By Elizabeth Varnell, Vogue
As leading breast cancer researchers move toward precision medicine—informed by factors like family histories and genetic markers—when
and even how to screen women is becoming more of a case-by-case
decision now than ever before. Mammograms can detect changes and lumps
in older women, but often don’t reveal much when breast tissue is dense—as
it more commonly is when women are younger—because density appears
white on a white-image X-ray, as do breast masses and tumors.
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Now,
an expanding menu of genetic tests is driving the search for
alternatives to traditional screening for those in their 20s and 30s who
are at risk—and for those whose breasts remain dense as they age. And
then there’s the matter of the cumulative low-level radiation and
heavy-metal accumulation facing those advised to undergo yearly
mammograms and 3-D mammography (which takes multiple X-rays of the
breast, rather than a single image). Among the radiation-free options
gaining momentum as a frontline weapon for early detection? Many doctors
are increasingly looking to ultrasound scans.
To
understand the advantages of the procedure, which uses sound waves to
penetrate and analyze breast tissue, patients must first appreciate what
a mammogram can—or cannot—do. “Mammography has always been an imperfect
tool,” explains Dr. Deanna J. Attai, a UCLA Health surgeon and past
president of the American Society of Breast Surgeons. To explain why,
she points out that pap tests work well at any age, noting, “a cervix is
more or less a cervix.” Breasts are all different. Attai says widely
varying density and consistency combined with the changes breasts
undergo over a lifetime—and even month to month—explain how this one
test can sometimes fail to detect cancer. Additionally, doctors
currently disagree on when and how to screen using the modality, with
some major institutions suggesting that testing begin at age 40, while
others recommend age 45 or even 50.
[post_ads]That leaves
younger women—particularly those with a family history—cancer survivors
avoiding radiation, and anyone with dense breasts searching for an
early-detection alternative. A Los Angeles plastic surgeon specializing
in breast reconstruction, Dr. Barbara Hayden, herself a cancer survivor,
credits high-resolution ultrasound with finding a lump in her lymph
node, and has since become a champion of radiation-free, automated,
whole-breast ultrasound imaging. “Ultrasound is safe and has a long
track record; it’s been around for a while. We use it on pregnant women
and fetuses,” she says. Hayden says automated machines—SonoCiné and GE’s
ABUS are two such devices—can view the whole breast from the outer
quadrants to the sternum, covering much more breast tissue than the
protruding parts compressed into a mammogram.
Though
imaging younger breasts and areas surrounding breasts can statistically
lead to more false positives—causing anxiety at best and unnecessary
surgery at worst—benign tumors grow very slowly, according to Hayden.
Even cancer can take two to five years to double. “When you see
something on ultrasound, you don’t have to run to take it out; you can
repeat the test in a reasonable time frame—in three months, six months, a
year—without any accumulated radiation,” she says. Attai maintains
mammography is still useful to detect calcifications (which can signal
early breast cancer), but ultrasound allows younger women to avoid
accumulations of heavy metals like gadolinium, sometimes injected during
MRIs to enhance pictures.
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Highlighting a point Julia Louis-Dreyfus thoughtfully raised
while discussing her recent breast cancer diagnosis, both Hayden and
Attai confirm that automated ultrasound scans and even some handheld
ultrasound screenings aren’t always covered by insurance. But as more
women seek out nontoxic screening alternatives, the pressure on health
insurers is likely to mount. “When and how to screen is a personal
decision for each woman,” Hayden says, adding, “What I like about
medicine is that it’s very intimate, very individual.”
