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Screening Advances

May 21, 2014 | Leigh MacMillan and Dagny Stuart

Finding cancer early may make it easier to treat—and possibly cure. Imaging plays a role in screening to detect breast cancer (mammography) and lung cancer (CT). Vanderbilt has made recent advances in both areas, with the implementation of powerful new breast imaging technology and the launch of a lung cancer screening program.

The Vanderbilt Breast Center now offers tomosynthesis, a technology that generates 3D mammograms and provides clearer views of breast tissue, said John Huff, M.D., professor of Radiology and Radiological Sciences and chief of Breast Imaging.

Tomosynthesis gives cross-sectional information (like a CT image) rather than projection information where everything on the image is superimposed (like an X-ray image).

Tomosynthesis can be used for both screening and diagnosis.

In the screening setting, studies from another center have demonstrated that tomosynthesis reduces the rate of recall for additional diagnostic images (because of an abnormality on the screening mammogram) and finds additional cancers.

“Because tomosynthesis gives us the ability to see things in cross-sectional detail, it can replace the need for additional diagnostic imaging,” Huff said.

The clearer views provided by tomosynthesis are especially useful for dense breast tissue, which may obscure cancer on a standard mammogram or look like cancer and increase rates of recall for diagnostic imaging.

A new law in Tennessee requires providers to notify women of their breast density, and to inform them that dense breast tissue can make mammograms harder to read and may increase the risk of breast cancer. Fifty percent of women have dense breast tissue and may need supplemental screening.

“Tomosynthesis helps us with that,” Huff said, but he noted that supplemental screening is not currently covered by third-party payers.

Vanderbilt is expanding the model of breast cancer screening into lung cancer, for heavy smokers at high risk of the disease. The new lung cancer screening program will offer CT scans to high-risk patients—current or former smokers who have a history of 30 or more pack-years of smoking.

The benefit of lung cancer screening was confirmed by the National Lung Screening Trial, which randomized more than 53,000 current or former heavy smokers to receive three annual low-dose spiral CT scans or a standard chest X-ray. The trial found a 20 percent reduction in deaths from lung cancer among patients who received the CT scans.

John Worrell, M.D., professor of Radiology and Radiological Sciences and chief of Thoracic Radiology, was Vanderbilt’s principal investigator for the trial.

“Nearly 160,000 patients die from lung cancer every year, and if we can save 20 percent of those patients through screening, that’s a big number,” said Worrell, who along with Otis Rickman, D.O., assistant professor of Medicine, is serving as co-director of the new lung cancer screening program.

Patients whose scans reveal a suspicious nodule in the lung—early-stage lung cancer—can be treated with minimally invasive surgery. Worrell emphasized that the best way for patients to reduce their lung cancer risk is to stop smoking.