Latest news with #FionaGilbert
Medscape
27-05-2025
- Business
- Medscape
New Imaging Triples Dense Breast Cancer Detection
Supplemental imaging techniques could more than triple cancer detection in dense breasts compared with standard care alone, according to new research. The study, published in The Lancet , found that abbreviated magnetic resonance imaging (AB-MRI) and contrast-enhanced mammography (CEM) could help detect an additional 3500 breast cancer cases per year in the UK. Around 2.2 million women undergo breast cancer screening each year in the UK. Approximately 10% have very dense breasts. Understanding Breast Density Breast density refers to the proportion of glandular and fibrous connective tissue relative to fatty tissue as seen on mammography. Dense breasts contain more glandular and fibrous tissue and less fatty tissue. Women with the densest breasts have a four-fold higher cancer risk than those with fatty breasts. They are also more likely to receive delayed diagnoses. Professor Fiona Gilbert from the Department of Radiology at the University of Cambridge told Medscape News UK that introducing these imaging techniques to routine screenings could save around 700 lives each year. "Existing research indicates that around one in five cancers detected via screening become life-threatening without intervention," said Gilbert, who is also honorary consultant radiologist at Addenbrooke's Hospital. The interim results form part of the Breast Screening - Risk Adapted Imaging for Density (BRAID) study. It is the first study to compare each imaging technique in women with normal mammograms and dense breast tissue. Study Methodology Researchers recruited more than 9000 women aged 50 to 70 years with dense breasts who had received negative mammograms. Participants were randomly assigned to undergo AB-MRI, automated whole breast ultrasound (ABUS), CEM, or the current standard of care, full-field digital mammography. The primary outcome measured detection rate, defined as the percentage of women with positive supplemental imaging results leading to histologically confirmed breast cancer. Key Findings AB-MRI detected 17.4 cancer cases per 1000 examinations. CEM detected 19.2 cases per 1000. ABUS detected 4.2 cases per 1000. Of these, 15 per 1000 for AB-MRI, 4.2 for ABUS, and 15.7 for CEM were invasive cancers. Detection rates for AB-MRI and CEM were similar and significantly higher than for ABUS. Secondary outcomes included the difference in recall rates and tumour characteristics among the arms. Both AB-MRI and CEM had recall rates of 9.7%. ABUS had a 4% recall rate. Invasive tumours found by AB-MRI and CEM were half the size of those detected by ABUS. Safety Profile No adverse events occurred in the ABUS group. The AB-MRI group had one case of extravasation but no other adverse events. The CEM group experienced 24 iodinated contrast events: 17 minor, six moderate, one severe, and three extravasations. 'There were some adverse reactions to IV iodine (the contrast agent in CEM) but this is already commonly used (about 40% of CT scans), and these people could still be offered AB-MRI. As such, the fact that there are two options (CEM and AB-MRI) that performed equally well, can be a real benefit,' said Gilbert. Study Limitations The researchers noted that they could not measure screening benefit and overdiagnosis. 'Some of the detected cancers would not have gone on to become life threatening if left alone,' according to Gilbert, who said that 'a future challenge for research is to work out how we can get better at telling the difference between the ones that will become harmful and the ones that won't." The cohort will be followed for 3 years to account for possible relapses and interval cancers. Recall rates for AB-MRI and CEM improved as clinicians became more familiar with analysing the scans. However, care should be taken to minimise these should the supplementary techniques be introduced to population screening, the authors noted. According to Gilbert, the study made use of technologies that are already widely available without additional costs or resources. However, she noted that a cost-benefit analysis is needed before the techniques could be integrated into routine screening. Kotryna Temcinaite, head of research communications and engagement at Breast Cancer Now, called for the research findings to be considered. 'If the UK National Screening Committee recommends additional imaging for screening women with very dense breasts, we'll push for those changes to be rolled out as quickly as possible across the UK,' she said.
