Mammograms, now in 3D!

Hologic, Inc. just received approval from the Food and Drug Administration for the first ever 3-D digital mammography system for screening breast cancer.

Current mammograms – with 2-D X-ray breast pictures – are limited because tissues overlapping tissues could be hiding lesions or, on the other hand, make benign areas look suspect. (About 10% of women undergo additional testing for abnormalities that are later determined to be noncancerous.)

The Selenia Dimensions digital breast tomosynthesis system (pictured at right) reveals the inner architecture of the breast, free from the distortion typically caused by tissue shadowing or density, according to Hologic.

In studies where radiologists viewed 300 mammography exams, the 3-D system “could significantly enhance existing diagnosis and treatment approaches,”says FDA’s Jeffrey Shuren. The system had better accuracy and detection, visibility and sensitivity – a 7% improvement over 2-D.

The breast is briefly compressed during the exam, which combines 3-D and 2-D imaging – resulting in a stack of thin high-resolution image slices that provide a clear rendition of the structures within the breast and the surrounding tissue.

The combination of 2-D and 3-D images about doubled the radiation dose the patient received. However, the increase in cancer risk from having both a 2-D and 3-D exam is expected to be less than 1.5% compared to natural cancer incidence, and less than 1% compared to the risk from conventional 2-D imaging, according to the FDA.

Nearly 40 million mammograms are performed each year in the US. In 2009, there were 192,370 new cases of invasive breast cancer diagnosed, and over 40,000 American women died from it in that same year. If detected early, the 5-year survival rate is 98%, according to the American Cancer Society.

“We believe tomosynthesis has the potential to change how screening and diagnostic mammography is performed, and over time will prove invaluable to the earliest possible detection of breast cancer and in the reduction of unnecessary diagnostic interventions,” says Hologic president and CEO, Rob Cascella.

Dimensions 3-D, which is an add-on to Hologic’s 2-D system, has already been commercially available in more than 40 countries. The National Cancer Institute recommends women ages 40 and older have a mammogram every one to two years.

by: www.Smartplanet.com

Images: Hologic

  

New breast cancer treatment SLND to replace ALND

A study for a new cancer treatment procedure called sentinel lymph node dissection (SLND) that may take the place of axillary lymph node dissection (ALND) has been published in the Journal of American Medical Association (JAMA).

The common procedure ALND is an important and effective cancer treatment  for more advanced breast cancer, but it is also a very painful early breast cancer treatment which involves removing multiple lymph nodes from the armpit. It not only removes the cancerous nodes, but it also removes surrounding nodes that could be cancerous as well. This method is not only painful, but can come with very disturbing side effects such as numbness, shoulder pain, limitation of motion, infection and lymphedema when the arm swells. This swelling can often times be permanent.

The new method SLND could save approximately twenty percent of breast cancer sufferers from having to undergo ALND, according the JAMA study. The study for SLND involved approximately 900 women who were being treated for breast cancer through the processes of lumpectomies and radiation therapy. The women were being treated at 115 different centers in the United States. According to the study, approximately half of the women also received ALND which showed to not significantly prevent recurrence of breast cancer or increase the survival rate of these women.


The co-author of the study and head of surgical breast oncology at M.D. Anderson Center, Dr. Kelly Hunt stated, “As we've learned more about biology of breast cancer we don't need these radical surgeries.  [We do] not [need to] create all this collateral damageby removing normal uninvolved lymph nodes."

www.examiner.com 

by KC kelly- mind and body examiner

Study highlights medical split on breast cancer surgery

By Anna BrowningReporter- BBC News-Health

Removing cancerous lymph nodes from some women with breast cancer has no benefit, US scientists have revealed in a new study.

But while the findings may have been hailed in parts of the media as a revolutionary approach to combating breast cancer, it has also revealed divisions among cancer specialists in the UK on how best to treat the disease.

