mammogram Archives - Amazing Health Advances

Why Are Mammogram Guidelines Conflicting?

AHA Publisher — Fri, 01 Oct 2021 07:00:49 +0000

Michael Greger M.D. FACLM via Nutrition Facts – When women are fully informed about the risks and benefits of mammograms, 70 percent may choose not to get screened. You may be in that 30 percent who opts to get a mammogram and absolutely have the right to decide for yourself. “For nearly a century, public health organizations, professional associations, patient advocacy groups, academics, and clinicians largely viewed cancer screening as a simple, safe way to save lives.” But these days, even though we’re all looking at the same body of evidence, “differing interpretations about evidence on benefits and harms of screening mammography has led to conflicting recommendations…that range from intensive screening starting at age 40 to no screening at all.” Currently, the four main groups in the United States charged with making mammogram recommendations—the American Cancer Society, the U.S. Preventive Services Task Force, the American College of Obstetricians and Gynecologists, and the National Comprehensive Cancer Network—each set contradictory guidelines. What’s a woman to do? This is the issue I discuss in my video Mammogram Recommendations: Why the Conflicting Guidelines?. Guidelines are based on systematic reviews of the evidence. “In the last 15 years, 50 systematic reviews on the use of routine mammography for breast cancer screening in asymptomatic women have been published but a consistent conclusion has not emerged.” Why? It turns out that the conclusions of systematic reviews may have been influenced by competing conflicts of interests of the authors. “It is only in health care, after all, that the same group that provides a service also tells us how valuable that service is and how much of it we need…We must acknowledge that just as in any other profession or industry, self-interest is unavoidably at work in health care.” Indeed, an analysis of more than a hundred papers concluded: “Scientific articles tend to emphasize the major benefits of mammography screening over its major harms. This imbalance is related to the authors’ affiliation.” It may be no coincidence that all of the expert panels that have come out against routine mammograms excluded radiologists. Perhaps those who depend on mammograms for their paycheck might be more likely to recommend them. One “leading proponent of mammography screening said ‘I earn my living reading mammograms’, and ‘if you don’t have a conflict of interest you probably don’t have the expertise’.” He accused the breast cancer screening panels of injecting their own biases. “In this debate, there are armies of the faithful, and only a disappointing scattering of moderators and peacemakers.” Some have even suggested that “this debate should not be taking place in public…Such paternalism assumes that women cannot decide for themselves whether the available evidence supports or refutes the case for mammography. Discouraging a discussion with women about the evidence for and against mammography is more harmful for women’s health, not less, if doctors truly believe that patients should be active partners in making decisions about their care.” If you read the actual studies, you can determine whether the investigators declare any conflicts of interest, but if you simply hear about the studies second-hand, you may have no idea. Until the developers of screening guidelines “emphasize evidence over commercial or financial interests,” we all have to take personal responsibility to become informed consumers. It would be nice to be able to trust cancer charities, but it is “virtually impossible” for such organizations to remain strictly “evidence-based” when they must rely on donors “for their very existence.” To his credit, the Chief Medical Officer of the American Cancer Society (ACS) “noted that we need to be true to the science”—but he was talking about prostate cancer screening. Although the ACS simply tells women to get mammograms, it lets men decide for themselves. The charity is open about the harms of prostate cancer screening, but “very little transparent ‘educational’ information about the harms of mammography is provided on the American Cancer Society website.” “In the United States…a double standard exists: women are encouraged to participate in screening mammography”—to just do it—“while men are advised to make informed decisions regarding prostate screening, although the fundamental issues to consider are very similar.” The “dissimilarity” in how organizations like the American Cancer Society “view the shared decision making of women contemplating breast cancer screening versus that of men contemplating prostate cancer screening, couldn’t be clearer. Do [they] believe that men can handle uncertainties regarding screening tests for prostate cancer, but that women cannot handle uncertainties, and in fact become confused by them when making decisions about breast cancer screenings?” Men get to “make informed decisions,” but women are merely “summoned.” The bottom line is that there is “more than one right answer” to the question, “Should I be screened for breast cancer?” My goal is to enable you to make the decision that is right for you and your loved ones. One survey found that “if women knew how small the real effectiveness of breast cancer screening in preventing breast cancer deaths is, 70% said they would not submit to it.” But, you may be in that 30 percent—and you have every right to decide for yourself. When it comes to this topic, there’s just so much confusion, combined with the corrupting commercial interests of a billion–dollar industry. As with any important health decision, everyone should be fully informed of the risks and benefits, and make up their own mind about their own bodies. KEY TAKEAWAYS At present, the American Cancer Society, the U.S. Preventive Services Task Force, the American College of Obstetricians and Gynecologists, and the National Comprehensive Cancer Network have each set contradictory guidelines regarding mammography screening. Conclusions of systematic reviews on the use of routine mammograms for breast cancer screening in asymptomatic women have been inconsistent, and the evidence may be influenced by competing conflicts of interests of the authors. An analysis of more than a hundred papers concluded: “Scientific articles tend to emphasize the major benefits of mammography screening over its major harms. This imbalance is related to the authors’ affiliation.” Cancer charities may also be challenged with remaining strictly “evidence-based” when they rely on donations to exist. A double standard exists in the United States where women are encouraged to get routine mammograms, while men are advised to make informed decisions about prostate screening even though the fundamental issues to consider are quite similar. A survey found that “if women knew how small the real effectiveness of breast cancer screening in preventing breast cancer deaths is, 70% said they would not submit to it.” You may be in that 30 percent who opts to get a mammogram, and you have every right to decide for yourself. To read the original article click here.

