|A Conversation with Dr. Wendie Berg |
| Dr. Wendie Berg, a researcher with an M.D. and a Ph.D. in pharmacology, is the principal investigator of the ACRIN 6666 trial. She proposed the study concept and developed the ACRIN 6666 protocol in collaboration with ACRIN investigators. In addition to her research, Dr. Berg practices breast imaging at American Radiology Services-Johns Hopkins Greenspring.|
What is the thinking behind using ultrasound as a supplement to mammography screening?
Screening should identify cancers at an early stage, before they are clinically evident. A screening tool must be safe, convenient, cost-effective, widely available, and show a benefit for the participant. Mammography is the gold standard for breast cancer screening; with regular screening, mammography can reduce the number of breast cancer deaths by 48 percent between the ages of 40 and 74. In women with dense breast tissue, more than half of cancers may be difficult to see. Ultrasound may help depict cancers in these women.
What about MRI as a supplemental screening tool?
MRI is being investigated to supplement mammographic screening and preliminary results have shown it depicts early breast cancers not seen on mammography. MRI is limited, however, by high cost, variable patient tolerance, lack of widespread availability of scanner time, a shortage of experienced radiologists, the need for intravenous contrast, and the technical and expertise requirements for biopsying lesions seen only on MRI.
That brings us back to ultrasound. How does ultrasound fit into the supplemental screening picture?
Ultrasound is widely available, relatively inexpensive, and well-tolerated by patients. It is easy to guide biopsy or aspiration of lesions seen only on ultrasound. Research efforts thus far have shown that ultrasound doubles the detection rate of cancer in women with dense breasts and that cancers seen only on ultrasound are almost all small invasive cancers with negative nodes and therefore good prognoses. Ultrasound should be considered a supplement to mammography, not a replacement.
Where do we go from here?
Although several issues are unresolved, it is clear that screening ultrasound warrants further study. The ACRIN 6666 study is designed to address those issues.