Warm bath may soon replace uncomfortable mammograms

For almost 30 years the mammogram has been regarded as the gold standard for breast cancer screening, but now scientists are to test a new option that may be more accurate and less uncomfortable.

For the fact is the mammogram, while credited with saving 1,300 lives each year in the UK, is not without its drawbacks.

First, as it is an X-ray, it means the checks are normally limited to one every three years due to concerns about radiation exposure.

It is also notoriously uncomfortable, involving the breast being squeezed between two X-ray plates. Its image is not crystal-clear and this can lead to false positives, meaning women are sent for needless biopsies.

Furthermore, research presented at the European Breast Cancer conference earlier this year suggested that mammograms miss tumours in as many as one in six cases.

Missed diagnosis is a particular issue for the one in four women with dense (more fibrous) breast tissue as this is harder for the X-ray to penetrate. These are mainly younger women, as after the menopause much of the dense tissue (needed for milk production) turns to fat, which is less dense.

Now government-backed scientists are testing a new pain-free way to screen for breast cancer that involves a form of ultrasound administered while the breast is suspended in a bath of warm water — it is hoped this will give such clear images it may be able to detect cancer early, even in women with dense breast tissue. To have the test the woman lies face down on a special table with openings for the breast to rest in warm water. The water helps the ultrasound waves travel.

The ultrasound consists of 14 beams that produce an image similar to a more sophisticated MrI image. The readings can be colour-coded to present a map of characteristics including healthy or diseased tissue.

The test is being designed to be used at GP surgeries, doing away with the need for hospital visits.

And women could have it multiple times as ultrasound has an excellent safety record. The new test is being developed by the government- owned National Physical Laboratory, London, and is about to be trialled on 20 to 30 volunteers, women with various symptoms of breast disease, in a landmark clinical trial at Southmead Hospital, Bristol.

Some will have the new test, others standard mammography and ultrasound. results will be compared after five months.

This is not the first alternative to mammograms to be tried. Already some women are being offered another form of ultrasound to try to verify whether a lump spotted on an MrI is a cyst or a tumour. Meanwhile, a 3D mammogram is facing more trials after initial tests found it may be more accurate.

Another option is thermography, in which a camera takes images based on the heat of the tissue. Tumours are ‘hotter’ than healthy tissue, so show up on the image.

However, it is not available on the NHS and some research has found the camera does not always distinguish between benign and malignant tumours.

Mark Hodnett, a senior research scientist, who is part of the NPL team developing the new warm bath test, says it has the potential to be a ‘revolution’ in diagnosing breast cancer. ‘The prevalence of cancer in young women is growing, but the mammogram is less able to pick up cancer in younger people, whereas ultrasound has the potential to give accurate images without exposure to radiation,’ he says.

‘The ultimate aim is to have the machine at doctors’ surgeries so that more of the population can be reached.’

Currently women aged between 50 and 70 are offered mammograms every three years, with the programme being extended to women aged 47 to 73 in England — and it finds cancer in about eight out of every 1,000 cases.

THE NPL team believe the ultrasound approach will vastly improve scan image quality and make diagnosis more uniform, rather than relying on a clinician’s judgment of a scan.

‘Ultimately, your diagnosis would be based on a measurement, not a picture that needs subjective interpretation,’ adds Hodnett.

Dr Emma Pennery, clinical director of the charity Breast Cancer Care, says ‘the future prospect of a screening technique that could reduce the number of breast cancer false alarms is exciting’.

‘It could mean women who don’t have cancer are spared the anxiety of being told they might have it. It may also help spot cancer in women with denser breasts.’

But she adds: ‘It needs rigorous testing to ensure it is safe and can pick up breast cancers precisely.

‘At the moment, breast screening with mammograms remains the best way to detect cancer at the earliest possible stage.’