It's Time to Improve Methods for Breast-Cancer Detection

It has been more than six years since I was first diagnosed with breast cancer at age 35. Since then, my life has changed in more ways than I could have imagined. I became an activist, founding a nonprofit advocacy organization for Latin American women with breast cancer. And I learned that I am by no means alone. Each year, more than 180,000 new cases of invasive breast cancer are diagnosed and more than 40,000 women die from it. Breast cancer is still a leading cause of cancer death in this co

Apr 30, 2001
Carolina Hinestrosa
It has been more than six years since I was first diagnosed with breast cancer at age 35. Since then, my life has changed in more ways than I could have imagined. I became an activist, founding a nonprofit advocacy organization for Latin American women with breast cancer. And I learned that I am by no means alone. Each year, more than 180,000 new cases of invasive breast cancer are diagnosed and more than 40,000 women die from it. Breast cancer is still a leading cause of cancer death in this country, and it's the leading cause of death for women ages 35 to 50.

I also learned a lot about what is needed to fight this disease. One of the most obvious areas for improvement is in breast-cancer detection. Since the 1970s, X-ray film mammography has been the main tool for breast-cancer screening. And indeed, mammography has contributed to a reduction in mortality from breast cancer. But it also has many serious limitations. X-ray mammography does not detect all cancers, including some that are picked up by physical examination. Mammograms are particularly difficult to interpret for women with dense breast tissue, which is especially common in younger women. In addition, some tumors may develop too quickly to be identified at the most treatable stage by using annual screening mammograms.

And because there is still limited understanding of the biology and progression of breast cancer, mammograms can sometimes lead to more questions than answers. For example, as many as three-quarters of all breast lesions that are biopsied as a result of suspicious findings from screening mammograms turn out to be benign. Some small lesions are treated as cancerous or precancerous when they might never have developed into a life-threatening disease if they had been undetected and left untreated.

Make no mistake about it: Despite its limitations, X-ray mammography is still the best technology available right now. Women should continue to consult with their health care providers about when to begin annual screening mammograms. However, new technologies and tools to detect breast cancer are urgently needed. I recently served on an Institute of Medicine and National Research Council committee that examined several new imaging and molecular biological technologies that may someday improve our ability to detect breast cancers at a curable stage. We found that more evaluation and development of these tools are required--and warranted.

Some new imaging technologies such as digital mammography, ultrasound, computer-aided detection systems, and magnetic resonance imaging are promising. Many other technologies are at relatively early stages of development. In addition, new technologies that are not based on imaging have potential for screening or diagnostic applications. For example, biological techniques can provide information about the genetic and cellular characteristics of breast abnormalities even before they can be captured on an image.

The federal government needs to develop a more systematic approach to evaluating these technologies. Clinical trials--designed with support and input from relevant federal agencies and breast-cancer advocates--are needed to assess screening tools. The National Cancer Institute (NCI) should create a permanent infrastructure for testing new detection technologies and reassessing the effectiveness of established screening tools. It's also essential that women be willing to participate in these studies. Private insurers should cover the costs of screening tests for women who participate in clinical trials but are not eligible for Medicare or Medicaid.

But before any real breakthroughs are possible, researchers need a better understanding of the basic biology of breast cancer. Improvements in breast imaging techniques that allow for better detection of small, early lesions will not provide the maximum benefit of early detection unless more research is done to clearly define their significance. NCI should expand access to breast-tissue specimen banks, and women who contribute should be assured confidentiality and protection against genetic discrimination.

Even the best technologies will be of limited help unless women have greater access to them. The breast- and cervical-cancer screening program offered by the Centers for Disease Control and Prevention--which provides free screening mammography to uninsured, low-income women--reaches only 15 percent of eligible women. Congress should expand this program to reach at least 70 percent, and state legislatures should provide Medicaid funds for timely treatment of women diagnosed through this screening program.

There may never be a single technology that can detect all breast cancers. But taking these important steps will most certainly improve understanding of the disease--and save women's lives.

M. Carolina Hinestrosa, co-founder and executive director of Nueva Vida, Support Network for Latinas with Cancer, Silver Spring, Md., recently served on an Institute of Medicine and National Research Council committee that produced the report Mammography and Beyond: Developing Technologies for the Early Detection of Breast Cancer, online at books.nap.edu/ catalog/10030.html?onpi_newsdoc030801.