the effectiveness of early diagnosis, confusion regarding screening guidelines and avoidance of screening due to cost, accessibility, fear and discomfort.


2. Interval Cancers (Missed/ Occult Cancers): A significant number of breast cancers are still going undetected with current screening technology.


3. Lack of awareness in two ways:
   
   
   
   • The expectations of detection screening do not align with the capabilities of widely used screening technology.
   
   
   • There is a lack of awareness of the masking effect of dense breast tissue, the risk factors for breast cancer and the proper use of diagnostic exams
   
   
   
   


4. Prognostic factors: Limitation on predicting prognosis amongst various forms of breast cancer and subsequently tailoring treatment accordingly.


5. Mortality rates: We are seeing increasing mortality rates in many regions of the world.

While there has been confusion around the proper use of diagnostic exams as an issue, and we have seen a lot of commentary coming from the UK about the over-prescription of diagnostic tests as a potential danger, Dr Jacob believes over-prescription is not as much of a concern as underutilisation of the proper tools and a lack of individualising and personalising diagnosis and treatment based on characteristics, risk, history and findings.
And so she has partnered with GE Healthcare to launch InveniaTM ABUS in Australia, an ultrasound technology used to detect breast cancer in those with dense breast tissue.
Breast density is defined as the amount of fat and glandular tissue that is within the breast. In dense breast tissue, there is more glandular tissue than fat and the mammogram appears white as opposed to gray. Since cancers are also white, detecting cancers in a background of white (dense tissue) can be challenging since the cancer hides in the dense tissue. This is called the “Masking Effect”. Dense breast tissue is a normal finding in a large number of women. Since mammography alone can be limited in women with dense tissue, using supplemental imaging such as ABUS may improve breast cancer detection. ABUS is especially effective in finding small invasive node negative (early) breast cancers.
While men are still at risk of breast cancer, they are less likely to have ndense breast tissue. Typically, men have only a sparse amount ofglandular tissue unless it is present due to other influences.

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“Mammography remains the gold standard and significantly reduces mortality. However, other emerging technologies such as ABUS (automated breast ultrasound) aid in improving performance and the effectiveness of screening.”

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“I am a strong advocate for being open minded to new technologies that could change the imaging arena. U-Systems, the startup that developed ABUS, is an example of how new technology can make a significant contribution,”

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Mammography remains the gold standard and significantly reduces mortality. However, other emerging technologies such as ABUS (automated breast ultrasound) aid in improving performance and the effectiveness of screening. [pull quote]
To explain how it works, ABUS uses sound waves as opposed to x-rays. The sound waves are able to better penetrate the dense breast tissue. Additionally, on mammography in women with dense breasts, cancers appear white in a white background but with ultrasound in dense breast tissue, cancers appear dark in a background of white and are therefore easier to detect.
Mammography has become synonymous with early detection and is the primary screening exam for all-comers. The evolution of mammography involves both improvement in quality assurance and quality control as well as the progression from film-based (analog) imaging to digital imaging technology. The benefits of mammography have been repeatedly demonstrated. However, the limitations of mammography in women with dense breast tissue is also well known. It is no surprise that ABUS received unanimous FDA PMA approval as the first and still the only supplemental screening tool specifically for women with dense breast tissue.
The introduction of ABUS into the breast imaging landscape has just begun. With improved workflow and reproducibility, ABUS is well positioned to take the forefront of pioneering technologies and improve accessibility, compliance and misdiagnosis across the world. Given the ability to detect small, invasive, early breast cancers, ABUS will fulfill an unmet need.
Based in Silicon Valley, Dr Jacobs is also a passionate supporter of healthcare startups.
“I am a strong advocate for being open minded to new technologies that could change the imaging arena. U-Systems, the startup that developed ABUS, is an example of how new technology can make asignificant contribution,” she says.
Dr Jessie Jacob
Dr Jessie Jacob is a board certified, fellowship trained radiologist, a dedicated breast imager and an avid medical writer. Dr. Jacob received fellowship training in Breast Imaging and Intervention at Yale University and has directed breast centers in both New York and California. While directing, she initiated multiple programs including accreditation as an ACR Breast Center of Excellence, a 3T Breast MRI program and a High Risk Breast and Ovarian Program.