Moffitt Cancer Center Researchers Discuss New Frontiers in Breast Cancer Screening

Researchers at Moffitt Cancer Center predict that advancements in breast cancer screening will need a personalized touch because mammography is not a "one strategy fits all" technology.

Their review "Beyond Mammography: New Frontiers in Breast Cancer Screening" appears in the April 4 issue of The American Journal of Medicine.

"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," said study lead author Jennifer S. Drukteinis, M.D., assistant member in Moffitt's Department of Diagnostic Imaging.

The writers refer to a controversial disagreement on mammography screening issues. In 2009, the U.S. Preventive Services Task Force, a panel of health care professionals charged with reviewing published research and making health care policy recommendations, issued guidelines that women should get mammograms every two years starting at age 50. They recommended against screening before 50. Their recommendation generated great controversy, even outrage, because of a well-established convention recommending mammography screening beginning at 40 and, for those with a first-degree relative with breast cancer, screening should start a decade before that relative's age at diagnosis.

"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 study co-author Blaise P. Mooney, M.D., an assistant member in Moffitt's Department of Diagnostic Imaging. "There is, however, clear evidence that mammography detects early breast cancers in this population. Data suggest that large-scale screening reduces mortality."

As effective as mammography has been, the authors consider it an imperfect screening tool.

The sensitivity of mammography is highly variable, the authors point out. The effectiveness for women with fatty breast tissue is as high as 98 percent while the effectiveness for women with dense breasts can be as low as 36 percent. Women who undergo annual mammography may still present with cancers found only on physical examination, they said. Additionally, some studies suggest that radiation exposure may contribute to an increase in breast cancer incidence in high-risk populations.

More successful breast cancer screening requires increased sensitivity and specificity while limiting costs and radiation burden, the authors recommended.

They also suggested that optimal patient care will require a new screening paradigm with patient-specific strategies tailored to risk based on family history, age, genetic profiles and breast density.

"The sensitivity of mammography is inversely proportional to breast density," explained Mooney. "Owing to decreased sensitivity in women with dense breast tissue, but with attention to radiation concerns and a high rate of false positives, breast imagers are adapting with new technologies."