In what's being touted as the largest analysis of breast cancer screening methods for women under the age of 40, researchers at the Seattle Cancer Care Alliance (SCAA) and University of Washington put mammography and ultrasounds to the test.
What they found: Among women ages 30 to 39 with symptoms of possible breast cancer (including palpable lumps, localized pain and tissue thickening) ultrasound is a superior diagnostic tool with a "far higher" sensitivity for cancer detection than mammography. And while the risk for malignancy among women in this age group is what the study's lead author, Constance Lehman, M.D., Ph.D., calls “small but real,” at about 1.9 percent, her findings hope to prompt health officials to revise the current U.S. clinical practice guidelines, which recommend mammography as the first evaluation for women with symptoms of the disease.
Last month, doctors pointed to regular mammography screening as a critical practice in narrowing the breast cancer gap between black and white women, and, last year, championed mammography's ability to cut breast cancer mortality rates in half.
But for those under age 40, particularly black women, who have a greater incidence of breast cancer than white women of the same age, the latest findings prove that ultrasounds may be best.
"Mammography is still our best tool for screening women 40 and older, but targeted ultrasound is our tool of choice in evaluating symptomatic women under 40," the study authors wrote in their report, published in the Oct. 22 issue of the American Journal of Roentgenology. But "in women under 40, ultrasound is better at evaluating breast lumps compared to mammography," the authors went on to say, citing the 1,208 cases they examined in which sensitivity for ultrasound was 95.7 percent compared to 60.9 percent for mammography.
According to the study, ultrasound exams found 22 cancers versus 14 by mammography.
Revised guidelines -- which would mirror those in Europe, where ultrasound is often recommended as a first course of screening for women under age 40 -- could prove doubly effective in combination with a new ultrasound device that the FDA approved last month, the somo-V Automated Breast Ultrasound System (ABUS), designed to help detect cancer in women with dense breasts, who often aren’t diagnosed until they are experiencing more advanced stages of the disease.
Approximately 40 percent of women who undergo screening, a disproportionate number of which are black, have dense breasts, experts say. In contrast with less-dense breasts, which have a high amount of fatty tissue, dense breasts have a high amount of connective and glandular, or fibroglandular, tissue that appears as solid white areas on a mammogram, just as tumors do.
Unlike the patients in Lehman's study, however, ABUS was approved for use in women with no symptoms of the disease.
Earlier on HuffPost:
One Treatment Does Not Fit All
In a landmark series of <a href="http://www.huffingtonpost.com/2012/09/24/breast-cancer-gene-study-new-treatment-black-women_n_1910142.html">studies that honed in on four major classes of breast cancer</a> last month, researchers have been able to provide clues as to why the disease differs between races. At North Shore-LIJ Health System's Monter Cancer Center, researchers found that <a href="http://www.huffingtonpost.com/2012/06/06/breast-cancer-genetics-race-therapy-treatment_n_1574724.html">Caucasian women may carry microRNAs that protect against breast cancer, genes that African American women don't carry.</a> The finding not only explains why cancer outcomes are often different between black and white women, it also supports the importance of personalized treatment for cancer that focuses on the genetic make-up of tumors, rather than a one-treatment-fits-all approach.
"D" Stands For Decreased Risk
A study published in the journal <em>Breast Cancer Research</em> in April revealed <a href="http://www.huffingtonpost.com/2012/04/08/vitamin-d-may-reduce-breast-cancer-in-black-women-study_n_1411599.html">African-American women with the highest levels of vitamin D also had a specific variation in the vitamin D receptor that cut their breast cancer risk in half</a>, compared to women without it. About a third of African Americans are vitamin D deficient, however, and melanin in the skin make it harder for many to get enough. Along with a healthy does of sunshine, experts recommend a vitamin D supplement of 600 IU per day.
Even Moderate Exercise Helps
In June, researchers at University of North Carolina in Chapel Hill found that women who<a href="http://www.huffingtonpost.com/2012/06/25/exercise-breast-cancer-risk-moderate_n_1619175.html"> exercise between 10 and 19 hours each week had a 30 percent lower risk of breast cancer</a>. And there isn't a need to break a serious sweat either. <em>All</em> levels of exercise intensity were linked with a decreased risk, the study authors said.
Regular Screening Are Key To Closing Racial Gaps
According to a study published in <em>Breast Cancer Research</em> in August, <a href="http://www.sciencedaily.com/releases/2012/09/120925153327.htm">mammograms may be the key to closing the breast cancer gap between black and white women.</a> When study participants received regular breast screening, "there was no difference in the rate of how many of them presented in the disease's later stages," researchers found. "This study reinforces the fact that racial gaps in breast cancer outcomes can be improved," said lead author Dr. Paula Grabler, an assistant professor of radiology at Northwestern University Feinberg School of Medicine and a radiologist at Northwestern Memorial Hospital.
Affordable Care Is Within Reach
In a <a href="http://thehill.com/blogs/healthwatch/public-global-health/259519-obama-sebelius-healthcare-law-is-fighting-breast-cancer">commemoration of Breast Cancer Awareness month Monday, President Obama and Health and Human Services Secretary Kathleen Sebelius</a> credited the Affordable Care Act with bringing on "a new day for women's health and the fight against breast cancer." According to Sebelius, the healthcare law "means that women can get the potentially life-saving services they need to detect breast cancer before it spreads, without worrying how a copay would affect their family budget."
Existing Treatments Work
A September study by Washington University researchers suggests basal-like breast tumors, one of the deadliest forms of the disease that has been shown to disproportionately affect younger women and those who are African-American, <a href="http://www.huffingtonpost.com/2012/09/24/breast-cancer-gene-study-new-treatment-black-women_n_1910142.html">have a similar genetic makeup to ovarian tumors and could potentially be treated with the same drugs. </a> This means some women may be able to forgo less effective treatments that are typically used for basal-like tumors and have been know to cause heart problems and lead to the development of other cancers, including leukemia.
Triple-Negative Treatments Are Closer
The notoriously fatal triple-negative breast cancer (TNBC) may have met its match, according to researchers from Memorial Sloan-Kettering Cancer Center in New York who found that a form of the small pox virus can be used against TBNC. In the study released this week, researchers found that a certain form of smallpox vaccine was able to kill 90 percent of TBNC cells in four days of treatment. It also inhibited blood flow to the cancer stopping its spread. TNBC is found in about 15 out of every 100 cases and is more likely to occur in Hispanics and African Americans.