Removing lymph nodes is a painful procedure which can leave lasting problems

While some hope the study will bring widespread change to practice - some UK units already operate a less surgically-agressive approach - others urge caution about the findings.

The study, published in the Journal of the American Medical Association, found that in women with early stage cancer the standard practice of removing cancerous nodes made no difference to survival rates.

They also found that carrying out the painful procedure - which can leave women with lasting arm swelling, stiffness and pain - made no difference to whether cancer returned.

The study, which involved about 850 women, follows a trend away from radical surgery in combating breast cancer in recent years.

Rates of mastectomy (the removal of the breast) are declining, but the removal of nodes as a way of preventing the spread of cancer, has remained standard procedure, particularly in the US.

All those taking part in the clinical trial, between 1999 and 2004, had had initial biopsies showing cancer had spread to one or two nearby lymph nodes.

They were then assigned at random to have 10 more more additional nodes removed or none at all.

They were also treated with lumpectomies to remove their tumours and a common type of radiation that covers the breast and underarm area. Most also had chemotherapy, hormone treatment, or both.

The researchers were led by Armando Giuliano of Saint John's Health Center, in Santa Monica, California.

'Practice-changing'

Professor Ian Ellis, professor of cancer pathology at the University of Nottingham, said the study was "very powerful" and had been conducted in an "exemplary way".

"You can't knock it, it should be practice changing," he said, but acknowledged units in the UK were very "polarised".

"It sometimes takes more than one study to change people's minds. In the UK doctors are a little bit conservative, they want more evidence."

He said a trial of 3,000 women conducted in Edinburgh about 15 years ago, and which produced similar results, had failed to change practice across the UK, but that this study vindicated his unit and others'.

"This shows centres doing less aggressive therapy were correct in their approach."

Dr Rachel Greig, senior policy officer at Breakthrough Breast Cancer charity said the findings were "exciting", particularly as they corroborated past findings, but was cautious on how quickly practices would change.

"They could change the way some women are treated for breast cancer in the future," she said.

"This is important as it may mean these women can avoid unnecessary lymph node surgery. The findings agree with past research so we eagerly await further developments in this area."

Professor Michael Baum, retired breast surgeon and director of the clinical trials group at University College London, said he was amused at the research.

"What they are doing is reinventing the wheel," he told the BBC. "I have been preaching this for decades."

"We have known for 20 years or more that leaving an untreated lymph node behind that contains a tumour does not impair long-term survival."

However, he said, the study would be influential in changing practice and patients would benefit.

But Professor Robert Mansel, professor of surgery at University of Wales College of Medicine, Cardiff, and expert in breast cancer research, said it was a very controversial area with a lot of practice "based on feelings, not data".

Caution urged

He currently favours the removal of lymph nodes, believing the research on leaving them intact to be inconclusive so far.

He urged caution about the US study, pointing to "lots of warning signs" in the paper, such a failure to recruit as many women to the study as they would have liked - meaning the trial was "under powered".

When faced with the prospect of lymph nodes not being removed, a lot of patients failed to enter the trial, he said.

He also pointed to the study's five-year follow-up, which he said was quite short.

"Breast cancer, if nothing else, is a long-term disease, which makes this study only half way to being reliable".

On the differences of opinion in the field, he said: "We are using the same evidence, but interpreting it differently."

"It's a classic problem in cancer management; we don't have the answer."

He said a European trial, Amaros, which he is heading and is due to publish its results like year, would be more likely to change practice.

Like the US trial, this trial takes an initial biopsy, but it then gives radiotherapy to the remaining nodes to see if this is in fact enough and there was no more need for surgery.

"We are on the cusp of finding out the information, but there isn't enough of it. If you make changes before you have the data that you can get a shock. Nobody is right or wrong, it's a philosophy.

"When Amos reports hopefully we should get a definitive answer.

"We may well change practice, but it's going to take two or three years before we can say definitively one way of another."