Mammography does not recognize many tumors

Mammography often can not detect tumors in dense breast tissue

16/09/2012

Mammography is used to detect malignant tumors in the woman's breast. In the past, however, it has been shown that the expressiveness of the images is at least limited when the breast tissue of women is very dense. Breast density is very high, especially among young women. Only in old age does the density decrease. In the US, therefore, further procedures should be used if women wish to do so. In Germany, such a procedure is not provided in the framework of the screening program of health insurance companies.

Every year, around 60,000 women in Germany alone become ill with breast cancer. About 17,000 patients succumb to cancer every year. "From the age of 50, the risk of getting breast cancer increases," reports the German Cancer Aid. If a gynecologist finds abnormalities during a so-called palpation examination, a mammogram usually follows. With the X-ray examination, the cancer should be recognized as early as possible, even in regular check-ups, in order to increase the chances of recovery of the patients. While in older women the diagnostic accuracy is very high, the method is reaching its limits in younger women.

The reason for this is the density of the breast tissue, because then the created X-ray image loses its significance. As part of this, a debate has arisen in the US on whether women should be informed about their breast density by the doctor after a mammogram. Some US states are advocating additional education to conduct further examinations, such as the ultrasound procedure, if necessary. Meanwhile, some states such as Texas, Connecticut, Virginia and currently New York have introduced the advanced diagnostics and education binding.

High breast density increases the risk of breast cancer
The reason: If women have a high breast density, ie less fatty tissue, but more glandular and connective tissue, according to some studies there is an increased risk of breast cancer. On the other hand, breast cancers due to the nature of the breast on the image can not be clearly identified and can therefore be easily overlooked. This is also confirmed by the initiative "Mamazone" (Women and Research Against Breast Cancer) in Augsburg. According to the association, "the screening program is rather blind in around 30 percent of women". In about the proportion women have a high breast density. "It is true that during mammography small calcifications can be found, which may be a precursor to cancer. But at high breast density, chest radiography is less successful in detecting tumor tissue ".

As a rule, the density of the breast decreases as the age progresses. Most women have a rather mixed breast tissue. About ten percent of women have nearly complete adipose tissue, according to the American Radiology College. Another ten percent of women in the States would have an "extremely dense tissue," the radiologists report.

Numerous cancerous tumors not detected by mammography
Many cancer patients in the past have been outraged that they have not been told by the doctor that at a high breast density cancer tumors remain rather hidden and therefore the diagnosis of mammography falsely from an inconspicuous finding. But what should happen if breast density is increased and screening is not enough? Can further examinations such as ultrasound provide better results?

The US Cancer Society does not see the demand for an ultrasound examination as critical. These are "not standardized and in some cases trigger a false alarm," Otis Brawley reports. The result: It may be necessary to perform unnecessary biopsies afterwards. Therefore, "we move in a gray area," says the expert. Anyway, the results are often wrong.

Experts call for additional ultrasound examination at high breast density
Prof. Dr. Ingrid Schreer from the Mammazentrum of the University Hospital Schleswig-Holstein explained that overall the situation in Germany was unsatisfactory. Every woman has a right to receive information about a higher breast density. The examining physician should then recommend a supplementary ultrasound examination as well as a palpation. However, advanced diagnostic procedures are currently not subject to quality assurance. Affected would not know how experienced and specialized the physician is here. "It would be much better to offer the women with high tissue density in the context of the German mammography screening, a supplementary ultrasound," said the specialist in relation to the "world". According to Schreer, this approach is rejected by the cooperation group Mamographie-Screening in Germany.

"In the ultrasound examination, the sound waves of tumor tissue can be reflected differently than healthy tissue," warns "Mamazone". However, as with mammography, ultrasound diagnostics can not provide a "clear statement on the question of malignancy in numerous tumors". That can only be proven by a biopsy. However, "shape, orientation, limitation and other parameters are first indications".

However, the screening program in Germany, initiated by the statutory health insurances and the associations of statutory health insurance physicians, only recommends a free mammogram for cancer screening every two years for women between the ages of 50 and 60 years. The breast cancer self-help group "Mamazone" criticized for years the mammography screening program. An additional ultrasound examination was "absolutely necessary, so that women with high tissue density do not weigh in false security." But the program rejects an additional education about breast density. It is feared that this will make women more insecure than that they will get useful details.

Study for improved diagnostics with high tissue density
The US expert Karla Kerlikowske from the University of California has been working for years on the context between breast density and breast cancer. The globally recognized researcher is currently undertaking a larger study on this topic with a science team. The research will identify which diagnostic methods are best for women with high tissue density to detect tumors in a timely manner. "In a year or two we could make reasonable recommendations," the scientist hopes.

The doctor has good news for women with a high breast density. Although the tumors may be discovered later, they appear to be "less aggressive or more difficult to treat than soft tissue". A study published recently in the journal "Journal of the National Cancer Institute", in which the expert carried out research, came to this conclusion. (Sb)

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