Watershed Exam

Using ultrasound waves, the “breast Jacuzzi” could be the long-awaited, more comfortable alternative to mammography

As marketing phrases go, “like a Jacuzzi for your breast” has to rank right up there with, well, a Jacuzzi for your breast. Connect it not to a spa service but to breast-cancer screening, suggest that one day a nice bubbly bath might replace the hated squeezing of a mammogram, and it’s enough to make a woman start placing bets on a future Nobel Prize in medicine.

Hold your horses, ladies. The breast Jacuzzi — now under development as a machine called CURE, or Computerized Ultrasound Risk Evaluation — is still a few years down the road, if it ever arrives. But if it does, grateful patients everywhere can thank professionals in Detroit, who are developing the machine under the auspices of the Barbara Ann Karmanos Cancer Institute’s Walt Breast Center.

Leading the team are Dr. Neb Duric and Dr. Peter J. Littrup, a Ph.D and M.D., respectively, who took on the project after participating in a series of Karmanos workshops some years ago.

“The [workshops were held] to brainstorm on how we might be able to approach cancer in a different way,” Duric says. The question on the table was the problem of mammography, which, while effective in detecting many cancers before they’re detectable through self-exam, still fails in enough cases to make an alternative worth researching.

“There’s a category of women for which mammography is useless, no better than a flip of the coin,” says Duric, referring to women with so-called dense breast tissue. (It’s a technical term for how radiation penetrates tissue, not a description for how the breast feels or looks.) And given that women with denser breast tissue may have a higher cancer risk anyway, there’s a need for an alternative screening technique that can catch what mammography misses.

In the past year, magnetic resonance imaging, or MRI, has been recommended as a supplemental screening tool for women with higher risk factors — family history, certain genetic profiles, et cetera. But MRI is expensive and time-consuming. There still could be a better way, Duric believes.

Ultrasound, the basis of the CURE system, wouldn’t seem to be an alternative. Most people who’ve had an ultrasound scan and watched the screen as it was happening remember a series of gray blobs that may or may not be what the technician thinks they are. (Ask any woman expecting a girl who discovered, in the delivery room, that she’d soon be exchanging all her pink baby clothes for blue.) Ultrasound has its limitations, Duric says; it bounces sound waves off whatever the operator aims the machine’s probe at, but it sees only shapes, and most of the waves are lost to the probe. But Duric points out that the technology has much to recommend it — no radiation is involved, it’s non-invasive, it doesn’t require compression, and it’s much faster to conduct than an MRI. The challenge, he says, was making ultrasound work in a better way.

The CURE machine was designed to take advantage of the breast’s relative autonomy from the body. The patient lies face down on a hammock-like platform, her breast hanging down into a water bath. The ultrasound waves emanate from a ring that surrounds the breast.

“It’s the same idea as a CAT scan, but [those use] X-rays,” Duric says. The trick is in how the ultrasound waves are captured and interpreted. Speed, reflection, and attenuation are all fine-tuned to produce an image much more detailed than the blobby gray pictures of fetuses parents pasted into baby books. The breast images are rendered in 3-D and in color, and look like a cross-section of a vividly colored hamburger. Each breast can be scanned in less than a minute.

It’s an intriguing advance to mammography — or at least an alternative — but it has a way to go before it leaves the Walt Breast Center. The device has yet to be submitted for certification by the Food and Drug Administration, and approval, if it comes, will be in stages. The first non-experimental application will likely be in patients who have already been diagnosed with breast tumors, an additional tool for assessing the growth before surgery. Next, it could be a supplemental screening device, like the MRI, used only in women at higher risk. Depending on its success and speed of adoption by hospitals, it could be five years or more before it becomes available for routine screenings, Duric says.

Those who hate mammograms shouldn’t put them off in hopes of a more pleasant alternative in a few years, however. Dr. Mark Helvie, director of the breast-imaging division at the University of Michigan Health System, says mammograms are not painful for the vast majority of women, and if they are, a consultation with the technologist should help minimize discomfort.

Bottom line, “the thinner (a mammogram can make) the breast, the less radiation we need and the better we can detect cancer.” From a medical perspective, the best breast image is the best breast image, not the one most comfortable to the patient.

In Michigan, Helvie says, slightly over half of women over age 40 are getting annual screening mammograms. “That’s below the goal,” he says, but a variety of factors affect it, not just comfort, the main one being physician recommendation.

“Mammography performs very well for women with non-dense breast tissue,” Helvie says. In other words: no more excuses. Just get one.