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Wednesday, March 2, 2016

Women's Health News Wednesday: A Simple Test of Tears Has Been Shown to Detect Breast Cancer

Currently breast cancer detection relies most heavily on a woman being mindful of breast changes or the appearance of a lump; getting a mammogram, or getting a clinical breast exam with her health care provider. For years we have asked for a breast cancer screening test similar to the blood tests that help to detect prostate cancer and ovarian cancer. Since no such test has existed we still rely on the standard tools like mammography. Although mammography can save lives with earlier detection than palpation of the breast, too many women either do not get mammograms, don't get them as regularly as has been recommended, or have false readings which compromise detection rates. 

Mammograms have continually improved with detection of density scores, computer re-reads, and the use of ultrasound to clarify the changes on mammography that are detected. We determine when to begin mammograms and how often to repeat them based on a various combination of risk factors, including the scoring of breast cancerrisk with the Gail scale, and calculation of the degree of statistical risk based on the amount of density. Women with dense breast tissue have 3-5 times greater risk of breast cancer than women with normal breasts, and hormone therapy can increase breast density in 30-50% of women who take it.  The National Cancer Institute Breast Cancer Surveillance site also has a lot of data on breast density at their site. They have developed a tool for health care providers to help them understand what patients are at most risk from dense breasts

Generally a physician can look at the mammogram and the amount of ‘black’ verses ‘white’ components of the x-ray. Very white means very dense. Since breast tissue is actually 3 dimensional the denseness of the breast also is based on the internal structures that the radiologist is seeing. The thought has been that too dense of a breast would then obscure the view of a cancer. In general the pictures are graded by the ‘percentage’ of density, and greater than or equal to 75% dense correlates with dense breasts and less ability to predict the presence of a very small cancer. For decades the individual reading a mammogram reported their interpretation of density, but now the CAD or Computer Aided Detection programs can very accurately reportthe percent of density. Women who are heavier tend to have more dense breasts, like other features of our breast the density is somewhat genetic. Density is also related to hormone use and thus it is the position of the North American Menopause Society that taking estrogen and progesterone hormone therapy can interfere with the diagnostic interpretation of mammograms. 

Now a new test has been discovered. Dr. Steven Harms working with Ascendent Dx has discovered that there is a test of tears that can reveal if one has breast cancer cells within ones body. This test, looking for protein biomarkers, is a screening test, further testing, such as a mammogram, would have to be then used to determine if and where the breast cancer exists. The test needs many more trials to determine if it can be practically integrated into women's health care. Tear testing is not used extensively in diagnostic health care, one of the only common tests has to do with testing the quantity of tears in various dry eye syndromes, but actual presence or absence of proteins or other substances in tears is uncharted territory. 

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