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Keeping abreast of latest techniques

Consultant radiologist Kenneth Saliba outlines the latest mammography and ultrasound methods used to detect breast cancer.

It is important to raise awareness on breast cancer and learn more about what detection methods are available. Because there is good scientific evidence that regular breast imaging detects breast cancer at an early stage (when there are no lumps or other signs or symptoms) or better still in its pre-cancerous stage, when it is eminently treatable.

There are also women who are at higher risk of breast cancer, most importantly those with a significant family history (i.e. those with a first or second degree relative with a history of breast cancer under the age of 50 years) who benefit likewise.

The standard go-to imaging tool to look for breast cancer when there is no clinical complaint is mammography.

Here the woman has her breasts compressed between two plates and two views of each breast are obtained. The images are then reviewed by a radiologist. If the latter interprets the mammograms as normal, nothing further is required. If not, the radiologist will assess the area about which there is uncertainty, with further mammographic views or with an ultrasound or both. In 90 per cent of such instances the radiologist will be able to confidently rule out any worrying pathology. In the remaining cases a biopsy will be required to ascertain what exactly is causing the altered appearances.

It is important to note that out of these cases only a small percentage will turn out to be cancer. 

On the other hand, if a woman feels a lump and is under the age of 35 years, ultrasound is often resorted to in the first instance and in a good number of cases is all that’s required.

There are a number of recent innovations in equipment and techniques used to detect breast cancer. Among these is Tomosynthesis also known as 3D mammography – the acquisition of multiple mammographic views by using different angles of exposure, while maintaining a similar radiation dose as with a conventional mammogram.

This provides the radiologist with enhanced depth perception and allows more confident mammographic reports, with less need for secondary assessments, less biopsies, and consequently less anxiety for women. 

Tomosynthesis has also been shown to detect 10 to 20 per cent more breast cancers, which can be occult on conventional 2D mammographs.

Then there is also ABUS (Automated Breast Ultrasound). This innovative ultrasound machine obtains a whole volume of data which can be analysed by the radiologist in different planes, and is therefore dubbed 3D ultrasound, unlike the standard 2D ultrasound which is uniplanar.

ABUS offers more comprehensive coverage of the breast.

The definitive clinical applications of ABUS are still in development, but its main use appears to be in the evaluation of dense breasts, in conjunction with mammography. ABUS is not to be used in isolation, at least not routinely as the strengths and weaknesses of mammography. It may have a role in isolation, in young women with a significant family history, where breast tissue is likely to be dense and mammograms would not contribute the desired information. Also in women under 40, and especially under 30, the radiation risk outweighs any potential gain from cancer detection, and therefore mammography is largely avoided under the age of 40.

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