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Elizabeth Morris, MD
Chief, Breast Imaging Service
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. Morris’ and Comstock’s 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. Morris and Comstock.
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. It’s a challenge that BCRF researchers want to meet head-on. 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 compared to a combination of digital 3-D mammography and whole breast ultrasound (WBUS) in women with dense breasts.
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 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.
Elizabeth Morris, MD is the Chief of Breast Imaging Service at Memorial Sloan Kettering and responsible for the breast imaging program at all MSK locations and professor of radiology at Weill Cornell Medical College. Her research focuses on how best to use newer techniques to detect breast cancer early and to assess whether treatment is working. In collaboration with colleagues, she has written many papers, chapters, and books about breast disease. They have published studies on using new techniques such as MRI for screening women at a high risk of cancer as well as monitoring the treatment of a known breast cancer.
Dr. Morris was elected a fellow of the Society of Breast Imaging, the American College of Radiology, and the International Society for Magnetic Resonance in Medicine. She is a past president of the Society of Breast Imaging. She lectures and teaches breast-imaging radiologists, both nationally and internationally, on breast imaging and biopsy techniques. To stay connected through social media, you can follow her on Twitter, where she regularly posts about breast imaging. Treating breast cancer when a tumor is small can save a woman’s life, which is why Dr. Morris is strongly drawn to breast imaging.