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Pictures may be worth a thousand words, but better pictures from the breast
cancer screening technology known as mammography would be worth far more.
Enhanced images could boost doctors' ability to diagnose the deadly illness
early and save countless lives.
In hope of cutting the toll from breast cancer among women in the United States
and beyond, the National Cancer Institute has awarded a $26.3 million grant to
a consortium of researchers at 19 institutions in the United States and Canada,
including Carolina. Clinical scientists, statisticians, physicists and others
will compare the new digital mammography to standard film mammography in a
project eventually involving almost 50,000 women.
The grant will go to the American College of Radiology Imaging Network to fund
a study titled the Digital Mammographic Imaging Screening Trial. Using computer
and special detectors, digital mammography produces a digital image of the
breast that can be displayed on high-resolution monitors.
"Standard mammography has been the most studied screening technology over the
past 40 years, and so we know more about it than almost any other diagnostic
technique in medicine," said principal investigator Etta D. Pisano, professor
of radiology in Carolina's School of Medicine and co-leader of the University's
Lineberger Comprehensive Cancer Center's breast program.
"What we have is a well-proven technology and one that is in its infancy and
not as well studied yet so we have to be very careful," Pisano said. "Before it
is widely used, we want to make sure that digital mammography is at least as
good as standard mammography at finding early breast cancers."
Digital mammography may reveal cancers in women with dense breast tissue better
because of its improved contrast resolution, she said. Smaller previous studies
also suggested it could reduce the number of women called back to check
suspicious lesions.
"Although the equipment for digital mammography costs more, fewer callbacks and
extra office visits could save money and lessen patients' concerns," Pisano
said. "As part of this study, we also plan to study cost effectiveness and the
impact of false positives on women's quality of life."
Daniel Sullivan, who is coordinating the trial for the National Cancer
Institute, said digital mammography might detect breast cancer earlier.
"But a large study is needed to really determine whether digital mammography is
better than conventional mammography, and if it is better, how large the
difference is," Sullivan said.
Results of the trial, which is the cooperative research network's most
ambitious undertaking, will guide women's breast care into the future, said
Bruce J. Hillman, chair of the research network.
"This work is very exciting, and it's going to be very important," said Pisano,
chief of breast imaging for the UNC Health Care System.
Beginning Oct. 15 at most sites and ending 18 months later, 49,500 symptom-free
women will be recruited into the study during their regular screening
mammograms, she said. Patients will receive both conventional and digital
mammography under nearly identical conditions and be followed for several
years.
Carolina faculty most closely involved will be Cherie Kuzmiak, Marcia Koomen
and Robert McLelland, all radiologists, and R. Eugene Johnston, a physicist.
Others involved in the clinical research include co-principal investigator R.
Edward Hendrick of Northwestern University, lead physicist Martin Yaffe of the
University of Toronto and statistical coordinator Constantine Gatsonis of Brown
University. Respectively, Dennis Fryback of the University of Wisconsin and
Anna Tosteson of Dartmouth Medical School will direct the quality-of-life and
cost-effectiveness analyses. Data coordination will take place at the American
College of Radiology's research network headquarters in Philadelphia.
GE Medical Systems, Fuji Medical Systems, Fischer Imaging and LORAD digital
mammography systems will be tested in the trial. The U.S. Food and Drug
Administration approved the GE device in February, 2000, and the other two are
pending approval. Widespread film mammography use dates to the early 1960s.
Participating institutions are the universities of California at Los Angeles
and Davis, Massachusetts and Washington at Seattle, Memorial Sloan-Kettering
Cancer Center, Georgetown University and others. A complete list is available
at http://www.dmist.org Women wishing to volunteer should contact the sites
directly to learn how.
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