The post Why Are Mammogram Guidelines Conflicting? appeared first on Amazing Health Advances.

New Technology Detects Breast Cancer Using Tears

AHA Publisher — Fri, 26 Jun 2020 07:00:48 +0000

Kobe University via News-Medical Net – Kobe University and System Instruments Co., Ltd. researchers have developed TearExo®; new technology to detect breast cancer using the exosomes found in tears as biomarkers. Exosomes are a subtype of extracellular vesicles. Research team members included Professor TAKEUCHI Toshifumi (Kobe University Graduate School of Engineering), Project Professor TANINO Hirokazu and Professor SASAKI Ryohei (both of Kobe University Hospital), and Mr HAMADA Kazuyuki (System Instruments Co., Ltd.). This research was mainly conducted by researchers at Kobe University’s Medical Device Fabrication Engineering Center (Director: Professor MUKAI Toshiji). It is hoped that this technology can make a great contribution towards people’s health by enabling prompt cancer detection. This research was first published online on March 10, 2020 in the Journal of the American Chemical Society and was featured on the journal cover. Main Points TearExo® uses the world’s first chemical nano-processing technology to detect exosomes in a very small amount of bodily fluid, demonstrating extremely high sensitivity and smooth operability, without the need for pretreatments and detection reagents. TearExo® enables non-invasive breast cancer testing to be conducted using tear fluid samples that can be easily self-collected by the patient. The researchers demonstrated a new liquid biopsy methodology for early cancer detection using the exosomes in tear fluid as biomarkers. This was realized through an ‘automatic exosome analyzer’; a highly sensitive assay to measure exosomes, which enables bodily fluid tests to be conducted quickly and easily. Research Background Currently, imaging-based screening methods such as mammography are used to detect breast cancer. However, these medical devices are often large and it takes time to obtain the results, as at least two specialists need to interpret the images. This imposes a heavy burden on the patient. Recently liquid biopsies, where the extracellular vesicle exosomes found in patients’ bodily fluids are used as biomarkers to detect cancer, have gained attention as a possible alternative. Liquid biopsies are noninvasive and reduce the burden on the patient. It is hoped that they would improve both cancer testing rates and early cancer detection rates. It has been reported that exosomes are involved in cancer metastasis and malignant development. Therefore exosomes are often the target of liquid biopsies as they are considered to be extremely important markers for diagnosing cancer. However, it is difficult to conduct a prompt analysis using regular exosome analysis methods because they require cumbersome preprocessing. If a new, convenient and highly sensitive method for detecting cancer cell-related exosomes in bodily fluids were to be implemented, it would provide an extremely powerful cancer screening method. Research Methodology Principle TearExo® consists of a fluorescent exosome sensing chip and an automatic exosome analyzer. The fluorescent exosome sensing chip was constructed by placing an antibody and a fluorescent reporter molecule in a 100nm nanocavity formed on a glass chip. The antibody recognizes the surface proteins of exosomes and the fluorescent reporter molecule can be used to read the exosomes’ binding with the antibody based on changes in the fluorescence. With the automatic exosome analyzer, the researchers achieved a rapid, ultra-sensitive assay (about 1000 times more sensitive than current immunoassays) capable of detecting 50 exosomes in 100µL of fluid in ten minutes, without the need for the lengthy pretreatment required in the past. Detecting Cancer from Tear Fluid Tear fluid was sampled from breast cancer patients and healthy donors via Schirmer tests, whereby a small strip of filter paper is used to collect the tear fluid. TearExo® was used to measure the exosomes in these tear fluid samples and analyze the pattern of the surface proteins’ composition (principal component analysis). A clear difference was found between the samples obtained from healthy donors and those from breast cancer patients, demonstrating that tear fluid can be used to detect breast cancer. Exosome composition is different before and after mastectomy; after surgery the composition is the same as that found in healthy people. This shows that TearExo® could also be used to check and monitor patients’ post-treatment recovery, as well as for initial cancer detection.For the first time in the world, this research demonstrated that cancer can be detected using tear fluid. Further Research Exosome analysis of clinical samples will be conducted on a larger scale to determine the specificity and sensitivity of this method of breast cancer diagnosis. After that, there are plans to establish a venture company within the next year and apply to Japan’s PMDA (Pharmaceuticals and Medicals Device Agency) for the approval of TearExo® as an in vitro diagnostic device. To read the original article click here.