New York Times
23-05-2025
- Health
- New York Times
One Type of Mammogram Proves Better for Women With Dense Breasts
Cancer screening poses a quandary for women with dense breast tissue. They're at elevated risk for breast cancer, but mammograms often miss tumors buried in dense breasts — and insurers often resist paying for additional scans that may help find the masses. Now a large study comparing various types of scans has found that mammography enhanced with iodine-based dye can detect three times as many invasive cancers in dense breast tissue as ultrasound. And so-called contrast-enhanced mammography can find tumors that are much smaller than those found by regular mammography. M.R.I.s are better at detecting more tumors than standard mammograms, the study found, but are considerably more expensive. The scans were given to women with dense breast tissue who had already undergone mammograms that hadn't turned up any abnormalities. 'Contrast-enhanced mammography needs to become standard of care for women with dense breasts,' if they are at high risk of developing breast cancer, said Dr. Fiona J. Gilbert, a professor of radiology at the University of Cambridge's School of Clinical Medicine. She is lead author of the study, which was published Wednesday in The Lancet. Tumors typically show up as white spots on mammograms, but dense breast tissue also appears white, obscuring the tumors. 'When you have lots of white normal breast tissue, it's hard to see the white cancers,' Dr. Gilbert said. 'But when you do the contrast, the cancers take up the iodine, and all you're seeing is this cancer lighting up.' A large Dutch study published in 2019 showed that M.R.I.s are more effective than standard mammography at finding tumors in dense breast tissue. The new study is the first randomized controlled clinical trial to compare M.R.I.s, ultrasounds and contrast-enhanced mammography in women with dense breast tissue. JoAnn Pushkin, executive director of the educational group DenseBreast-info, said the study showed that contrast-enhanced mammograms could save lives. They not only found more tumors but detected them when they were small and had not yet spread to the lymph nodes. 'This means these cancers were found early enough that most were still contained within the breast,' Ms. Pushkin said. 'These were tragedies averted. If they had not been found, they would have grown undetected until they were horror stories.' But while contrast-enhanced mammography is available in some centers in the United States, its use for breast cancer screening has not been approved by the Food and Drug Administration. (It is more often used as a diagnostic tool after suspicious findings appear on a regular mammogram.) Partly that's because of concern over allergic reactions to the contrast agent, which are uncommon but can be severe, according to Dr. Wendie Berg, a professor of radiology at the University of Pittsburgh School of Medicine and chief scientific adviser to DenseBreast-info. Dr. Gilbert, the study's lead author, also cautioned that while extra imaging can lead to earlier detection in women with dense breasts, it may also increase overdiagnosis and overtreatment of a medical condition that may never become life-threatening if left alone. Yet most of the tumors detected with the contrast-enhanced scans actually were invasive and potentially life-threatening, Dr. Berg said. These cancers show up more readily when dye is used. Contrast-enhanced mammograms are more cost-effective than M.R.I. scans, and they could be made more widely available at existing mammography centers with staff training and sometimes technology upgrades, Ms. Pushkin said. The new study, carried out at 10 screening sites in the United Kingdom between Oct. 18, 2019, and March 30, 2024, was the kind of trial considered the gold standard in medicine. More than 9,000 women aged 50 to 70 who had dense breast tissue and normal mammograms were randomly assigned in roughly equal numbers to receive standard digital mammography, M.R.I.s, ultrasounds or contrast-enhanced mammography. About 6,305 completed the additional imaging tests. M.R.I. scans turned up 17.4 cancers per 1,000 exams, while ultrasounds found only 4.2 cancers per 1,000 exams. Contrast-enhanced mammograms detected 19.2 cancers per 1,000 exams, but the difference between M.R.I. and contrast-enhanced mammography was not statistically significant. Not all of the tumors were invasive. M.R.I.s revealed 15 invasive cancers per 1,000 exams, ultrasounds found 4.2 invasive cancers per 1,000 exams, and contrast-enhanced mammography detected 15.7 invasive cancers per 1,000 exams. Most of the cancers were less than two centimeters in size, and had not spread to the lymph nodes. Detecting cancers when they are smaller should lead to better outcomes, Dr. Gilbert and her colleagues said. But the grade of the cancer — a measure of its abnormality and thus aggressiveness — is also important. The research did not follow the patients long enough to learn whether using contrast-enhanced mammography would ultimately reduce deaths. There were adverse events associated with the use of iodine dye. Twenty-four patients who underwent contrast-enhanced mammograms had reactions, and three experienced so-called extravasation, in which the dye leaks out of blood vessels into adjacent tissue. There were no adverse events associated with ultrasound, and there was one