Recent research published in Radiology (that has also been tested clinically) reveals the use of three-compartment breast image analysis along with mammography radiomics—a form of computer-aided detection that identifies texture characteristics associated with lesions—can more accurately distinguish benign and cancerous findings.
According to Karen Drukker, PhD, research associate professor in radiology at the University of Chicago, the water, lipid, and protein breast component measurements completed as part of three-compartment analysis can pinpoint more malignancies because invasive cancers contain significantly more lipids and water than normal tissue. Tested in 100 patient mammograms, study results revealed this strategy not only improved cancer predictions by between 32% to 50% above visual interpretations, but it also reduced unnecessary biopsies by approximately 30%.
The technique is non-invasive, but it does have an important drawback—it requires exposing patients to a 10% higher radiation dose.
Mammography for Men
Men don’t typically pop to mind as breast cancer patients, says Yiming Gao, MD, a breast imaging specialist at New York University Langone Health. But, more men die annually from breast cancer than from more-widely known testicular cancer, about 500 men and 410 men, respectively. That unfamiliarity—along with a lack of screening—can be deadly.
“Because screening is not indicated in men, in combination with a lack of awareness, male breast cancer often presents at a more advanced stage than in women, and men with breast cancer often don’t do as well as women,” she says.
Most cases of male breast cancer are not identified until the patient is symptomatic, she explains.
Like women, several factors impact a man’s breast cancer risk. A personal or family history of breast cancer, a BRAC1 or BRAC2 genetic mutation, and hormonal imbalances, as well as African-American or Ashkenazi descent can increase likelihood. Consequently, early detection is vital, Gao says, and her recent investigations published in Radiology revealed mammography screening can be critical in those catches.
In her study, mammography detected 2,304 breast lesions. Of the 149 biopsied lesions, 41 (27.5%) were malignant, yielding a cancer detection rate of 18 per 1,000 exams among high-risk men. That’s significantly higher, she says, than the five cancers detected per 1,000 average-risk women. Additionally, cancers pinpointed in men were identified at an early stage before metastasis to the lymph nodes, significantly improving survival prognosis.
Men have less breast fibroglanular tissue that can mask abnormal findings in women. Consequently, according to the results, mammogram screening offers greater clarity for male patients, demonstrating 100% accuracy in detecting cancer and 95% accuracy in distinguishing breast cancer from other findings.
“We have shown mammography has the potential to detect cancers early in men before they become symptomatic,” she says. “Screening certain high-risk men may help improve their individual prognosis.”
Ultimately, Gao says, providers should discuss family history and risk factors with male patients, as well as consider adding breast cancer to their checklist for men who might benefit from genetic counseling and possible screening.
“As for clinical changes, conversations about male breast cancer is a good start,” she says. “And, as we accumulate further data, more tangible clinical guidelines may be able to be provided in the future.”
Based on existing research, adding contrast enhancement to imaging techniques, including mammography, can increase detection of biologically relevant cancers, such as high-grade invasive tumors, when conventional mammography more often misses those diseases. In fact, according to Elizabeth Morris, MD, chief of breast imaging service at Memorial Sloan Kettering Cancer Center, contrast-enhanced mammography can reveal small cancers even in very dense breasts.