Close

Ways to Be Certain

Secondary Breast Cancer Screening Methods

Molecular Breast Imaging (MBI) and Magnetic Resonance Imaging (MRI) are functional imaging methods that highlight molecular and cellular level activity in the breast regardless of tissue density. Anatomical imaging methods, such as mammography, tomosynthesis (3D mammography) and ultrasound can often obstruct or mask cancer due to tissue density. Dense tissue and cancer appear the same, similar to trying to find a snowflake in a snowstorm. Using anatomical imaging methods often make it extremely difficult to distinguish between tissue density and cancer. Studies have shown that mammograms fail to detect cancers in one-third to one-half of women with dense breast tissue.Utilizing functional imaging, such as MBI, for secondary breast cancer screening allows you to Be Certain nothing has been missed. 

Not having a definite answer for the mammogram was also sort of scary in a way because you had nothing to go on. Having this MBI be an option for me was very reassuring that I knew that something was going to get done…It was very reassuring, I can sleep at night, and I have peace of mind that everything is going to be fine.Erika, patient at ProMedica Breast Center

Molecular Breast Imaging (MBI)
Dense breast tissue is a serious concern and there is a growing awareness of the limitations of mammography screening for women with dense breast tissue. As such, the urgent need for an effective secondary breast cancer screening technology led to the creation of LumaGEM Molecular Breast Imaging.

Molecular imaging is also known as nuclear medicine, which provides detailed pictures of what is happening inside the body at the molecular and cellular level.  LumaGEM MBI is a simple, safe and fast medical study that is specific to the breast.  When a MBI study is performed, the patient receives an injection of a small amount of a commonly used radiotracer. The injection is given in a vein and is similar to having blood drawn. The tracer has a higher rate of uptake in cancerous lesions due to increase activity in the cells.  The increased activity shows up clearly on the image as a ‘hot spot’ which may indicate that cancer is present.

MBI Procedure Overview

See demonstration of Gamma Medica's MBI technology, used for secondary breast cancer screening.

While the study is conducted on a system that looks and feels like a mammogram, it’s a much more comfortable exam. The breast is minimally compressed to maintain gentle stabilizing pressure to ensure that it doesn’t move during the imaging process. While women often complain about the breast pain during mammography procedure where the breasts are compressed with up to 45 lbs. of pressure, during a MBI exam the breasts are only compressed with approximately 15 lbs. of pressure, making for a significantly better patient experience. Typically, two views of each breast are completed during the study, just as with mammography. Each view takes approximately 10 minutes while the patient sits comfortably. She’s free to watch TV or use a tablet for entertainment, and can reposition arms and legs as needed. The results are often available immediately, allowing the patient to Be Certain prior to leaving the appointment.

Ultrasound
Ultrasound is an anatomical screening method that uses sound waves to image the breast.  Ultrasound is readily available, and no radiation is involved.  It may generate false positives and is highly dependent on the sonographer’s technique and experience.  A recently introduced technology, automated breast ultrasound (ABUS) is also an option that strives to reduce the operator dependency seen in standard ultrasound by automating the system.  However, like with standard ultrasound, the rate of false positives is similarly high with women with dense breast tissue. This can lead to unnecessary biopsies.

Tomosynthesis (3D mammography)
Tomosynthesis, also known as 3D mammography, is an evolutionary step in 2D digital mammography.  Recent studies report a small increase in cancer detection when compared to 2D mammography in women with dense breast tissue (BI-RADS C and D); higher rates are seen in women with fatty breast tissue (BI-RADS A and B).  As an anatomical screening method, tomosynthesis poses the same concerns with masking cancer within dense breast tissue. The specificity associated with tomosynthesis is slightly higher than that of mammography,11 meaning, there are slightly fewer false positive than seen with mammography. However, tomosynthesis does not approach the specificity associated with MBI or magnetic resonance imaging (MRI)12, meaning both MBI and MRI have far fewer false positive compared to mammography and tomosynthesis.

Magnetic Resonance Imaging (MRI)
Magnetic Resonance Imaging (MRI) uses magnetic field concentrating on the breast to track where blood is being directed. Gadolinium, a contrast agent often associated with allergic reactions, is used during this process to make abnormalities more clearly visible. MRI is primarily recommended for women with high lifetime risk of developing cancer as it is very sensitive and may result in higher cancer detection rates; however, the number of biopsies that were found to be benign are also significantly increased.13 Many women are not candidates for a MRI due to pacemaker or other implants, poor renal (kidney) function, claustrophobia, body size or gadolinium allergies and cumulative toxicity.