The post New Technology Detects Breast Cancer Using Tears appeared first on Amazing Health Advances.

Better 3-D Imaging of Tumors in the Breast with Less Radiation

AHA Publisher — Fri, 25 Oct 2019 07:00:21 +0000

DOE Science News Source via News Wise – In breast cancer screening, an imaging technique based on nuclear medicine is currently being used as a successful secondary screening tool alongside mammography to improve the accuracy of the diagnosis. Now, a team is hoping to improve this imaging technique. The technique is known as molecular breast imaging or breast specific gamma imaging. The team, including Seung Joon Lee at Thomas Jefferson National Accelerator Facility (Jefferson Lab), added the Variable Angle Slant Hole (VASH) collimator. The addition maintains or improves image quality and precise location within the breast. Simultaneously, it reduces patient radiation dose. (Photo Credit: Thomas Jefferson National Accelerator Facility, Seung Joon Lee holds the variable angle slant hole collimator. This device can help a breast molecular imaging system get six times better contrast of cancer lesions, providing the same or better image quality while potentially halving the radiation dose.) The Impact When used in a molecular breast imager, the VASH collimator allows the imager to capture 3-D molecular breast images at higher sensitivity than current 2-D scans. Full system tests demonstrate that it could provide up to six times better contrast of tumors in the breast. Gaining the higher contrast does not interfere with image quality (improving it in some cases), and it decreases the radiation dose to patients. Related Articles: Breast Cancer Preventative Care: Breast Density — Separating Myth From Fact Breast Cancer Prevention: Researchers Announce Amino Acid Breakthrough Summary To screen for breast cancer, medical offices use imaging techniques based on nuclear medicine to reduce the number of false positive results rendered by mammography alone. While a mammogram shows the structure of breast tissue, molecular breast imagers show tissue function. For instance, cancer tumors are fast growing, so they gobble up certain compounds more rapidly than healthy tissue; a radiopharmaceutical made of that compound will quickly accumulate in tumors. As the pharmaceutical decays, it gives off gamma rays. To focus the gamma rays, current molecular breast imaging systems use a traditional collimator, which is essentially a rectangular plate of dense metal with a grid of holes, to “filter” the gamma rays for the camera. The collimator helps produce a clear, well-defined image of any cancer tumor. Researchers at Jefferson Lab, Dilon Technologies, and the University of Florida developed the VASH collimator for 3-D imaging of the breast. They constructed it from a stack of 49 tungsten sheets, each one a quarter of a millimeter thick and containing an identical array of square holes. Two small motors slide the individual sheets by their edges. Sliding the sheets changes the angle of the array of square holes in the stack. The result is a systematic varying of the focusing angle of the collimator during the imaging procedure. In system tests, the team found that while using the VASH collimator with an existing breast molecular imaging system, they could get six times better contrast of tumors in the breast. With this higher contrast, imagers could potentially reduce the amount of radiopharmaceutical used, thus halving the radiation dose to the patient, while maintaining the same or better image quality. The results match a published paper that predicted this performance via a Monte Carlo simulation. Jefferson Lab was awarded a patent for this novel mechanism that has been licensed to Dilon Technologies. Additionally, Jefferson Lab and Dilon Technologies have entered into a Cooperative Research and Development Agreement to further advance this technology to commercialization. To read the original article click here.

