A study conducted by Kevin Hughes, MD identifies women at risk of inherited breast or ovarian cancer can help pinpoint those who may need further screening and preventive treatment.

The results of a questionnaire that was filled out by 14,000 women coming to the Avon Foundation Comprehensive Breast Evaluation Center for mammograms, may allow for an earlier diagnosis of cancer. The women completed a questionnaire on their family history of breast or ovarian cancer, whether they had developed any tumors, and other related factors. The information was captured into a database that was available to the patients' doctors. The data was analyzed in order to evaluate cancer risk among women who carried mutations in the so-called breast cancer genes -- BRCA1 or BRCA2.

Among the 1,764 study volunteers who had been diagnosed with breast or ovarian cancer, 20.6% had family histories that indicated an elevated risk of one of the tumor-associated mutations in BRCA1 or BRCA2, concluded the authors of the study which will be published in the November issue of Cancer.

"We wanted to show we could identify these high-risk women with an automated system that provides accurate information without requiring more work for our staff, an approach that has been tried in very few centers worldwide," study senior author Dr. Kevin Hughes of the Division of Surgical Oncology.

"In addition to verifying the utility of this strategy, these results remind us how many women who should be tested for these genetic mutations are not being screened," Hughes said.

New type of breast imaging being developed here holds great promise in earlier detection of breast lesions.

The Massachusetts General Hospital Cancer Center is world-renowned for its pioneering research endeavors in the early detection and diagnosis of breast cancer. Early detection has been shown to save lives: there is a 97% five-year survival rate when breast cancer is caught before it spreads to other parts of the body. At the Avon Foundation Comprehensive Breast Evaluation Center, our patients have access to new approaches that are not available anywhere else.

Digital tomosynthesis of the breast is different from standard mammography in the same way that a ball is different from a circle – one is 3-D and can be picked up, rotated and viewed from all angles, while the other is flat.  

In traditional mammography, one image is taken across the entire breast, in two directions: top to bottom and side to side.  These images can be difficult to read especially when cancers are small and breast tissue is dense.  In addition, the compression of the breast that is required during a traditional mammogram causes breast tissue to overlap, sometimes “hiding” a cancer.  As a result, it can be difficult to determine if something seen on the mammogram is cancer or if it is normal tissue.  In fact, in 25% of the patients who are called back because their mammogram showed “something”, closer examination reveals only normal tissue. 

Digital tomosynthesis overcomes these issues by taking multiple pictures of the breast from many angles.  These pictures are then collected electronically and synthesized to create a 3-D view that provides much more detail and can be rotated in space for more careful examination.  While the breast is positioned in the same way as in a conventional mammogram, only slight pressure is applied, providing a more comfortable experience for the patient and making abnormalities more visible by minimizing the overlapping of breast tissue.

Standard Mammogram	Same Part of Breast using Digital Breast Tomosynthesis
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The cancer looks like a star with lines radiating out from it, and is much more clearly seen with the digital tomosysnthesis than with standard mammography.

 “We believe that with tomosynthesis, we will find more cancers, and we will find them earlier.  Because it is a more comfortable experience for the patient, we also hope more women will seek out mammograms on a regular basis,”  according to Daniel Kopans, MD, director of Breast Imaging.

Digital tomosynthesis is currently only available at the Cancer Center only as a research protocol.  However, with FDA approval pending, Kopans and his team hope it will soon become the standard of diagnostic care across the country.