Dianne's Story

Kula's Story

Why I Am Grateful for MBI

My Story
I have known for more than 10 years that I have “extremely dense breasts” and that the density makes my mammograms very difficult for radiologists to read. 

In 2007, I learned about molecular breast imaging (MBI) after I was approached by Mayo Clinic to participate in a study for women with dense breasts. I was grateful for the opportunity to participate. I knew that if/when a tumor developed in my breast it would be difficult to detect on a regular mammogram, so I wanted to do whatever I could to make early detection of breast cancer more reliable for women with dense breasts.

In 2015, during my annual GYN exam, I requested an MBI, which I hadn’t had since 2007. I had not been feeling well and had been experiencing intermittent breast pain on my left side for a long time (cancer does not cause pain, or so they say). My nurse practitioner and I had talked about MBI for years because of my dense breast tissue and after receiving a negative routine mammogram just a year prior, going straight to MBI this year was the newly recommended and agreed upon approach.

The 2015 MBI was positive…I was called back for numerous mammograms followed by breast tomosynthesis (3D mammogram), which showed a “slight density” in the area that was highlighted by the MBI.  Ultrasound (US) then confirmed the mass in my left breast and also detected an enlarged lymph node in the left axilla. An ultrasound guided biopsy of the left breast and lymph node proved positive for breast cancer…Invasive Ductal Carcinoma Grade III, ER -, PR -, HER2 +, Stage IIIC.

Getting an MBI
I am grateful for the MBI…it was easy to tolerate and there is little risk involved. The procedure took approximately 40 minutes from start to finish. A very small amount of radioactive tracer was injected into my arm prior to starting the examination. Sitting in a comfortable position, my breast was positioned much like a mammogram, but with minimal compression.

Who and Why MBI
In my opinion, given the fact that approximately 50% of women have dense breasts and this density makes mammogram reading difficult, this cost-effective and research-proven examination should be an option for all women with dense breasts. Education is necessary… only 28 states in the U.S. require radiologists to inform women about their breast density and what their options are.

Most Important Information
Know and understand your breast density, your screening options and your insurance coverage…Mammogram and MBI are first lines of defense. MBI is now covered by many insurance companies and is available in medical centers throughout the U.S.

Dispelling myths

Myth: Molecular Breast Imaging (MBI) exposes patients to too much radiation
Facts:

  • MBI uses Tc-99m sestamibi, measured in millicuries (mCi), and has been used since the late 1980s. It’s commonly used during cardiac stress tests at a typical dose of 30 mCi. Over 10 million cardiac stress test are estimated to be completed annually in the United States alone.
  • The dose of radiotracer that providers generally utilize for a LumaGEM MBI exam is as small as 4-8 mCi14, which is less than the radiation exposure received from one mammogram and one tomosynthesis, and is well below natural background radiation levels.
  • Professionals working in areas where radiation risk is monitored are calculated have been studied for over 60 years. Since that time, there have been no reported incidences or increases in cancer compared to the average human population. The radiation exposure from the radiotracer given as part of the MBI exam is comparable to x-ray mammography, CT and tomosynthesis. While the radiation exposure is comparable, LumaGEM MBI provides almost 4 times the invasive cancer detection rate when used as a secondary screening method. The clinical literature indicates the hypothetical low risk is outweighed by the high detection rates.

Myth: MBI is painful like an mammogram
Fact: While an MBI system looks and acts similarly to mammography, MBI gently compresses the breast with a force of approximately 15 lbs. as opposed to mammography that compresses up to 45 lbs. and can be quite painful. During a MBI exam, the patient is able to sit comfortably without the need for painkillers.

Myth: Mammogram will find something if I have breast cancer
Fact: While mammogram is an important screening tool, 40-50 percent of women in the United States have dense breast tissue. On a mammogram, breast cancer and dense breast tissue appears the same, making it difficult to differentiate between the two. Women who have dense breast tissue should discuss secondary screening options with their doctor to decide if this is appropriate for them. Clinical literature on screening mammography finds 3 cancers per 1,000 women screened (3/1000). Tomosynthesis, when used for secondary screening as indicated for reimbursement, finds an additional 1.2 cancers per 1,000 patients (4.2/1000 when combined with mammography). Compare this to MBI, where it has been reported to find 8.8 more cancers per 1,000 patients screened (12.0/1000 when combined with mammography). In comparison, using ultrasound for secondary screening finds only an additional 3.2 cancers per 1,000.12 The value of functional imaging screening technology, such as MBI, is not reliant on visual interpretation the radiologist eye; MBI is likely finds lesions that you cannot see.

Learn more about breast cancer myths.

Clinical Imagery

Normal:

Cancer: Case 1

Cancer: Case 2