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Digital mammography better for some women
Newsdesk
Digital mammography better for some women Digital mammography takes an electronic image of the breast, and stores it directly in a computer, allowing the data to be enhanced, magnified, or manipulated for further assessment. Film mammography, the gold standard in breast cancer detection for 40 years, uses film to capture and display the image. The sensitivity of film mammography is lower in women with dense breasts because tumours surrounded by dense breast tissue do not stand out as much. Although digital mammography might be more accurate in spotting cancers in some women, digital systems can be 1·4 to four times more expensive than film systems. Still, as electronic medical records become more widespread, digital mammography could also become more standard, says Rowan Chlebowski, Los Angeles BioMedical Research Institute, Torrance, CA, USA. However, this shift might lead to fewer places offering mammograms.
Chlebowski continues: “The question is do centres want to spend the capital to buy digital mammography equipment? So, the centralisation of mammography services in the USA might be a consequence of this emerging requirement to go to digital mammography”.
Leslie Harris O'Hanlon
© Geoff Tompkinson/Science Photo Library
Digital mammography is more accurate in detection of breast cancer in women who have dense breasts, are premenopausal or perimenopausal, or are younger than 50 years old, reports a study in the N Engl J Med (published online Sept 16, 2005; DOI: 10.1056/NEJMoa052911). The study enrolled 49 528 women with no signs of breast cancer from 33 sites in the USA and Canada; women received both digital and film examinations. Digital mammography comprises 8% of the US mammography market, says lead author Etta Pisano, University of North Carolina, Chapel Hill, NC, USA. “Getting a mammogram of any sort is better than not getting a mammogram”, she says. “We don’t want women to stop getting screened because digital is not available . . . once [it] becomes more available, if you fall into one of the three groups of women, you should get a digital mammogram.”
Will film mammography become outdated?
Drug combination disappoints in pancreatic cancer Combination chemotherapy with pemetrexed plus gemcitabine in patients with advanced pancreatic cancer does not improve overall survival compared with gemcitabine alone, report researchers. “The results of our international phase III trial are certainly disappointing”, says senior author Hedy Kindler (University of Chicago Cancer Research Center, IL, USA). “Although there was a modest increase in response rates with the combination, this regimen does not warrant further evaluation in pancreatic cancer”, she adds. Pancreatic cancer accounts for only 2% of cancers in the USA, but is the fourth leading cause of cancer death. The current standard of care is chemotherapy with gemcitabine, a nucleoside analogue. But although this drug increases 1-year survival from 2% to 18%, and lengthens median survival from 4·4 months to 5·6 months compared with fluorouracil, the out-
look remains poor for patients newly diagnosed with pancreatic cancer. Gemcitabine plus the antifolate pemetrexed is one of many drug combinations being tested for its ability to remedy this situation—in phase II trials, this combination gave higher than expected response rates. For the phase-III trial, 565 previously untreated patients with unresectable or metastatic pancreatic cancer were randomly assigned to either pemetrexed plus gemcitabine or gemcitabine alone. Overall survival was 6·2 months in the combination group and 6·3 months in the gemcitabine-alone group. Although tumour response was slightly better in the combination group than in the gemcitabine-alone group (14·8% vs 7·1%), side-effects, including neutropenia, were more frequent in this group (Ann Oncol 2005; 16: 1639–45). The results of this trial suggest that pemetrexed plus gemcitabine has no
http://oncology.thelancet.com Vol 6 November 2005
role in the treatment of advanced pancreatic cancer, comments Jordan Berlin (Vanderbilt-Ingram Cancer Center, Nashville, TN, USA). Although other doses or schedules of these two drugs might help some patients, both Berlin and Kindler believe that combination chemotherapy that includes targeted treatments could hold the best hope for the future. Kindler is heading a phase III trial of gemcitabine plus bevacizumab, a monoclonal antibody that targets vascular endothelial growth factor. “Another ongoing phase-III trial in the USA is investigating gemcitabine plus cetuximab, which targets the epidermal growth factor receptor”, says Kindler. “Both these trials should complete accrual in early 2006, so hopefully, in the next year or two we will have some answers.”
