The 1st Annual Ladies' Home Journal Health Breakthrough Awards

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Dr. Etta D. Pisano: Better Screening for Breast Cancer

When the FDA approved digital mammography in 2000, it was hailed as a breakthrough technology. It allows radiologists to manipulate images of breast tissue, adjust contrast, and zoom in on suspicious areas, possibly eliminating the need for repeat mammograms. Another plus: A digital mammogram requires less radiation than film, can easily be stored electronically (reducing the need to store bulky files with records of breast film) and can be sent quickly to another doctor for a second opinion.

But an important question needed to be addressed: Are digital tests as reliable as film mammograms, which have been used for 35 years and have significantly reduced breast-cancer deaths? The person who answered the question is Etta D. Pisano, MD, director of the University of North Carolina Biomedical Research Imaging Center, in Chapel Hill.

In 2001 -- after 14 years of laying the groundwork (finalizing the test protocol, for example) -- Dr. Pisano launched an estimated $26 million study with the tongue-twisting name of Digital Mammographic Imaging Screening Trial, nicknamed DMIST. The study, focused on nearly 43,000 women, was conducted under her direction by the American College of Radiology Imaging Network (digital breast-screening technology became available experimentally in 1992). In a way, she had been preparing for the study since her mother died of a brain tumor when Dr. Pisano, the eldest of seven kids, was just 15. "I decided at a very young age that I wanted to help other families avoid what I had experienced as much as I could," she says.

The verdict? Both types of mammography have similar rates of accuracy overall, but digital has an edge in finding breast cancer in women under age 50, women who are premenopausal or perimenopausal, and those whose dense tissue makes their breasts difficult to screen with film mammography. Another plus: Many of the small tumors digital technology finds in these women are the ones that need to be caught early. So while experts still don't know whether digital mammography will save lives in the same way that the film method does, it looks promising.

"Finding tumors when they're small is the single most important contribution we can make to a woman's chance of being cured of breast cancer," says Robert A. Smith, PhD, director of cancer screening for the American Cancer Society. "Digital mammography is effective in finding small breast cancers, and recent research results suggest that it may offer an advantage in certain subgroups of women."

Dr. Pisano heeds her own findings: As befits someone under 50, her last two annual mammograms were digital. (Her previous mammograms, which she started having at age 40, were film.) But by no means should a woman forgo having regular mammograms just because she doesn't have access to equipment that provides the digital variety, she insists.

"Women need to get whatever kind of mammogram they can," Dr. Pisano says. Digital machines are still harder to find than film machines -- only about 8 percent of U.S. facilities had them in 2005, according to the American College of Radiology and the New England Journal of Medicine. In addition, the procedure is costlier and may not be covered by insurance. Women in the groups that may benefit particularly from digital mammograms should point this out to their insurance providers, if necessary.

Dr. Pisano's work on digital mammography is far from finished. She and her colleagues are now trying to learn why digital seems to do a better job than film at spotting tumors in certain women. And she is optimistic that even better screening tools will be developed.

"I am certainly going to continue to work in this area," says Dr. Pisano, who is also vice dean of academic affairs at the University of North Carolina School of Medicine (also in Chapel Hill). "We're hoping to develop new tools that require less compression or no compression. I would even like to find a way to prevent breast cancer so we don't have to screen for it."

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