The post Better 3-D Imaging of Tumors in the Breast with Less Radiation appeared first on Amazing Health Advances.

Breast Cancer Preventative Care: Breast Density — Separating Myth From Fact

AHA Publisher — Mon, 30 Sep 2019 07:00:23 +0000

Penn State Health Medical Minute via News Wise – While fatty tissue appears grey on a mammogram, dense tissue appears white. Some cancer lesions also appear white on a mammogram. “Therefore, high levels of dense tissue in some women may mask a cancer lesion on a mammogram,” Sivarajah said. Newswise — Mammograms remain the gold standard for detecting breast cancer in its earliest stages, potentially saving lives. So, why do some women receive a letter after a negative mammogram – meaning there’s no sign of cancer – asking them to consider additional tests? The answer, according to Dr. Rebecca Sivarajah, a specialist in breast imaging with Penn State Health, boils down to the type of tissue in a woman’s breasts. “Most breasts include both fatty tissue and the fibroglandular, or dense, tissue,” she said. While fatty tissue appears grey on a mammogram, dense tissue appears white. Some cancer lesions also appear white on a mammogram. “Therefore, high levels of dense tissue in some women may mask a cancer lesion on a mammogram,” Sivarajah said. That’s why, six years ago, Pennsylvania enacted a law requiring radiologists to notify women with dense breast tissue about supplemental screenings following a negative mammogram. While the law raised awareness of the risks associated for women with dense breast tissue, the topic itself evokes many questions and myths. Let’s separate some myths from the facts. Myth 1 – I can tell my breast density by the way they feel. Fact: “In general, you can’t determine breast density by ‘feel’,” Sivarajah said. Instead, a mammogram will determine breast density. The American College of Radiology breaks down breast density into four classes. Women whose breasts rank in the “fatty” or “scattered fibroglandular tissue” classes do not have enough dense breast tissue to raise concern. Women whose breasts rank in the “heterogeneously dense” and “extremely dense” classes have high breast density. An estimated 40% of U.S. women fall into those latter two classes. Myth 2 – I can’t have dense breast tissue because I’m not overweight. Fact: Obesity has little impact on breast density. “Being overweight or obese may increase the amount of fatty tissue in a woman’s breast, but it doesn’t increase the relative amount of dense breast tissue,” Sivarajah said. However, a woman’s breast density often decreases with age. Myth 3 – Breast density doesn’t affect my cancer risk. Fact: “Women in the highest density class (‘extremely dense’) are more likely to be diagnosed with breast cancer compared to a woman in the lowest density class (‘fatty’),” Sivarajah said. Myth 4 – Because I have dense breasts, I don’t need a mammogram. Fact: Supplemental tests do not take the place of a mammogram. “While dense breast tissue can make a mammogram less sensitive, mammograms can still find breast cancer,” Sivarajah said. In fact, some potential signs of breast cancer, such as certain calcifications and distortions, can only be found with a mammogram. For most women with high breast density, a screening breast ultrasound is the most common supplemental test. Penn State Breast Center offers Automated Breast Ultrasound Screening (ABUS), which uses soundwaves – not radiation – to create a 3-D image of the breast. During this screening, a padded, curve-shaped transducer is placed on the breast while the patient lies down. “The test is comfortable for most women,” Sivarajah says. For women with a higher lifetime risk of cancer – 20 percent or more as determined by a doctor – breast MRI may be recommended as a supplemental test. This test uses magnets and contrast dye to enhance any potential lesions differently from dense breast tissue. Most insurance plans cover ABUS or screening ultrasound of the breast. Breast MRI is often covered by insurance for patients who have an elevated lifetime risk greater than 20%. Patients should check with their insurance carrier to verify coverage. So, what’s the best next step for women who get a letter about their breast density? “Talk with your primary care doctor about whether a supplemental test is right for you,” Sivarajah said. The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience. To read the original article click here.

The post Breast Cancer Preventative Care: Breast Density — Separating Myth From Fact appeared first on Amazing Health Advances.