case of extravasation among the women who received M.R.I.s, in which contrast dye is sometimes used. Among the trial participants whose cancer was discovered during a supplemental M.R.I. was Louise Duffield, 60, who lives in Ely, near Cambridge. Ms. Duffield was invited to participate in the trial in 2023, after her regular mammogram screening showed that she had very dense breasts. When she came in for an extra M.R.I., the scan identified a small lump. A biopsy determined that the tumor was Stage 0, or very early, and confined within the milk ducts. Ms. Duffield had surgery to remove the tumor six weeks later, by which time it had already grown larger than it had appeared on the scans, hospital officials said. Because of the location of the tumor, Ms. Duffield would have had difficulty identifying it with a self-exam. And since the tumor was not detected during her regular mammogram, she would not have had to come in for another scan for at least three years, based on U.K. guidelines. Ms. Duffield was treated with radiation and is now free of cancer. 'The tumor was deep in the breast, so if I hadn't been on the trial, it could have gone unnoticed for years,' Ms. Duffield said in a statement. 'Without this research, I could have had a very different experience.'
Business Mayor
22-05-2025
- Health
- Business Mayor
Extra cancer scans for women with dense breasts could save 700 lives a year
Hundreds of lives could be saved every year with extra cancer checks for women with very dense breasts, a study suggests. Millions of women undergo breast screening, but regular mammograms can be less effective at spotting cancer in the 10% with very dense breasts, as the tissue can hide tumours on X-rays. This is because very dense breasts look whiter on scans, making it harder to detect early-stage disease, which also appears white. Offering this group of women enhanced scans could find 3,500 more cases of cancer and save 700 lives a year in the UK, researchers from the University of Cambridge said. Their findings were published in the Lancet. The study's lead author, Prof Fiona Gilbert, said: 'Getting a cancer diagnosis early makes a huge difference for patients in terms of their treatment and outlook. We need to change our national screening programme so we can make sure more cancers are diagnosed early, giving many more women a much better chance of survival.' She added: 'In addition to the relevance for the UK's breast cancer screening programme, this study has global implications for all countries where screening is undertaken for women with dense breast tissue.' The study involved 9,361 women in the UK who had dense breasts and had received a negative (no cancer) mammogram result. When additional scanning methods were trialled, an extra 85 cancers were found. Two methods examined were contrast-enhanced mammography (CEM), in which dye is used to make blood vessels more visible, and abbreviated magnetic resonance imaging (Ab-MRI), which is faster than a regular MRI. Example mammogram images of healthy breasts showing fatty/least dense (left) and dense (right). Photograph: Cambridge University Hospitals NHS Foundation Trust/PA Researchers said adding either method to existing screening could detect 3,500 more cancers a year in the UK. With screening reducing mortality for about 20% of cancers detected, this could mean an extra 700 lives saved a year, the Cambridge team said. A third scanning method used in the trial – automated breast ultrasound (Abus) – also picked up cancers but was much less effective than CEM and Ab-MRI. CEM detected 19 cancers for every 1,000 women scanned, Ab-MRI found 17 and Abus found four. With mammograms already detecting about eight cases of cancer per 1,000 women with dense breasts, additional scans could more than treble breast cancer detection, the researchers said. The trial was funded by Cancer Research UK (CRUK) with support from the National Institute for Health and Care Research Cambridge Biomedical Research Centre. Although the trial showed the scans could detect additional small cancers, which would probably save lives, further research is needed to confirm whether they could reduce the number of deaths, in order to establish the risk of overdiagnosis and to estimate the cost-benefit ratio of offering extra scans. 'More research is needed to fully understand the effectiveness of these techniques, but these results are encouraging,' said Dr David Crosby, the head of prevention and early detection at CRUK. Dr Kotryna Temcinaite, the head of research communications and engagement at Breast Cancer Now, said: 'The UK National Screening Committee now needs to consider this research as part of their current review to determine whether women with very dense breasts should be offered additional imaging during their routine screening.' She added: 'Routine breast screening is the most likely route to finding breast cancer early, when treatment is most likely to be successful. While we know that the current process can be less effective in detecting cancers in dense breasts, we still encourage all women to attend mammogram screening when invited.' The Department for Health and Social Care said research into enhanced scans for women with dense breasts was being carried out as part of the NHS breast screening programme. 'The UK National Screening Committee is reviewing this evidence as it becomes available,' a spokesperson said.
