Digital Mammogram an Efficient Tool in Cancer Fight The mammogram is the first line of defense against breast cancer. Doctors in state-of-the-art facilities are now reading mammograms off computers instead of film. They say it's more efficient and sometimes more effective than film in detecting cancer.

Digital Mammogram an Efficient Tool in Cancer Fight

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It's MORNING EDITION from NPR News. I'm Deborah Amos in for Renee Montagne.


And I'm Steve Inskeep. Good morning.

In Your Health this morning, we're tracking a change in the way doctors diagnose breast cancer. It's a new way to read a mammogram. The two-dimensional x-ray is highly effective in diagnosing breast cancer long before a lump may be felt. Today, doctors in state-of-the-art facilities are reading mammograms off computers instead of film. They say it's more efficient and sometimes more effective.

NPR's Patricia Neighmond reports.

PATRICIA NEIGHMOND: About a dozen people sit around a large, oval table. They include radiologists, medical assistants, a surgeon and a pathologist. They're reviewing cases of patients with suspicious mammograms. Doctor Lily Wang.

Dr. LILY WANG: So this next case is a 71-year-old female who, on screening mammogram, we found calcifications in the right breast at 10:00 region. I'm not sure if you can see these screening mammograms, so I'm going to blow it up. It was in this area - pretty hard to see at this mag. I'm going to blow it up some more.

NEIGHMOND: Blowing up a tiny portion of the picture wouldn't be possible if Wang was looking at film. This is why digital mammography has proved more effective than film in some cases. Compared to film, the digital photo isn't a lot better. The real benefit is that you can tinker with the image.

Dr. Lawrence Bassett heads the UCLA Iris Cantor Center for breast imaging.

Dr. LAWRENCE BASSETT (UCLA Iris Cantor Center): You can enlarge it. You can change the contrast - I'm going to do that right here. I'm changing the brightness right now. I can make it brighter or less - whatever works best.

NEIGHMOND: Whatever works best to spot cancer. Not only can doctors manipulate the image, they can e-mail it anywhere quickly.

Dr. BASSETT: You can send the images within a few minutes to another site. Right now, I can look at images from our other hospital - which is 10 miles away - within a minute or two. So I can just have them sent to this site from the other site if they want me to look at something.

Unidentified Woman: All right. We're going to do four pictures - starting with the left side...

NEIGHMOND: Susan Stitch(ph) is only 39 years old - a year younger than current recommendations for getting yearly or biyearly mammograms. But she's here at UCLA because her mother recently died of breast cancer, and her father and brothers insisted she get screened.

Unidentified Woman: It's gonna be a little tight. Okay. Don't move. Okay. Hold your breath.

NEIGHMOND: The machine that takes pictures of Stitch's breast looks like any other mammography unit. It's just that this one sends its images to a computer.

Unidentified Woman: Okay. You can step back.

NEIGHMOND: Only 8 percent of mammography units in the U.S. are digital. Lucky for Stitch, this is one of them. Lucky because a large study of 50,000 women found digital mammograms were actually better than film mammograms in picking up cancers in certain groups of women, including women with particularly dense breasts and women under 50 like Stitch.

Researchers aren't sure why digital is more accurate in these women, but they think it's because it simply offers radiologists a better view. And in cases where cancer is diagnosed, MRI is often recommended. It's been around for about two decades, but MRI has only been used for the past five years in breast cancer diagnosis. Dr. Bassett says it's good for detecting high blood flow.

Dr. BASSETT: Because breast tumors generate angiogenesis - it means that they cause the increase and the development of new blood vessels around them and within them. They need this to grow.

NEIGHMOND: MRI is also effective in detecting cancer among women at high risk -those with a family history of the disease and those who have already had breast cancer. Doctors also use ultrasound to supplement a mammogram.

Doctor Susan Love is a surgeon at UCLA and a well-known breast cancer specialist. Love says imaging is increasingly effective, but she hopes science can move beyond it.

Dr. SUSAN LOVE (Surgeon, UCLA): We focus all our efforts in early diagnosis of breast cancer on imaging - seeing it in the breast. But the trouble is by the time you can see it or feel it, it's been there a long time. And really, I think what we should be shifting to is not finding cancers that are already there but finding cells that are just thinking about being cancers.

NEIGHMOND: Love heads the Doctor Susan Love Research Foundation, which is now working to detect cancer in the making. Cancer begins in the milk ducts, says Love. Love's foundation is testing the milk duct fluid of 100 healthy volunteers.

Dr. LOVE: We take the fluid. We divide it up. We send it to five different labs. We're looking at cells - are the cells abnormal? Are they not abnormal? Do abnormal cells correlate with high hormone levels, or don't they? We're looking at the protein levels. We're looking at the white blood cells that are in the fluid. We're looking at the protein patterns.

So, we're trying to get a lot out of every drop of fluid we get out of these women.

NEIGHMOND: Understanding what might turn cancer cells on, says Love, could someday produce a screening tool similar to the Pap test, where milk duct fluid is tested. That, together with recent advances in the genetics of breast cancer, could mean interventions could be initiated to stop cancer before it begins.

Patricia Neighmond, NPR News.

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