New law, new technology aim to improve breast cancer detection
Enid, Okla. — One in eight American women will develop breast cancer during their lifetime, according to American Cancer Society (ACS). Almost 42,000 American women are expected to die of breast cancer this year, according to ACS, making it the second-leading cause of cancer deaths among women.
For women who have dense breast tissue, those risks of developing breast cancer can be as much as six times greater than the general women’s population, according to National Institutes of Health.
A new law signed recently by Gov. Kevin Stitt, and some new technology in breast imaging, have some members of the health care profession optimistic about improving those outcomes for women with dense breast tissue.
Breast cancer screening guidelines
Dr. Michael Jackson, M.D., an obstetrician-gynecologist at Integris Bass Baptist Health Center, said it’s recommended all women begin having an annual checkup with their doctor by at least age 21.
That’s important, Jackson said, for general health as well as women’s reproductive and preventive health. It also establishes a relationship, he said, for women to have conversations with their doctor about all aspects of their health, including breast health, and risk factors for and family history of breast cancer.
The question of exactly when to start having mammograms has become somewhat muddled in recent years, Jackson said, by conflicting recommendations, ranging from age 40 to 50 for women at average risk for breast cancer.
“The problem is, over the last several years, several different, highly-respected organizations came out with different screening recommendations on when to start having mammograms, and how often,” he said.
Jackson said he follows the guidelines of American College of Obstetricians and Gynecologists, which recommends women who don’t have a significant family history of breast cancer or other risk factors start annual mammograms at age 40.
One of the reasons mammograms aren’t recommended for younger women, Jackson said, is women younger than 40 tend to have denser breast tissue, making the mammograms less reliable in detecting any masses that could be cancerous.
And, for women whose breast tissue remains dense past age 40, Jackson said there’s “a higher risk something could be missed.”
‘A snowball in a snowstorm’
Bob Brice, director of radiology at St. Mary’s Regional Medical Center, said breast cancer is harder to detect in women with dense breast tissue because traditional mammography looks for denser masses, which could be cancer, among less-dense breast tissue.
Denser tissue shows up as white areas on the mammography imagery, Brice said. But, he said, when the breast tissue is dense, looking for a dense mass, or tumor, can be like “looking for a snowball in a snowstorm.”
According to New England Journal of Medicine, mammography sensitivity can be reduced by more than a third in women with dense breasts.
That’s a serious issue, Brice said, because as much as 40% of women have dense breast tissue.
Brice said some new technology recently installed at St. Mary’s Women’s Imaging Center has the potential to close the gap on catching early-stage breast cancer for women with dense breast tissue.
The ABUS (Automated Breast Ultrasound System) expands on existing ultrasound technology, which already is used for diagnostic analysis once a mass is detected, to create a full ultrasound image of the breast for screening purposes. Brice said the system is not meant to replace mammograms or conventional ultrasound for pinpointed examination of a suspected mass, but it serves as an “adjunct level of screening” for women with dense breast tissue.
“Mammography is an effective tool for the detection of breast cancer; however, it doesn’t work equally well in all women, especially those women who have dense breast tissue,” Brice said. “The ABUS technology, when used in addition to mammography, has the potential to find 35.7 percent additional cancers that would not have been found with mammography alone.”
Adding ABUS to radiology tools already in place gives the hope of “improving detection for small cancers in dense breast tissue that cannot be seen on a mammogram alone,” Brice said.
While ABUS represents a new technological advancement in breast cancer screening, Brice said it’s still just as important women follow regular mammogram guidelines and talk to their doctors.
“It’s important for women to get regular mammograms as suggested by their doctor,” Brice said, “and if they have been informed they have dense breast tissue, they should talk to their doctor about their specific risk and additional screening tests that might be appropriate.”
Nancy’s Law — a new level of notification
Part of ensuring women take those extra screening precautions is making sure they know if they have dense breast tissue.
Nancy’s Law, signed by Stitt on Aug. 6, 2019, enhances requirements for health care providers who perform mammograms to notify patients about their test results.
The legislation is named for Nancy Simpson, of Edmond, who lost her life to breast cancer in 2018 at age 69, according to a press release from Oklahoma Medical Research Foundation (OMRF).
Sen. Adam Pugh, R-Edmond, who co-authored the bill, said Nancy’s Law will equip women with dense breast tissue “with the knowledge they need to take charge of their health and, in some cases, save their lives.”
Under existing Oklahoma law, if a patient is found to have dense breast tissue, the health care facility that performed a mammogram must advise the patient of this fact and provide information on additional testing options when she receives her mammography results, according to OMRF. Nancy’s Law requires those mammography results and notification be emailed to the patient if she requests them.
“Our wives, mothers, sisters and daughters depend on breast screening to detect cancer,” said the bill’s co-author, Rep. Lewis Moore, R-Arcadia. “This new measure will give more Oklahoma women the chance to live their lives cancer-free.”
Simpson worked for 30 years as a laboratory technician at OMRF, according to the press release, “searching for effective ways to control fats that play a major role in heart disease and stroke.”
Although she underwent yearly mammograms, Simpson’s dense breast tissue hid her cancer until doctors discovered it at stage 4, when it was too advanced to respond to treatment, according to OMRF. At the end of her life, she wrote a letter to Pugh and Moore that served as the catalyst for the new legislation.
“Nancy dedicated her career to helping make discoveries to benefit people she would never know,” said OMRF President Stephen Prescott, M.D. “Even in the fight for her own life, she did what she could to ensure that future generations of women could take control of their own breast health and live longer.”
Simpson’s husband, John, and their daughters, Elyzabeth and Melissa, attended the governor’s signing ceremony, along with a group of her friends and OMRF coworkers.
“We are so grateful to Sen. Pugh and his staff for what they’ve done in Nancy’s memory,” said John Simpson. “Nancy was a caring, empathetic person. She would love knowing that Nancy’s Law will save lives.”
“This law is a major step for women’s health in Oklahoma,” Stitt is quoted in the OMRF press release. “It ensures that all women can take advantage of advances in breast cancer detection and treatment that can spell the difference between life and death.”
Nancy’s Law will take effect Nov. 1.
Be your own advocate
While increased notification requirements and the availability of new technology hold the promise of improved cancer screening outcomes for women with dense breast tissue, Jackson, with Integris, said there’s still no replacement for women being proactive about monitoring their own health, making their regular checkups and screenings and having conversations with their doctors.
“If you’re in charge of your health care, you tend to make better decisions,” Jackson said, “you have better outcomes, and you have a better quality of life.”