Conventional breast cancer screening tests are far from perfect. The next scans could focus on sound, light, breath and elasticity
Find a breast cancer tumor when it is tiny, and a woman will probably beat the disease. Find that same malignancy when it is larger or has spread to other organs, and she is far more likely to die, even after surgery, radiation and chemotherapy. Finding breast tumors before they turn deadly is a challenge and one that medical technology has so far failed to master.
“We desperately need better breast cancer screening tools,” says Otis Webb Brawley, chief medical officer at the American Cancer Society. His organization promotes mammography in an effort to reduce the 40,000 deaths from breast cancer every year in the U.S. But that emphasis, Brawley fears, leads engineers and medical device manufacturers to presume that the problem of breast cancer detection is not worth their attention, because it has been solved. It has not. Mammograms miss up to 20 percent of tumors, and an average of one out of 10 readings mistakenly identifies healthy breast tissue as possibly malignant. Those false positives mean that women who try to do the right thing by going in for routine cancer screening face a substantial risk of needless biopsies (which can themselves be disfiguring and interfere with treatment later on) and expense, as well as the misplaced fear that they have cancer when they really do not.
Mammography’s shortcomings have spawned controversy and confusion. In 2009 the U.S. Preventive Services Task Force (USPSTF) determined that routine mammograms would save too few lives of women ages 40 to 49 to justify the number of false positives and unnecessary biopsies that would result in that age group. Medical societies and patient advocacy groups attacked the recommendation; the American Cancer Society still advises women in their 40s to undergo mammography every year. Some health experts fret, though, that the USPSTF finding has discouraged more than a few women, not just those in their 40s, from getting tested. “It’s made women more skeptical about the test,” says Sheryl Gabram-Mendola, a surgical oncologist at Emory University’s Winship Cancer Institute. “Women say, ‘I’m just not going to do it, I’m too busy.’”
Nancy Shute
