Breast cancer remains the largest prevalent form of cancer in women and its early detection is essential to improve survival rates. To combat a disease that is the leading cause of cancer death in women, claiming an astounding 458,000 lives worldwide in 2008, we need to rely on advances in diagnostic technologies including imaging and gene testing. Despite many debates on how effective diagnosis is using mammography, it still remains the most widely used technique for the screening and detection of breast cancer. Now, with the advent of cutting-edge technologies that address the flaws with traditional mammography techniques, are we ready for a new era in breast cancer diagnostics?
A recent portable optical scanner developed by the Tufts University School of Engineering offers several promising advantages over the current gold standard - mammography. This new Tufts optical scanner would be a stand-alone device which does not need to be combined with an adjunctive modality or contrast agent, further allowing differentiation between benign and malignant tissues, unlike in mammography which is usually combined with other imaging techniques such as ultrasound for breast cancer diagnosis. In essence, such a device could possibly replace the use of mammography/ultrasound.
The Tufts scanner lightly presses the breasts between glass plates for illumination with Near Infrared (NIR) light and scans them by using an optical system; this information is then interpreted with the help of an algorithm. Optical mammography, also known as diffuse optical imaging, measures changes in blood oxygenation and blood flow of a tissue when illuminated with NIR light. This technique is also capable of differentiating between fats and water based on varying light absorption.
Other advantages of this technique include non-invasiveness, cost effectiveness and patient comfort. Since the technique uses non-ionizing radiation, real-time detection is possible without the risk of radiation exposure and, unlike in traditional mammography, the breast tissue does not need to be greatly compressed. A five year clinical study to test the Tufts scanner's effectiveness, funded by a $3.5m grant from the National Institutes of Health, is currently recruiting patients.
The global mammography equipment market is expected to grow from $897.2m in 2009 to $1.2 billion by 2016. A research study conducted by the Cancer Registry of Norway in 2010 suggests that traditional mammography might not be as effective as was previously perceived. The study indicated that routine mammography only reduced breast cancer mortality by 10%, much less than the World Health Organization's estimate of 25%. This failing, combined with the associated high number of false positive diagnoses and use of ionizing radiation (leading to a significant health risk), points to a clear unmet need for accurate and early diagnosis of this deadly disease. The new Tufts device also focuses on reducing the number of false positives and providing more specific breast screenings, explained Tufts professor Sergio Fantini. A reduction in the false positive rate could be achieved by this device provided that a large number of high resolution images can be captured. Without the ability to generate high resolution images, it is unlikely that the scanner can achieve an accurate visualization standard.
For a new technology to be adopted, it should exhibit specificity and sensitivity that is at least as good as, if not better than, the current methodologies, while addressing the safety issues. If optical mammography succeeds at this, there is no reason why it will not be embraced rapidly by the medical community, as it clearly offers several advantages, and since the technology is comparatively cheap, the cost would not be a bar to its adoption.
There are many gaps, such as accurate early tumor detection, that need to be filled as far as the diagnostics are concerned. Newer, more effective technologies are the need of the hour to improve patient management. Hologic's 3D mammography device, which was approved by the FDA in 2011, was very well received and has already achieved market penetration in 29 countries. In due course, more technologies, including the Tufts device, are in the pipeline and it is important for the medical community to be flexible and adopt technologies that patients can benefit most from. Furthermore, the Hologic device offering 3D mammography is having trouble justifying the benefit versus cost of its new technology; this new optical technique, if as effective, should be able to penetrate the market efficiently mainly due to its low cost. Optical mammography definitely hits a lot of targets and is one to watch out for.
This expert insight was written by Niharika Midha, MSc, research analyst covering diagnostic imaging.
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