Jane Bradbury 829
Digital mammography better for some women Digital mammography takes an electronic image of the breast, and stores it directly in a computer, allowing the data to be enhanced, magnified, or manipulated for further assessment. Film mammography, the gold standard in breast cancer detection for 40 years, uses film to capture and display the image. The sensitivity of film mammography is lower in women with dense breasts because tumours surrounded by dense breast tissue do not stand out as much. Although digital mammography might be more accurate in spotting cancers in some women, digital systems can be 1·4 to four times more expensive than film systems. Still, as electronic medical records become more widespread, digital mammography could also become more standard, says Rowan Chlebowski, Los Angeles BioMedical Research Institute, Torrance, CA, USA. However, this shift might lead to fewer places offering mammograms.
Chlebowski continues: “The question is do centres want to spend the capital to buy digital mammography equipment? So, the centralisation of mammography services in the USA might be a consequence of this emerging requirement to go to digital mammography”.
Leslie Harris O'Hanlon
© Geoff Tompkinson/Science Photo Library
Digital mammography is more accurate in detection of breast cancer in women who have dense breasts, are premenopausal or perimenopausal, or are younger than 50 years old, reports a study in the N Engl J Med (published online Sept 16, 2005; DOI: 10.1056/NEJMoa052911). The study enrolled 49 528 women with no signs of breast cancer from 33 sites in the USA and Canada; women received both digital and film examinations. Digital mammography comprises 8% of the US mammography market, says lead author Etta Pisano, University of North Carolina, Chapel Hill, NC, USA. “Getting a mammogram of any sort is better than not getting a mammogram”, she says. “We don’t want women to stop getting screened because digital is not available . . . once [it] becomes more available, if you fall into one of the three groups of women, you should get a digital mammogram.”
Will film mammography become outdated?
Drug combination disappoints in pancreatic cancer Combination chemotherapy with pemetrexed plus gemcitabine in patients with advanced pancreatic cancer does not improve overall survival compared with gemcitabine alone, report researchers. “The results of our international phase III trial are certainly disappointing”, says senior author Hedy Kindler (University of Chicago Cancer Research Center, IL, USA). “Although there was a modest increase in response rates with the combination, this regimen does not warrant further evaluation in pancreatic cancer”, she adds. Pancreatic cancer accounts for only 2% of cancers in the USA, but is the fourth leading cause of cancer death. The current standard of care is chemotherapy with gemcitabine, a nucleoside analogue. But although this drug increases 1-year survival from 2% to 18%, and lengthens median survival from 4·4 months to 5·6 months compared with fluorouracil, the out-
look remains poor for patients newly diagnosed with pancreatic cancer. Gemcitabine plus the antifolate pemetrexed is one of many drug combinations being tested for its ability to remedy this situation—in phase II trials, this combination gave higher than expected response rates. For the phase-III trial, 565 previously untreated patients with unresectable or metastatic pancreatic cancer were randomly assigned to either pemetrexed plus gemcitabine or gemcitabine alone. Overall survival was 6·2 months in the combination group and 6·3 months in the gemcitabine-alone group. Although tumour response was slightly better in the combination group than in the gemcitabine-alone group (14·8% vs 7·1%), side-effects, including neutropenia, were more frequent in this group (Ann Oncol 2005; 16: 1639–45). The results of this trial suggest that pemetrexed plus gemcitabine has no
http://oncology.thelancet.com Vol 6 November 2005
role in the treatment of advanced pancreatic cancer, comments Jordan Berlin (Vanderbilt-Ingram Cancer Center, Nashville, TN, USA). Although other doses or schedules of these two drugs might help some patients, both Berlin and Kindler believe that combination chemotherapy that includes targeted treatments could hold the best hope for the future. Kindler is heading a phase III trial of gemcitabine plus bevacizumab, a monoclonal antibody that targets vascular endothelial growth factor. “Another ongoing phase-III trial in the USA is investigating gemcitabine plus cetuximab, which targets the epidermal growth factor receptor”, says Kindler. “Both these trials should complete accrual in early 2006, so hopefully, in the next year or two we will have some answers.”
Jane Bradbury 829