Rachel Brem, M.D., director of breast imaging at George Washington University Medical Center, recently served as the principal investigator of a clinical study examining whether full-field digital mammography, in conjunction with an automated breast ultrasound system, could improve breast cancer detection when compared to mammography alone for women with dense breast tissue.
According to Brem, some studies have demonstrated that there is close to a 30 percent increase in cancer detection when 3-D automated breast ultrasound is used in conjunction with mammography. This is particularly important for women with dense breast tissue, Brem says, because in many cases, cancers detected in such women are larger and later staged, which means that finding them earlier when they are more curable could greatly impact survival rates.
Brem recently took some time to talk with FierceMedicalImaging about how such technology can impact clinician workflow compared to use of traditional ultrasound, and why she thinks adoption by imaging professionals could be slow.
FMI: What are the workflow advantages of automated breast ultrasound?
Brem: ABUS harnesses the significant ability of ultrasound to detect cancer by using it in an automated way so that the acquisition and interpretation of images is uncoupled. The image can by acquired by trained personnel and the radiologist gets the entire data set so that she can use her expertise to find the smallest clinically, significant cancers. And it only takes about three minutes of physician time to interpret an ABUS examination--so it really makes it possible to harness the screening power of ultrasound in a way that creates a very efficient workflow to it can be integrated into a screening environment.
FMI: What barriers are preventing ABUS from widespread clinical use?
Brem: The two biggest hindrances to the widespread integration of the technology are the same as integrating any new technology--the cost of new equipment and the false positive rate. And the biggest issue is really false positives.
There's no way you can find more cancers without doing more biopsies. Even in other types of situations where we have to biopsy, only about 20 percent of what we biopsy is cancer. But in order to find the earliest possible cancers we have to biopsy. A mass is a mass, but whether that mass is malignant, only a pathologist can tell us.
FMI: Do you expect widespread adoption?
Brem: I think so. We just find this to be an incredible game-changing technology and the cancers that we've found using this have really been jaw dropping. So I hope it gets into every clinic because it really is a life-saving tool that helps us not only find cancers, but those small invasive and largely node negative cancers--the kind we're trying to find.
FMI: What's the role that that traditional handheld ultrasound plays here?
Brem: Handheld ultrasound is good at detecting additional, clinically significant, invasive, node negative breast cancers in women with dense breast tissue because unlike mammography it has optimal contrast in detecting cancer. The problem with traditional ultrasound is that it takes about 20 minutes of physician time to do a whole breast ultrasound. There are 37 million mammograms performed in the U.S. every year. If you multiply that by 40 percent (the percentage of women who have dense breast tissue) and then multiply that by 20 minutes, you see that there is no way that we can have the number of physicians necessary to do handheld screening in a screening environment.
FMI: Can you talk about issues involved with mammography and women with dense breast tissue?
Brem: Mammography has definitely impacted the death rate from breast cancer, and it's a wonderful tool, but an imperfect one. One of the limitations is that it is not as effective in women with dense breast tissue--on a mammogram, breast tissue is white and cancers are white, so the lack of contrast makes the identification of cancer very difficult.
When you couple that with the fact that dense breast tissue is a strong independent risk factor for developing breast cancer, then have sort of a perfect storm. Not only are women with dense breast tissue at higher risk, mammography isn't as effective. And this is a significant problem because about 40 percent of all American women have dense breast tissue and it's present in significant numbers across all age groups.
Editor's note: This interview has been edited for length and clarity.