Breast Cancer, Part 1:Computer-Aided Mammography

Mammography remains the gold standard in breast cancer detection, but the quest to find better and better methods continues. Doctors are increasingly using devices along with mammography like computer-aided detection, digital mammography, ultrasound, and magnetic resonance imaging (MRI) to improve the ability to find cancers at their earliest and most treatable stage. Our health correspondent Dr. Emily Senay explains.

Breast cancer kills an estimated 40,000 women a year in the United States, and the key to fighting it is detecting it early. Despite new developments in breast cancer detection, the conventional mammogram is still the best way to spot cancer before it becomes a killer. But now doctors are increasingly using computers to help read mammogram films in an effort to find breast cancers even earlier.

For Roz Drawas, a regular mammogram is more than a matter of routine. A previous mammogram detected breast cancer in her. "By doing what I did, it saved my life, because if I waited or if it wasn't detected, it would have gotten a lot bigger," says Drawas.

Dr. Elsie Levin, a radiologist at the Faulkner-Sagoff Breast Center in Boston, says that they found this very small cancer (in Drawas) years before you would ever be able to feel it. "She was fortunate enough that they were close enough together that she was able to have a lumpectomy," says Levin.

Finding cancer on a mammogram is not easy. "Cancers can be missed on a mammogram for many different reasons," says Levin. "Sometimes it's the density of the breast tissue, or you get distracted by other things in the breast and your eye sees something and you focus in on that and may overlook another area."

So to help find things that might otherwise be overlooked, Dr. Levin uses a computer program to double check her own evaluation. "The computer thinks it sees some calcifications," says Levin. "I really think this is going to turn out to be normal but the computer thinks there's a high probability there's something there, so it's worth taking another look."

The computer can help find some of those cancers that are overlooked, so the radiologist still reviews the mammograms the way they normally would and then looks to see if the computer noticed anything you missed on the first go-around, according to Levin.

The computer results mean another mammogram and an ultrasound are needed to take a closer look before getting the "All clear." But Drawas knows it's worth her time and trouble. "I feel it's another pair of eyes, and I think anything that's going to look at the film and pick up something--whether it turns out to be something or not--is going to be helpful," says Drawas.

What about digital mammography?

Digital mammography uses a computer-generated image of the breast. It's still in the early stages of testing. Right now, there's no real proof that it detects cancer any better than the standard X-ray film.
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