Anupam DattaMajumdar, VP of Engineering, U-Systems at GE Healthcare, talked about the “Role of Automated Breast Ultrasound Screening (ABUS) in Early Detection of Breast Cancer” at www.bio2devicegroup.org event. “Why is mortality rate among women from breast cancer so high?”, said DattaMajumdar. Breast cancer is the most common cancer among women, world wide. About 1 in 8 women globally get breast cancer. In the US, over 200,000 women are diagnosed and over 40,000 women die each year, from this disease. Globally, the problem is more severe. Breast cancer is 5th leading cause of death globally, among women.
Here are some of the top risk factors for breast cancer. Gender is a factor, as it occurs most frequently among women. While breast feeding lowers the risk, factors that increase the risk of the disease include, higher age, oral contraceptives, previous breast disease, family history of breast disease, HRT usage, and breast density. If detected early, breast disease has very good prognosis. Early detection and using the right tools for early detection is particularly significant in cases of women with high breast density.
Breasts are made up of fat and breast tissue, along with nerves, veins, arteries and connective tissue that helps hold everything in place. The main chest muscle (the pectoralis muscle) is found between the breast and the ribs.. After menopause (when the ovaries stop producing hormones and a woman stops having periods), the number of lobules decreases and those remaining shrink in size. The loss of breast tissue during menopause means breast density also decreases and it becomes easier to read the mammograms of women after menopause. Before menopause however, the breasts have more breast tissue than fat (higher breast density), which makes it more challenging to read the mammograms, particularly in women with denser breasts. Women with high breast density are four to five times more likely to get breast cancer than women with fatty breasts or with low breast density, said DattaMajumdar.
Over 40% of American women have dense breasts and for these women additional tools are required for early detection of the disease. Unfortunately, all states don’t have mandatory rules to notify women of high breast density. About 47% of American women have no idea whether they have dense breasts and 89% of those that have dense breasts, do not know their breast density level. Those cancers that are not detected early, are larger, higher grade and have significantly poorer diagnosis.
Women with dense breasts should ask for and receive supplemental screening, said DattaMajumdar. In addition to routine mammograms, these women should be able to get ultrasound screening. Mammography is based on attenuation technology where visibility of pathologic conditions depend upon image quality. Dense breast tissue does not let energy pass through, making it difficult to see differentiate between healthy breasts and tumors. Sensitivity of mammography is in 85% range but when women have denser breasts the sensitivity can go down to 65% range.
Ultrasound is a better technology to use when screening denser breasts. Dense breast tissue does not allow for light to pass and mammograms are more challenging but in ultra sound, the return echo makes it easier to identify breast disease. However, screening by specially trained sonography technicians with labor intensive hand held ultrasound systems, is impractical for broader usage, said DattaMajumdar. Automated Breast Ultrasound system or ABUS uses high frequency sound waves targeted at the breast, with the scans providing physicians with a 3-D volumetric image of the entire breast. Currently, there are three systems in use.
Invenia ABUS by GE Healthcare is FDA approved system with software based processing and excellent user interface to enter the patient data. Proprietary beamforming technology accompanied by intelligent imaging algorithms, creates focus at every pixel and delivers image of high uniformity, resolution, and reproducibility. The system is extremely user friendly, with a smooth operator workflow and high patient comfort. Patient lies down in supine position and non toxic lotion is applied on the breast. Images generated are sent to the Invenia ABUS workstation for interpretation, enabling fast, quick review. The 3-D images obtained from ABUS systems allow radiologists the ability to check the denser breasts from a variety of angles, with vastly improved diagnostic ability, said DattaMajumdar.
The talk was followed by Q&A.