A SENSIBLE SOLUTION FOR EARLY DETECTION OF DENSE BREASTS

Written by: Dr. Robert L. Bard

WHO NEEDS A DENSITY SCAN?
The Density Screening quantifies the level of tissue density (or the whiteness) and records them in various levels: 50% whiteness = not dense or minutely dense. 60% is moderately dense and 70% is highly dense, which correlates with your cancer risk. Also, 3D Scanning is a high-resolution scan allowing us to see if the skin is invaded or if the muscle and of the breast tissue is invaded by a tumor.

INDEX AREA OF SUSPICION
Initially if somebody has lumpiness or abnormal pain/discomfort in the breast, the patient guides the technician to the area of concern. An initial scan of that area is conducted and recorded. Then the full ultrasound scan over the entire breast is performed. This includes the lymph node-bearing areas under the arm and the right and left Axilla.

DIAGNOSTIC IMAGING STRATEGY
For this program, we select the predominance of the 3D Ultrasound because of its performance as a real-time, non-radiation and affordable modality. By design, today's models are highly efficient and are highly rated by more and more cancer imaging specialists around the globe- especially for dense breast scanning. It is recorded as an automated VIDEO file, capturing 250 still pictures within a 10 second scan. The dataset goes into a system that reconstructs the 3D images and each of the thousand images on each breast are then reviewed by the radiologist to focus on any abnormalities and better determine the relationship of the possible tumor with respect to the skin, the muscle, the adjacent lifts nodes and the quality of a potential lesion.

FROM SCAN TO TREATMENT
Analysis for a lesion looks for: texture/smoothness or irregular edges. Is it fluid filled? Does it have mixed tissues (some fluid & some solid tissue). Is there inflammation? Are there cancer vessels that feed a tumor noted inside? If there are cancer vessels, how many are there per unit volume? In other words, the same way we give a breast density level, a percentage of whiteness, we do the same thing with the cancer vessels that feed the tumor. So this is quantifiable. And once we have a quantifiable reading on tumor vascularity, patients who are treated with radiation, immunotherapy, chemotherapy, or any of the new focal treatments such as laser and the focused ultrasound, then you can follow the treatment success. For example, in chemotherapy, you want the percentage of tumor vessels to steadily decrease. When you do focal therapies such as freezing or laser treatments, the end point of the treatment would show a reduction to elimination of tumor vessels and how there no active blood flow going to a tumor means the treatment is complete.

SCANNING INNOVATION:
Decades since the advent of breast scanning technology, innovations in non-invasive diagnostic imaging provide new options in the field of early detection. These technologies directly are recognized to align with breast density screening (and are part of the Bard Breast Density Diagnostic Program):

Hybrid imaging refers to combining diagnostic modalities to assess disease and monitor therapy. A useful combination of options is the tumor vessel flow density to assess aggression and treatment progress. Similarly, tissue elastography is useful for border detection of malignant masses.

THE DENSE BREAST SCAN MOVEMENT
7/8/2021- A wave of recognized medical sites, journals and reports are now indicating that dense breast tissue increases the risk of developing breast cancer and often masks a tumor from being seen on the mammogram since dense tissue is white and cancerous tissue is also white. Mammograms are the standard screening test for breast cancer, however, in the 21st Century, ultrasound non invasive imaging is the preferred exam for dense “lumpy” mammary disease.

The 1st World Conference of Breast Ultrasound in Philadelphia (1979) recognized ultrasound superiority in dense breast diagnostics but the density level was never quantified until recently. Mammography assessment of breast density is graded into four categories. Mammographers readily admit that these levels are subjective at best and technical factors such as mammary tissue compression and x-ray voltage/amperage dramatically influence the darkness or whiteness of the image

• Where is Ultrasound most useful?
Mammograms of dense (lumpy) breasts have an elevated miss rate since tumors are white and dense breast tissue is white. Cancer tumors on ultrasound appears as black on a white background. Experience shows that ultrasound is typically more effective and accurate in thin women with dense breasts.

• What is Doppler sonogram technology?
Doppler imaging shows a map of blood vessels like the Doppler weather map shows hurricanes. More blood vessels means more aggressive tumors. Decrease in vessels means clinical improvement. The testing is non invasive.

• What is 4D volumetric density histogram imaging?
3 D imaging takes 200 pictures in 5 second and sees invasive cancers as small as 3 mm. 4D shows the imaging in real time of the dense tissue. Computer analysis gives a quantitative measure of the whiteness of the volume which assesses cancer risk.

• How is 3D/4D Doppler imaging used?
This is currently used to predict complete treatment response in patients undergoing chemotherapy and/or radiation therapy according to the 2021 Journal of Ultrasound. Cessation of tumor blood flow documents therapeutic success.

• Can a negative test be used to reduce biopsies?
The finding of a simple cyst or suspicious area on a mammogram (“lumpy” or fibrocystic region) means most patients can be followed up in 6 months or opt for a tiny small needle aspiration instead of a biopsy. The accuracy for malignancy diagnosis is 95%. Suspicious lymph nodes are also analyzed.

What Does It Mean to Have Dense Breasts?

Source: CDC.gov

A mammogram shows how dense your breasts are. When you get the results of your mammogram, you may also be told if your breasts have low or high density. Women with dense breasts have a higher risk of getting breast cancer.

PARTS OF THE BREAST
A woman’s breast has three kinds of tissue: FIBROUS TISSUE holds the breast tissue in place. GLANDULAR TISSUE is the part of the breast that makes milk, called the lobes, and the tubes that carry milk to the nipple, called ducts. Together, fibrous and glandular tissue are called fibroglandular tissue. FATTY TISSUE fills the space between the fibrous tissue, lobes, and ducts. It gives the breasts their size and shape.

BREAST CANCER RISK: Women with dense breasts have a higher chance of getting breast cancer. The more dense your breasts are, the higher your risk. Scientists don’t know for sure why this is true. Breast cancer patients who have dense breasts are not more likely to die from breast cancer than patients with non-dense (fatty) breasts.

On July 27-29, Bard Diagnostic Imaging is offering a comprehensive DENSE BREAST SCREENING DAY, employing an array of imaging advancements dedicated to the visibility of dense breast tissue and cancer early detection. This special program is dedicated to supporting dense breasted patients by first identifying one's actual breast density (through a density assessment scan) to establish a base line for the full diagnostic study (est. 15-20 minutes per patient).

For those with any level of breast density, a major concern is the rate of possible cancers that may be missed from to potential misreadings of a mammogram. It is clinically imperative to have a second opinion with the breast sonogram in areas that are more suspicious. A second look of the dense breast area with 3D scanning technology consists of two parts: first is the regular 3D electronic sweep, which gives you a volumetric tissue study. The next is the 4D real-time automated scan, which focuses on the area of concern and the most dense part of the tissue.

Mammogram imaging tends to represent dense tissue as "white" as it also does a small tumor (associate this with a "Polar Bear in a Snowstorm"). Medical interpreters look upon the white tissue as the area where mammograms could miss looming cancers. This is where the 3D and 4D ultrasound imaging comes in; we can now read the density of the tissue which aligns with the potential risk of cancer and navigate through and around the breast giving us the ability to disseminate tissue from tumor. (Read about the data and elevated risk of cancer in dense breasted patients in cancer.org). Through the latest imaging innovation, we have the means to quantify and mitigate this risk by detecting and identifying the "white level" and scanning with the computerized analysis of the volume of suspicious tissue.

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