Sonography
Superior for Some Breast Cancers
Sonography
is more accurate than mammography for women under 45 with symptoms
Mammography may be the
standard screening test for breast cancer, but if you are a woman
under 45 with symptoms of the disease, an ultrasound (also called
sonogram) is more likely to find malignancies.
That is the conclusion
of a new study published in a recent issue of the American 
Journal of Roentgenology.
"Sonography was significantly
more accurate than mammography in diagnosing breast cancer in women
with breast symptoms who are 45 years and younger," says study author
Dr. Nehmat Houssami, a senior lecturer at the School of Public Health
at the University of Sydney, Australia. Houssami was the director
of the MBF Sydney-Square Breast Clinic at the time the study was
conducted.
Study
Did Not Look at General-Population Screening
Houssami is quick to point
out, however, that the study did not look at general-population
screening for breast cancer, and he says he is definitely not suggesting
that ultrasound replace mammography for screening.
Breast cancer is the most
common cancer among women, excluding non-melanoma skin cancer. Currently,
approximately three million women in the US are living with
the disease, including two million who have already been diagnosed,
and another one million who do not yet know they have the disease.
The American Cancer
Society (ACS) estimates for 2002 include 205,000 new cases
of invasive breast cancer being diagnosed in the US. In addition,
ductal carcinoma in situ will be responsible for 54,300 new cases
this year.
Symptoms
of Breast Cancer
Symptoms of the disease
include:
-
lump or thickening (a mass, swelling,
skin irritation, or distortion) in or near the breast or in
the underarm area
-
a change in the size or shape
of the breast
-
a change in the color or feel
of the skin of the breast, areola, or nipple (dimpled, puckered,
or scaly)
-
nipple discharge, erosion, inversion,
or tenderness
The symptoms of breast
cancer may resemble other conditions or medical problems. Always
consult your physician for a diagnosis.
Mammography
Guidelines
A mammogram is an x-ray
examination of the breast. It is used to detect and diagnose breast
disease in women who either have breast problems such as a lump,
pain, or nipple discharge, as well as for women who have no breast
complaints. The American Cancer Society recommends
that every woman over 40 have a mammogram annually. The National
Cancer Institute recommends women in their 40s and older
should have a screening mammogram on a regular basis, every one
to two years. Ultrasound is a diagnostic imaging technique that
uses high-frequency sound waves to create an image of the internal
organs.
For this study, radiologists
examined the mammograms and sonograms of 480 women between the ages
of 25 and 55. All of the women had symptoms of breast cancer. Half
of the women actually had breast cancer. The 240 women without cancer
were age-matched to those in the breast cancer group.
Overall, there was not
a statistically significant difference in the detection of cancer
between the two tests, they found. However, in younger women—those
under 45—sonography correctly identified 84.9 percent of breast
cancers, while mammography was only able to pick up 71.7 percent
of the cancers.
The reason for the difference,
Houssami says, is simple. Younger women's breasts are generally
more dense than older women's breasts, and sonography is better
able than mammography to capture images through that density.
In most cases, a woman
with breast cancer symptoms is referred for both mammography and
sonography, regardless of her age, according to the study.
For all the age groups
combined, researchers in this study found that 96 percent of the
cancers were detected using both tests together, versus 81.7 percent
for ultrasound alone or 75.8 percent for mammography alone.
Dr. Diane Palladino, a
breast surgeon at Exeter Hospital in Exeter, N.H., says she always
orders both tests for a woman who has symptoms of cancer, explaining
that both tests have their strengths and weaknesses.
Ultrasound
Better For Images of Denser Breast Tissue
"Ultrasound helps us judge
the size of the lesion and can give us some idea of whether the
tumor is benign or malignant," she says, adding that ultrasound
provides better images of denser breast tissue than mammography
does.
But, she says, ultrasound
cannot see microcalcifications, which are signs of very early breast
cancer.
Eventually, both Houssami
and Palladino think ultrasound may become the main imaging test
for detecting breast cancer in younger women after further research
is done.
Palladino says it is important
for women to realize "that mammography is not 100 percent, especially
in younger women. If you have a lump and a negative mammogram, you
still need to address that lump in your breast."
Always consult your physician
for more information.