Yahoo
22-05-2025
- Health
- Yahoo
Call for NHS to give women with dense breasts extra cancer scans
Women with very dense breasts should be offered additional scans as part of the UK's NHS breast screening programme to help detect more cancers and save lives, researchers say. A Cambridge University-led study of more than 9,000 women found using different scans from traditional mammograms could treble the number of cancers detected in this group of women. Around one in 10 women have very dense breasts and they have a higher risk of developing breast cancer, however cancers are harder to spot in dense breasts because of the way mammograms (breast x-rays) work. This is because they look whiter on the x-rays, the same colour as early-stage cancers. The trial tested different scanning methods on women with very dense breasts who had been given a mammogram and told they did not have cancer. It is only through mammograms that women and their health professionals can identify breasts that are very dense. Louise Duffield, 60, from Ely, Cambridgeshire, was one of the trial participants who had an early-stage breast cancer diagnosed. She had surgery to have the tumour removed within weeks. She says it was a "big shock" when she got the diagnosis. "It's been a stressful time and it's a huge relief to have it gone. The tumour was deep in the breast so if I hadn't been on the trial, it could have gone unnoticed for years." The study, published in The Lancet, found two alternative methods, an enhanced mammogram and a fast MRI scan, detected 17-19 cancers per 1,000 women screened. Both techniques use injections to make blood vessels more visible – tumours in the breast have a lot of blood vessels. By contrast, traditional mammograms detect eight cancers in every 1,000 women screened. This amounts to more than 20,000 cancers currently detected each year. Women aged 50 to 71 are invited for breast screening every three years and around two thirds take up the offer. Based on the study results and that level of uptake, using the different scanning techniques on women with very dense breasts could identify 3,500 extra cancers per year and potentially save 700 lives. Prof Fiona Gilbert, who led the research, said she was convinced the new approach could make a difference. "We need to change our national screening programme so we can make sure more cancers are diagnosed early, giving many more women a much better chance of survival." The Department of Health and Social Care said its screening advisory body had been looking at ways to improve detection rates in women with very dense breasts for a number of years. It said it would be reviewing the findings of this trial, but it was determined to "fight cancer on all fronts" to improve survival rates. A new national cancer plan for England is expected to be published later this year. Prototype 'to light up' hidden breast cancers
North Wales Chronicle
22-05-2025
- Health
- North Wales Chronicle
Improved breast screening could detect extra 3,500 cancers a year in UK
A new trial found extra scans for some women can pick up early-stage cancers that remain 'hidden' during regular mammograms – more than trebling cancer detection. Researchers from the University of Cambridge are now calling for additional scans to be added to breast screening programmes for the group of women who have very dense breasts. Around 10% of women have very dense breasts, which means they have more fibrous and glandular tissue and less fatty tissue than other women. Those with dense breasts are already known to face a fourfold increased risk of breast cancer compared to women without. The new trial, published in the Lancet medical journal, was carried out on 9,361 women across the UK who have dense breasts and had a negative (no cancer) mammogram result. During the trial, which looked at additional scanning methods, an extra 85 cancers were found. The two methods examined were contrast enhanced mammography (CEM), where dye is used to make blood vessels more visible, and abbreviated magnetic resonance imaging (AB-MRI), which is faster than a regular MRI. The experts calculated that adding either of these methods to existing breast screening could detect 