Detecting Breast Cancer with New Technology

with Mary Schmidt, M.D., Radiologist with Advanced Healthcare

Last Updated: Nov. 1, 2003

When Advanced Healthcare decided to begin the process of looking for an enhanced screening system to aid in early detection of breast cancer, Dr. Mary Schmidt immediately assumed a leading role.

Dr. Schmidt, a radiologist, participated on a team of medical personnel that spent months identifying, researching, evaluating and ultimately purchasing a computer-aided diagnosis system for breast cancer.

Mary Schmidt, M.D., Radiologist with Advanced Healthcare "We felt we really wanted to be on the cutting edge of technology, and thought this was another good way to be even more sensitive to getting those very early cancers."

In July 2003, every Advanced Healthcare breast imaging center began using the Second Look system, which provides a digitized printout of every mammogram performed.

Breast cancer and mammography
Dr. Schmidt said the pervasiveness of breast cancer in American women was a big part of the reason she became involved in the process. “Breast cancer is such an important disease and unfortunately it’s so common,” she said.

Second Look, an add-on to the existing mammography equipment, takes no additional time for women who come in for mammograms.

In a typical mammogram, the technologist performs a physical breast exam. Then, four pictures, two of each breast in different positions, are taken. The technologist then processes the films. They’re also digitized for the Second Look readout. The radiologist then compares the images to those of past mammograms.

“We compare with mammograms dating back at least two years if they are available. It is very important for women to obtain regular mammograms. This allows us to detect changes when cancer is at its earliest stages,” Dr. Schmidt said.

Radiologists are examining the images for subtle changes. They look for new calcifications, developing masses, asymmetric densities or areas of architectural distortion.

The Second Look system, utilizing advances in artificial intelligence and enhanced image processing, is doing the same thing.

Advantages of Second Look
“It really acts like an additional set of eyes and oftentimes will point out things that we can clear or that are obvious benign findings,” Dr. Schmidt said.

She emphasized that the Second Look system does not and will not take the place of a careful reading by a radiologist. “Most of us find that we read the mammogram cold as if we were reading a year ago, and then we refer to this as a second check, so we don’t let it bias us in any way.”

The new technology doesn’t add a lot of extra time for the radiologists, who take between 10 minutes and one hour reading each mammogram. It does, though, make a difference for at least one group of patients. The technology makes it easier to detect cancer in more dense breasts, which is important for younger women with a family history of breast cancer.

“It’s especially good for calcifications in dense breasts,” Dr. Schmidt said. But, she said, as good as it is, even mammography isn’t a foolproof way to detect cancer.

“The thing about cancers,” she said, “is that depending on the type, they can grow over a couple of months or be slowly growing over several years, so the changes can be very subtle.”

That’s why mammography is only 80% sensitive for cancers, she said. For that reason, she or her colleagues will request that a patient have an ultrasound if something inconclusive shows up during a reading.

But, she added, because Advanced Healthcare is committed to doing the utmost to provide the most accurate results available, she and her colleagues will continue to remain up-to-date on looking for new ways to find cancers.

Since Second Look has only been online since July 2003, Dr. Schmidt said, she and her colleagues don’t really have conclusive numbers on how effective the system has been in detecting cancers that might otherwise have been missed.

“Even if we find only a few extra cancers, that would justify the addition of the system,” she said. “Our accuracies have been quite good without it, but every extra case you find is a person with a family, and this can make all the difference to them.”

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