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nosurrender

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ASCO Breast: Molecular Breast Imaging Tops Mammography for Dense Breasts

By Charles Bankhead, Staff Writer, MedPage Today
Published: September 05, 2008
Reviewed by Emeritus Professor
University of Pennsylvania School of Medicine.
WASHINGTON, Sept. 5 -- In high-risk women with dense breast tissue, molecular breast imaging detected three times as many hard-to-find tumors as mammography, according to preliminary data from an ongoing study.

Among 940 patients screened with both imaging modalities, molecular breast imaging detected 10 of 13 cancers compared with three of 13 for mammography, Carrie Hruska, Ph.D., of the Mayo Clinic in Rochester, Minn., said at a press briefing before the 2008 Breast Cancer Symposium.

The investigational imaging technique led to twice as many biopsies as mammography did, but the diagnostic yield improved by 36%.

"These results suggest that molecular breast imaging could become an important adjunct to mammography for women who have dense breast tissue and increased breast cancer risk," said Dr. Hruska. "Our next step will be to compare molecular breast imaging prospectively with other screening methods, such as MRI."
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Breast MRI offers improved sensitivity in high-risk women with dense breasts but is costly as a routine back-up for mammography. Over the past six years, investigators at the Mayo Clinic have evaluated molecular breast imaging, which employs dual gamma cameras to detect breast-tissue uptake of the radiotracer technetium-99m sestamibi.

Dr. Hruska presented data from a trial comparing molecular breast imaging with mammography. Enrollment in the trial was limited to women who had dense breast tissue (defined as 50% or more of total breast tissue) and at least one factor associated with an increased risk of breast cancer.

Each study participant had both types of breast imaging. During molecular breast imaging, the breast rests on a platform between the two gamma cameras. In contrast to mammography, only light compression of the breast is required to limit movement, said Dr. Hruska.

A 740-MBq dose of the radiotracer is administered intravenously, and standard craniocaudal and mediolateral oblique views of each breast are obtained. Imaging requires about 10 minutes per view.

Thus far, 13 tumors have been detected in 12 patients. If only one imaging study had been performed, said Dr. Hruska, molecular imaging would have detected eight of the tumors and mammography only one. Two tumors were picked up by both techniques, and two were missed by both.

The recall rate was 7.7% with molecular breast imaging and 9.4% with mammography.

Thus far, 375 of the 940 patients have been followed for at least 15 months. In that subgroup, molecular breast imaging has a sensitivity of 75% compared with 25% for mammography. Specificity exceeds 90% with both imaging modalities.

Dr. Hruska said 36 biopsies were prompted by the findings of molecular breast imaging, 28% of which proved to be cancer. That compared with 17 biopsies and 18% yield with mammography.

"Molecular breast imaging detected more cancers than screening mammography without producing more false-positive results," said Dr. Hruska.

The molecular imaging machine remains in prototype form. If the machine were to become commercially available, Dr. Hruska said, imaging would cost more than mammography but perhaps five times less than breast MRI.

In a retrospective comparison involving fewer than 50 patients, Mayo investigators found that molecular breast imaging and breast MRI both had better than 90% sensitivity and a similar specificity. (See: EOH: Molecular Breast Imaging Shows Potential as MRI Alternative)


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CherylG

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Yes!!! Finally more diagnostic tools ... this would be a huge step forward. Research is great for methods of treatment but I still believe the need right now is for better methods of diagnosing and prevention. 


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coco

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I agree, Cheryl. So many women still believe mammograms are the "gold standard" of detection, and I literally heard a doctor use that term on a recent episode of Oprah. AArgh! So on top of better tools for detection, we still have a long way to go with regard to education. 20% of us BC folks don't show up on mammograms - that's way too many for a so-called "gold standard of detection" in my opinion!

BTW, a friend of mine who has dense breasts and doesn't trust mammograms (due to my experience with lobular cancer) is considering paying for a thermogram ($200-$300) out of her own pocket, as trying to get many insurance companies to pay for an MRI is like trying to win the Lotto. If something suspicious shows up on the thermogram, she can then use that as a means to get an MRI done. An expensive half-step, perhaps, but I think a viable alternative for some.

I wonder if anyone has had a thermogram or has more info about them? I'd appreciate any feedback...

Thanks!

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snhb

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I totally agree with all of you ladies.  The reason some doctor's still call the mammo's the "gold standard" is because the insurance companies will not pay for MRI's unless there is a history of BC.  Which is  a joke because like you've stated, many of us got mammo's that did not detect the BC, because they are way more inaccurate than MRI's. 
I'd just like to suggest to all of you too, if your doctor sends you for breast MRI, if he or she is going to submit the finding's to a study that is going on with regard to BC and MRI's. 

I'm suggesting this because my Breast Surgeon told me that she is pushing to get more insurance companies to cover MRI's.  She is totally convinced that they are so much better than mammo's, and she is submitting her research for a study to help get MRI's included with mammo's and sono's for all women by the insurance companies.

Oh, and by the way regarding the doctor on Oprah's show, was it by any chance that Dr. Oz?  If it was, I have heard that man also say that mammogram's can diagnose cancer!!!  

coco

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SNHB,

Bravo to your breast surgeon! With BC awareness month just passed, I am frustrated at the lack of awareness still so obvious in the general pop. The awareness campaign seems to be mainly about fundraising, which is essential, but still so many women are walking around with a -potenially- false sense of security because their mammos came out "clean." I think another major misconception is that if you don't have a first-degree family history, you can breathe easy. The standard info forms at Dr.'s offices may inadvertently reinforce this misconception. I was told that two great-aunts with BC did not constitute a close enough relationship to cause concern. The fact that 70% of those who do get diagnosed with BC have no "significant" family link was never mentioned!

These two things make me CRAZY and I tell everyone who stands still for 2 minutes! I don't want anyone else to follow my path and find out the hard way...(I know we all feel that way.)

Oh! And the dense breast factor too. The fact that it doesn't always manifest as lumps... I can't understand why this stuff is sooooooooo slow to get out there with so much emphasis on "awareness".

BTW, it wasn't Dr. Oz, it was a female doctor. I think it was the show with Christina Applegate (whom I greatly admire for her candor).

Thanks for the suggestion about speaking to our surgeons, oncologists, etc. about insurance coverage for MRI's. I don't know what it's going to take, but we need something better....

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snhb

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Reply with quote  #6 
Yes, my breast surgeon is fantastic, in fact she was instumental in getting the insurance companies to change they're hospital coverage regarding mastectomy.  She was disgusted with the "drive through" mastectomy mentality.  It used to be that you couldn't stay overnight if you had a mastectomy.
Anyway, my screen name snhb stands for Should Not Have Been, because the idiot doctor's kept telling me that the mammo and sono's showed that the lump I had was just a cyst. They never recommended a biopsy.  So, I like you agree that there are too many ill informed women who just rely on the mammo and sono reports. I tell anyone and everyone I can that only a biopsy can diagnose cancer.  Mammo's and sono's are just SCREENING tools. 
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