3,500 more cancers per year in the UK. And because screening reduces death for about 20% of cancers detected, this could mean an extra 700 lives saved each year, they said. A third scanning method used in the trial – automated whole breast ultrasound (ABUS) – also picked up cancers but was much less effective than CEM and AB-MRI. Overall, per 1,000 women scanned, CEM detected 19 cancers, while AB-MRI found 17 and ABUS found four. With mammograms already detecting around eight cancers per 1,000 women with dense breasts, additional scans could therefore more than treble breast cancer detection. At the moment, because denser breasts look whiter on mammograms, the usual mammogram scan cannot pick up all these cancers. Early-stage cancers also appear white, meaning they are difficult to distinguish. Professor Fiona Gilbert, from the University of Cambridge and honorary consultant radiologist at Addenbrooke's Hospital, led the study. She said: 'Getting a cancer diagnosis early makes a huge difference for patients in terms of their treatment and outlook. 'We need to change our national screening programme so we can make sure more cancers are diagnosed early, giving many more women a much better chance of survival.' In the study, the researchers concluded: 'Abbreviated MRI and contrast-enhanced mammography detected three times as many invasive cancers compared with ABUS, with cancers being half the size. 'This study shows that supplemental imaging could lead to earlier detection of cancer in women with dense breasts.' The trial was funded by Cancer Research UK with support from the National Institute for Health and Care Research Cambridge Biomedical Research Centre. Professor Stephen Duffy, from Queen Mary University, London, the trial statistician and a screening programme expert, said: 'The NHS breast screening programme has made a huge difference to many lives. 'Thanks to these results, we can see that the technology exists to make screening even better, particularly for the 10% of women with dense breast tissue.' Dr David Crosby, head of prevention and early detection at Cancer Research UK, said: 'This study shows that making blood vessels more visible during mammograms could make it much easier for doctors to spot signs of cancer in women with dense breasts. 'More research is needed to fully understand the effectiveness of these techniques, but these results are encouraging.' At the moment, the UK National Screening Committee does not recommend any additional imaging for women with dense breasts who have a negative result on a mammogram. Dr Kotryna Temcinaite, head of research communications and engagement at Breast Cancer Now, said: 'The UK National Screening Committee now needs to consider this research as part of their current review to determine whether women with very dense breasts should be offered additional imaging during their routine screening. 'If the UK National Screening Committee recommends additional imaging for screening women with very dense breasts, we'll push for those changes to be rolled out as quickly as possible across the UK. 'Routine breast screening is the most likely route to finding breast cancer early, when treatment is most likely to be successful. 'While we know that the current process can be less effective in detecting cancers in dense breasts, we still encourage all women to attend mammogram screening when invited.' Addenbrooke's patient Louise Duffield was one of 85 women diagnosed with cancer thanks to the additional scans used in the trial. Aged 60, the grandmother of four from Ely, Cambridgeshire, had an AB-MRI scan which identified a small lump deep inside one of her breasts. She said: 'When they rang to say they'd found something, it was a big shock. 'You start thinking all sorts of things but, in the end, I just thought, 'at least if they've found something, they've found it early'. The staff were brilliant, and so supportive.' A Department for Health and Social Care spokesperson said: 'Research is being conducted into the use of additional tests for women with dense breasts, as part of the NHS breast screening programme. 'The UK National Screening Committee is reviewing this evidence as it becomes available.'
