Each year more than 180,000 new cases of breast cancer are diagnosed in women in the U.S. If cancer is detected when small and local, treatment options are less dangerous, intrusive, and costly-and more likely to lead to a cure.

Yet those simple facts belie the complexity of developing and disseminating acceptable techniques for breast cancer diagnosis. Even the most exciting new technologies remain clouded with uncertainty. Mammography and Beyond provides a comprehensive and up-to-date perspective on the state of breast cancer screening and diagnosis and recommends steps for developing the most reliable breast cancer detection methods possible.

This book reviews the dramatic expansion of breast cancer awareness and screening, examining the capabilities and limitations of current and emerging technologies for breast cancer detection and their effectiveness at actually reducing deaths. The committee discusses issues including national policy toward breast cancer detection, roles of public and private agencies, problems in determining the success of a technique, availability of detection methods to specific populations of women, women's experience during the detection process, cost-benefit analyses, and more.

Examining current practices and specifying research and other needs, Mammography and Beyond will be an indispensable resource to policy makers, public health officials, medical practitioners, researchers, women's health advocates, and concerned women and their families.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON TECHNOLOGIES FOR THE EARLY DETECTION OF BREAST CANCER
• THE NATIONAL CANCER POLICY BOARD
• Reviewers
• Preface
• Acknowledgments
• Acronyms
• Executive Summary
  • TECHNOLOGIES IN DEVELOPMENT
  • TECHNOLOGY DEVELOPMENT PROCESS
  • ASSESSMENT OF NEW TECHNOLOGIES
  • TECHNOLOGY DISSEMINATION
  • RECOMMENDATIONS
• 1 Introduction
  • THEORY AND PRINCIPLES OF CANCER SCREENING
  • CURRENT PRACTICE OF BREAST CANCER DETECTION
  • LIMITATIONS OF CURRENT TECHNOLOGIES
  • DILEMMA OF “EARLIER” DETECTION
  • SUMMARY
• 2 Breast Imaging and Related Technologies
  • FUNDAMENTALS OF IMAGING ANALYSIS
  • DIGITAL MAMMOGRAPHY
  • OTHER TECHNICAL ADVANCES IN X-RAY IMAGING WITH POTENTIAL APPLICATION TO BREAST CANCER
  • COMPUTER-AIDED DETECTION AND DIAGNOSIS
  • ULTRASOUND
  • MAGNETIC RESONANCE IMAGING
  • MAGNETIC RESONANCE SPECTROSCOPY
  • SCINTIMAMMOGRAPHY
  • POSITRON EMISSION TOMOGRAPHY
  • OPTICAL IMAGING AND SPECTROSCOPY
  • THERMOGRAPHY
  • ELECTRICAL POTENTIAL MEASUREMENTS
  • ELECTRICAL IMPEDANCE IMAGING
  • ELECTRONIC PALPATION
  • EXAMPLES OF TECHNOLGIES IN VERY EARLY STAGES OF DEVELOPMENT
  • SUMMARY
• 3 Technologies in Development: Genetics and Tumor Markers
  • GERM-LINE MUTATIONS AND CANCER RISK
  • BRCA1 and BRCA2
  • POLYMORPHISMS AND CANCER RISK
  • SOMATIC CHANGES IN BREAST CANCER
  • SOMATIC GENETIC ALTERATIONS
  • GROWTH OF BREAST CELLS IN CULTURE
  • COLLECTION AND ANALYSIS OF BREAST FLUIDS
  • SERUM MARKERS AND CELLS IN THE CIRCULATION
  • OBSTACLES TO BE OVERCOME IN DEVELOPMENT OF BIOLOGICAL DETECTION METHODS
  • SUMMARY
• 4 Development and Regulation of New Technologies
  • DEVELOPMENT: THE PROCESS FOR SELECTING AREAS OF INVESTIGATION FOR CANCER DETECTION
  • NEW INITIATIVES AND COLLABORATIONS IN MEDICAL IMAGING RESEARCH
  • EXAMPLES OF FUNDING MECHANISMS FOR MEDICAL TECHNOLOGY DEVELOPMENT
  • PRIVATE INVESTMENT
  • FDA APPROVAL: PROCESS FOR GETTING NEW TECHNOLOGIES INTO THE CLINIC
  • EVALUATION OF SCREENING AND DIAGNOSTIC DEVICES
  • CASE STUDIES OF FDA APPROVAL
  • SUMMARY
• 5 Evaluation and Cost Coverage of Technologies
  • OVERVIEW OF TECHNOLOGY ASSESSMENT ORGANIZATIONS AND THEIR ROLES
  • CRITERIA BY WHICH NEW TECHNOLOGIES ARE JUDGED
  • RELATIVE MERIT OF DATA FROM STUDIES WITH VARIOUS DESIGNS
  • SPECIFIC CRITERIA FOR EVALUATION OF SCREENING AND DIAGNOSTIC TECHNOLOGIES
  • COST-EFFECTIVENESS
  • LIMITATIONS OF TECHNOLOGY ASSESSMENT PROCESS
  • NCI BREAST CANCER SURVEILLANCE PROGRAM TO MEASURE EFFECTIVENESS
  • REIMBURSEMENT
  • SUMMARY
• 6 Dissemination: Increasing the Use and Availability of New Technologies
  • HISTORY OF DISSEMINATION OF MAMMOGRAPHY
  • EVIDENCE ON USE AND ACCEPTANCE OF MAMMOGRAPHY BY WOMEN
  • IMPEDIMENTS OF EFFECTIVE DIFFUSION OF MAMMOGRAPHY
  • POTENTIAL FOR RISK-BASED SCREENING
  • NEW ISSUES THAT ARISE WITH ADOPTION OF EMERGING TECHNOLOGIES
  • SUMMARY
• 7 Findings and Recommendations
  • FINDINGS
  • RECOMMENDATIONS
• Glossary
• References
• Appendix Workshop Speakers

Support for this project was provided by the Breast Cancer Research Foundation, the Carl J. Herzog Foundation, Mr. John K. Castle, the Jewish Healthcare Foundation (Pittsburgh, PA), the Josiah Macy, Jr., Foundation, the Kansas Health Foundation, and the New York Community Trust. The views presented in this report are those of the Committee on Technologies for Early Detection of Breast Cancer and are not necessarily those of the sponsors.

NOTICE: The project that is the subject of this report was approved by the Institute of Medicine and the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.