Mammograms Save Lives — But They Can Get Better

Testing a tool to overcome concerns

Woman waiting in hospital gown

Are you confused about when to start having mammograms? And how often? You’re not alone.

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In the past five years, some researchers have questioned the best timing and frequency for mammograms. For example, recent research looked at 50 years’ worth of mammogram data. Researchers found that mammograms cut the risk of death for women in their 40s by 15 percent, compared with around one-third for women in their 60s.

Some argue that the potential harm outweighs the good for younger women. But not everyone agrees. At Cleveland Clinic, we believe in the value of early detection. Early detection leads to better outcomes and less need for later treatment. That’s why we still recommend yearly mammograms starting at age 40. So does the American Cancer Society.

However, mammograms do come with concerns. So researchers are working on new technologies to make them even more effective. In the PIONEER clinical trial, Cleveland Clinic and other major breast cancer centers around the country are testing a new breast-imaging tool called Imagio.

Imagio is an “opto-acoustic” imaging system. It uses both sound and light waves to generate images of the breast. If successful, opto-acoustic imaging could reduce the concerns and controversy surrounding mammograms.

1. Reducing the harms

Mammograms and ultrasound can identify lumps. But they can’t determine conclusively whether those lumps are cancerous or benign. As many as 7 out of 10 lesions seen on breast imaging studies are benign, based on biopsy results.

“Biopsies are invasive procedures. They also cause anxiety as patients wait for days for results. Opto-acoustic imaging may provide a quick alternative.”

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Stephen Grobmyer, MD

Director of Breast Services

With opto-acoustic imaging, doctors would follow a positive mammogram screening and ultrasound with a simple test. Imagio offers a real-time view of blood oxygen levels. It’s based on the idea that malignant tumors use more oxygen than benign growths. It could be a powerful predictor.

If the imaging shows a lesion doctors suspect is malignant, a woman would undergo a needle biopsy to determine the tumor type — and hence treatment. If the imaging shows a benign lesion, the patient could avoid an invasive biopsy.

2. Eliminating biopsies — and anxiety

Currently, women often need a needle biopsy after a mammogram and ultrasound to identify cancer. Biopsies are invasive procedures. They also cause anxiety as patients wait for days for results.

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Opto-acoustic imaging may provide a quick alternative. If proven effective, it would work like this: A mammogram and ultrasound identify a lesion within the breast. A woman then goes directly for an Imagio screening. The screening takes about 10 minutes. Results come in immediately.

There would be other benefits. With opto-acoustic imaging, you don’t need radiation (as with mammography or CT scan) or contrast agents (as with MRI or PET scans).

3. Creating a precise prediction

With traditional images, all we see is the lump. With opto-acoustic imaging, we see what’s happening at the edge of a tumor. That’s important because the edge is where growth occurs.

The PIONEER trial began in 2013, so there is much work ahead. Our goal is to determine whether it is as effective in large groups of patients as it was in small-scale studies. We’ll compare Imagio results in patients with their pathology reports and follow-up imaging studies to see how well it predicts cancer.

Imagio is one tool among many that could back up the results of tests such as mammograms. If we can reduce the potential harms of mammograms, they will become less controversial. More important, mammograms will become more effective at detecting cancer early, when it is most treatable.

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Stephen Grobmyer, MD

Stephen Grobmyer, MD

Stephen Grobmyer, MD, is Section Head of Surgical Oncology and the Director of Breast Services at Cleveland Clinic.
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