Breast
Cancer Patients Not Heeding Exercise Advice
Study finds many
decrease activity, despite its benefits
Breast cancer patients
are not sticking to prescribed diet and exercise routines, even
though working out and controlling weight gain might help them avoid
future bouts with the disease.
That is the observation
of a new study by researchers from the Fred Hutchinson Cancer Center
in Seattle, along with colleagues at the National Cancer
Institute, the University of New Mexico, and the University
of Southern California. Their report appears in a recent issue of
Cancer.
The new research explores
how even women who were diligent about working out before they were
diagnosed with breast cancer appear to let their routines slide
after the disease strikes.
"Most notable were the
decreases in activity among women who underwent surgery as well
as chemotherapy and radiation therapy, as well as the women who
were obese or overweight prior to diagnosis," says study author
Melinda Irwin, currently an assistant professor in the department
of epidemiology and public health at Yale School of Medicine.
The findings are important,
says Irwin, because previous studies show a lack of activity leads
to weight gain, which then increases the risk of cancer recurrence.
This is particularly true if women are overweight when they are
diagnosed.
"If a woman is already
overweight or obese when diagnosed with breast cancer, the chance
of having a recurrence within five years is twofold over lean women,
and the chance of dying from breast cancer, over a 10-year period,
is 60 percent greater than lean women," Irwin says.
For breast cancer surgeon
Dr. Jeanne Petrek, the study offers an interesting observation.
However, its real value may not be realized until the women are
followed and their cancer prognosis can be linked to activity levels,
she says.
"This is an early result,
and it just tells us what happened in the early months following
diagnosis and treatment. But what it doesn't tell us is whether
these women were able to lose the weight they gained, whether they
regained physical activity in one or two years, and if they did,
what would that mean to their prognosis," says Petrek, director
of the surgical program at Memorial Sloan-Kettering Cancer Center
in New York City.
"These are the kinds of
questions that must be answered before this finding has true relevance,"
she adds.
"Any exercise intervention
after a cancer diagnosis shows significant improvement in fatigue
and nausea and overall quality of life, including depression," Irwin
says. "If a woman didn't exercise before being diagnosed, she should
be counseled on the importance of starting an exercise program after
treatment; if she exercised before, it's important that levels don't
decrease after cancer."
Always consult your physician
for more information.
Online
Resources
(Our Organization is not
responsible for the content of Internet sites.)
American
Cancer Society
American
Journal of Roentgenology
Breast
Cancer Prevention Trial
Cancer,
Interdisciplinary International Journal of the American Cancer Society
Journal
of the National Cancer Institute
National
Cancer Institute
National
Institutes of Health (NIH)
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April 2003
Sonography
Is More Accurate Than Mammography For Women Under 45 With Symptoms
Study
Did Not Look at General-Population Screening
Symptoms
of Breast Cancer
Mammography
Guidelines
Ultrasound
Better For Images of Denser Breast Tissue
Breast
Cancer Patients Not Heeding Exercise Advice
What
Is an Ultrasound?
How
Are Ultrasounds Performed?
Online
Resources
What
Is an Ultrasound?
Ultrasonography, sometimes
called sonography, uses high-frequency sound waves and a computer
to create images of blood vessels, tissues, and organs. Ultrasounds
are used to view internal organs as they function, and to assess
blood blow through various vessels.
Ultrasound procedures
are often used to examine many parts of the body such as the abdomen,
breasts, female pelvis, prostate, scrotum, thyroid and parathyroid,
and the vascular system. During pregnancy, ultrasounds are performed
to evaluate the development of the fetus.
How
Are Ultrasounds Performed?
Ultrasounds may be done
on an outpatient basis, or as part of inpatient care. Generally,
an ultrasound procedure follows this process:
-
A gel-like substance is smeared
on the area of the body to undergo the ultrasound (the gel
acts as a conducer).
-
Using a transducer, a tool that
sends ultrasound waves, the ultrasound is sent through the
patient's body.
-
The sound from the transducer
is reflected off structures inside the body, and the information
from the sounds is analyzed by a computer.
-
The computer then creates a picture
of these structures on a television screen. The moving pictures
can be recorded on film videotape.
-
There are no confirmed adverse
biological effects on patients or instrument operators caused
by exposures to ultrasound.
Always consult your physician
for more information.
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