Analysis: A new beginning

This is one of the prime examples of what could be a revolution in healthcare - “personalised medicine”.

Cancers tend to be named after the place you find them; breast, colon, prostate, lung - the list goes on. It has long been known that this is not good enough, that some breast cancers can have more in common with an ovarian cancer than another breast tumour.

This study shows we should be thinking of breast cancer as 10 different diseases. Genes are going haywire in broadly 10 different ways and each category of mistake would require a different treatment.

This is the essence of personalised medicine - tailoring treatments to the genetics of a disease.

Similar studies could break other cancers down into several separate diseases, but the effects of personalised medicine could be much wider.

There are investigations into using genetic tests to predict which patients will respond well, or very badly, to blood thinners, bipolar medication and anti-HIV drugs.

The Health Secretary, Andrew Lansley, has already described the promise of the field as “immense”.

There is a long way to go, as only one of the 10 breast cancer categories has a personalised treatment at the moment. But as is so often the case, breast cancer research is leading the way.

Here the challenge is Mammogram and Digital Biopsy. Problem with mammogram may arise biopsy also. Now we are considering some kind of mammogram analysis. We have noticed same problem with Biopsy.

In most individuals the bulk of the breast extends from the second to the seventh rib. Since breast tissues often curve around the lateral margin of the pectoralis major muscle, the orientation of the muscle is important for optimal mammographic positioning. The pectoralis major muscle spreads like a fan across the chest wall. Portions of the pectoralis major muscle attach to the clavicle, the lateral margin of the scapula, costal cartilage, and the aponeurosis of the external oblique muscles of the abdomen. All these fibers converge on and attach to the greater tubercle of the humerus. The free fibers predominantly run obliquely over the chest from the medial portion of the thorax toward the humerus. The relationship of the breast to the pectoralis major muscle influences two-dimensional projectional imaging, such as mammography. Since the breast tissue is closely applied to the muscle, some of the lateral tissues can only be imaged through the muscle. As with any soft-tissue structure overlying muscle, it is easier to project the breast into the field of view by pulling it away from the chest wall and compressing it with the plane of compression along the obliquely oriented muscle fibers of the pectoralis major muscle. In order to maximize the tissue imaged, the free portion of the muscle should be included in the field of view.

In view of the enormous amount of work that has been done in an effort to understand the breast and the development of breast cancer, it is surprising that the normal breast has never been clearly defined. This is likely due to the fact that since breast cancer is really the only significant abnormality that occurs in the breast, it is really only the changes that appear to predispose to breast cancer that are considered significant. There is a large range of histologic findings that occur in women who never develop breast cancer, but where normal ends and abnormal begins is not obvious, and past classifications have been found to be inaccurate.

The ability to detect breast cancers earlier requires high-quality imaging, proper film processing, systematic review of the images, reasoned interpretation, the ability to solve problems raised by the imaging, and the ability to guide the diagnostic removal of cells or tissue for diagnosis. The interpreter should participate in all aspects of this process. It is very important that quality control be supervised by the interpreter(s) of the images so that any image degradation can be detected and corrected as quickly as possible. 

Errors can be reduced by following a carefully structured approach to the process. The detection and diagnosis of breast cancer can be divided into five very specific tasks: Detection-Find it. Verification-Is it real?  Triangulation-Where is it? Identification- What is it? Management- What should be done about it?