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Christopher E. Comstock, MD
Memorial Sloan Kettering Cancer Center
New York, New York
Goal: To evaluate the use of contrast-enhanced spectral mammography (CESM) as a breast cancer screening option for women with dense breast tissue.
Impact: This clinical trial, called CMIST, is being conducted to validate previous studies that showed that CESM can provide a more accurate and efficient screening approach for women with dense breasts than the current state-of-the-art, digital mammography plus breast ultrasound.
What’s Next: The trial is expected to launch in Summer 2020 at approximately 10-12 sites across the U.S. and enroll approximately 2,500 women with dense breasts between the ages of 40-75.
Breast density is common in women after 40 years of age. The condition is characterized by dense fibroglandular tissue that displaces the fatty tissue. This density can make mammograms less effective by obscuring small cancers. Breast ultrasound can improve cancer detection in dense breasts but may lead to false-positive screening results and unnecessary breast biopsies. The CMIST study builds on findings from Drs. Comstock’s and Morris’ work suggesting that CESM may by a more precise screening method in women with dense breasts.
Full Research Summary
Research Area: The Contrast-Enhanced Mammography Imaging Screening Trial (CMIST) is an effort to improve early breast cancer detection while reducing false positive exams in women with dense breasts. It is a collaborative effort with BCRF and GE Healthcare to support this groundbreaking trial led by Drs. Comstock and Morris.
Impact: About 40 percent of women over the age of 40 have dense breasts. The condition, characterized by relatively high amounts of glandular tissue and fibrous connective tissue and low amounts of fatty breast tissue, can make reading and detecting breast cancer on a mammogram difficult. Current guidelines call for supplemental screening with whole breast ultrasound (WBUS), however, this can result in false positives, as does screening with MRI. Results from this key clinical trial could drastically change the ability to diagnose and treat breast cancer early for the millions of women with dense breasts.
Current investigation: The planned clinical trial, managed by the American College of Radiology Center for Research and Innovation, seeks to validate early positive findings that contrast-enhanced spectral mammography (CESM) screening provides more accurate cancer detection in women with dense breasts compared to the combination of 3-D digital mammography and whole breast ultrasound (WBUS).
While current supplemental screening modestly improves breast cancer detection, it takes more time, has a high false-positive rate, and can increase breast biopsies and costs. To improve on early detection with accuracy, CESM combines mammography and vascular-based screening methods. This technology highlights areas of unusual blood flow patterns indicative of a cancer in a simple and quick procedure.
What they’ve learned so far: Early studies of CESM in screening women with dense breasts have shown that CESM has the potential to increase the breast cancer detection rate by 70-80 percent compared to conventional mammography with a significantly lower false-positive rate than what would be seen with WBUS or MRI.
Learn more about the study here.
Christopher Comstock, MD is an attending radiologist and director of Breast Imaging Clinical Trials at Memorial Sloan-Kettering Cancer Center. He earned his medical degree from Tulane in 1990 and finished his residency in radiology in 1995 at Ochsner Clinic Foundation in New Orleans. Following his residency, he completed a fellowship in Breast Imaging at the University of Chicago. Dr. Comstock then worked as an Assistant Professor of Radiology at the University of Chicago and later at Northwestern University Hospital's Lynn Sage Breast Center. From 2003 to 2009, Dr Comstock was the director of breast imaging at The University of California San Diego. In 2006 he completed a 2-year ACRIN fellowship in clinical trials in medical imaging.
His current research includes evaluation of the supplemental yield of whole breast screening ultrasound to screening tomosynthesis and contrast-enhanced digital mammography and abbreviated breast MRI. He is Co-PI of an active multicenter trial titled Effect of Preoperative Breast MRI on Surgical Outcomes, Costs and Quality of Life of Women with Breast Cancer (Alliance A011104/ACRIN 6694) and Study chair of the recent ECOG-ACRIN trial EA1141, “Comparison of Abbreviated Breast MRI and Digital Breast Tomosynthesis in Breast Cancer Screening in Women with Dense Breasts”.
Dr Comstock has co-authored textbooks on abbreviated breast MRI and breast cancer imaging, written several book chapters, been involved in numerous breast imaging publications and has given over 500 invited lectures. His past professional service includes: Chair of the ACR Breast Ultrasound Accreditation program, ABR Oral Board examiner, member of the NCI BOLD task force, Chair of the RSNA Breast Refresher course program and Chair of the ACRIN Institutional Participants committee. He is currently the Imaging Co-Chair of the ECOG-ACRIN Breast Committee and ACR Committee on BI-RADS Breast MRI Chair. In 2014 Dr Comstock was inducted as a Fellow of the American College of Radiology.
BCRF Investigator Since
The Lampert Foundation Award