A Clearer Picture of Breast Cancer
Last fall, a government panel recommended that unless women have a family history of breast cancer, they wait until age 50 to undergo annual mammograms. Women with the family history should begin annual mammograms at age 40.
Physicians at the University of Chicago Medical Center openly disagreed. They remain adamant that all women over age 40 should schedule mammograms yearly, regardless of family history.
“There’s overwhelming evidence that regular mammograms save lives,” said Gillian Newstead, MD, clinical director for the Section of Breast Imaging at the Medical Center. “We don’t have anything else. We know we find small cancers through mammography. What are we going to do? Wait until they grow and they become palpable and the patient’s prognosis is worse?”
Once a week at the Medical Center, oncologists, surgeons, pathologists and radiologists crowd into a conference room to view breast images on an 8-foot screen. Those meetings form the cornerstone of the Medical Center’s breast cancer program, where specialists outline what they believe is the best course of treatment for each newly diagnosed cancer patient. They base their conclusions on repeated and careful examinations of image-based tests such as MRIs, mammograms, CT scans and ultrasounds, along with a pathologist’s report about the biology of the tumor.
What few patients realize is that their doctors’ diagnoses depend directly on the quality of the diagnostic images. By working with physicists and the companies that produce imaging technology, the Medical Center breast imaging team combines the latest technology with sophisticated treatment and surgery to ensure that the full extent of a patient’s cancer is detected and removed.
“Because we have more accurate images, it changes how we treat patients,” said Newstead. “We have perfected MRI techniques here. We are able to show the extent of the cancer. Our whole toolbox has become much larger.”
But that is far from the end of the story.
Finding New Techniques
An $11.5 million grant from the National Cancer Institute’s Specialized Programs of Research Excellence (SPORE), led by Funmi Olopade, MD, funds the Medical Center’s continued research, enabling scientists here to learn even more from the images.
Two of the grant’s four major projects focus on improving mammography and MRIs. MRIs are becoming increasingly important for helping doctors more accurately locate tumors in a woman’s breast.
MRI tests involve using a scanner to bounce a magnetic field off of molecules within the patient’s body. This creates an image, providing a more precise picture of tumors than mammograms or ultrasounds.
One project within the SPORE grant, led by Maryellen Giger, PhD, concentrates on identifying a set of features (markers) revealed in breast images that can be used to better predict the risk of breast cancer.
The other project involves looking for ways to use MRIs to find very small early cancers or precancerous lesions by matching the markers found in tissue biopsies with findings from MRI scans.
“Half of the SPORE grants are for taking standard images and analyzing the data further and coming up with new ways of imaging,” Newstead explained.
As part of another research study, high-risk women, such as those with a genetic predisposition for breast cancer or those who received radiation to their chest as young adults, are screened with an MRI every six months for tumors as opposed to national recommendations to screen once a year. This helps catch tumors earlier, Newstead explained.
Additionally, every woman diagnosed with breast cancer at the Medical Center is given what’s called a “staging MRI” to create a clearer picture of the known tumors and locate any smaller tumors unseen in other tests. The Medical Center was one of the first hospitals in the Midwest to offer staging MRIs to all diagnosed women, Newstead said.
The Future of Treatment
Physicians also can perform biopsies with guidance from MRIs. This allows the physician to accurately pinpoint the tumor for the test. Newstead said the next step will involve aiming high-intensity ultrasound beams at tumors to remove them while the patient is inside the MRI machine.
“Physicists under the direction of Dr. Greg Karczmar have been using (the technique) in animals, not humans yet,” Newstead said. “It’s going to be another year or two, but we’ll be pioneering that effort here.”
The Breast Imaging Section also has added digital imaging mammography machines to its screening department. Digital images are better at detecting cancer in younger women and women with dense breast tissue, Newstead said. Having digital images also makes it easier for patients to take their results to another physician if they want a second opinion.
And the upgrades keep coming. Newstead and a team of physicians are working with Philips, a company that makes MRI machines. They want to design a multi-media database and work station where physicians can view MRIs, ultrasounds and mammograms. That database also would catalogue all imaging and medical records.
“We are working not just with the equipment we have, but we’re working to develop new equipment and advanced integration techniques with the company,” Newstead explained.
Researchers here are focusing on detecting cancer in lymph nodes, where breast cancer has the potential to spread. Newstead is collaborating with researchers in the university’s physics department to analyze the mathematics of cancerous tumors and their linkage to lymph nodes. The goal, she said, would be to allow less invasive treatment, perhaps ultimately avoiding surgery of lymph nodes in some cases.
Meanwhile, other scientists are finding better ways to distinguish between aggressive and “innocent” cancers in patients with ductal carcinoma in situ, an early cancer that has not spread beyond the milk duct.
The researchers fear that they “can’t differentiate between the good guys and the bad guys,” said Newstead, which sometimes leads to over-treatment.
But with new techniques on the horizon and clearer images already in physicians’ hands at the Medical Center, the era of extremely personalized medicine is upon us.