The 2nd Annual Ladies' Home Journal Health Breakthrough Awards

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Constance D. Lehman, MD, PhD: Finding Cancer That Mammograms Miss

You've just heard the shattering words: "You have breast cancer." Before you've had time to digest this life-changing news, your doctor adds that there is a five to 10 percent chance that you will develop breast cancer in your other, "contralateral" breast within 10 years. The mammogram and clinical breast exam you've already had showed no evidence of a tumor in that breast. Should you have it removed in the event a tiny cancer is lurking there? Or do you take your chances?

Now, thanks to Constance D. Lehman, MD, PhD, professor and vice chairman of radiology and director of breast imaging at the University of Washington School of Medicine and director of imaging at the Seattle Cancer Care Alliance, women newly diagnosed with breast cancer don't have to take chances. They can have an MRI (magnetic resonance imaging).

Dr. Lehman, 45, was principal investigator of a trial coordinated by the American College of Radiology Imaging Network that involved nearly 1,000 women at 22 sites in the United States, Canada, and Germany. Researchers found that an MRI is more effective than either standard mammography or a clinical breast exam at finding tiny tumors in the contralateral breast.

In fact, MRIs detected 30 tumors that the other two methods had missed. This amounted to 91 percent of all the cancer the trial found in women's other breasts. The cancers were so small that none had spread to surrounding breast tissue or the lymph nodes.

"We caught the cancers at the time when they were easily treatable, with significantly lower pain and discomfort associated with treatment and higher likelihood of a cure," says Dr. Lehman. The study, published in the New England Journal of Medicine, has also helped physicians better understand the role MRI might play in the diagnosis of breast cancer.

"Dr. Lehman is one of the leaders in the world in the use of MRI for breast cancer detection and diagnosis," says Etta Pisano, MD, Kenan Professor of Radiology and Biomedical Engineering at the University of North Carolina at Chapel Hill, who worked on the MRI study with Dr. Lehman. "She is very visionary about how we can use the technology."

Why did MRIs uncover more tumors than the other two methods? While mammograms capture a two-dimensional image of the breast, MRI uses magnetic fields to create a three-dimensional image. "That means we can find cancers that are hidden between layers of breast tissue," explains Dr. Lehman. In addition, a contrast agent injected into a woman before the MRI is performed highlights areas of new and/or leaky blood vessel growth, which might signal a cancerous lesion. Women who discover a tiny cancer lurking in the other breast can now have both treated simultaneously, avoiding a second round of surgery and chemo a year or two down the road. And those who find no cancer can rest easy, at least until their next MRI.

Because it's so expensive (upwards of $1,000, compared with around $125 for a mammogram), MRI isn't routinely used as a screening tool. "Whether or not women who have already had breast cancer will need to continue to be screened with MRI every year is still a matter of debate," Dr. Lehman says. However, the American Cancer Society recently recommended that all women classified as high risk for breast cancer get an annual MRI scan, starting at age 30.

"Without question, breast imaging is one of the most exciting areas in imaging," says Dr. Lehman. "We are moving into an era where we are seeing more individualized treatment of breast cancer. As imagers we want to provide as much information as possible on the true extent of the disease and the type so targeted therapies can be available to more women."

Dr. Lehman, who at one point wanted to be a psychologist, was attracted to radiology because of both its intellectual excitement and the patient contact that is an integral part of the job. "It provides so many opportunities to have an impact on women's lives," she says.

That impact is needed. The American Cancer Society estimates that 178,480 women will be diagnosed with breast cancer this year. Dr. Lehman's own familiarity with the disease is not just clinical. Her godmother has battled breast cancer, and, she says, "I am at an age where more of my friends than I would like to count have been diagnosed with the disease."

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