Nijemgen, The Netherlands, a woman arrives for a breast cancer screening. An appointment she wouldn’t want to miss. Every two years in The Netherlands women aged between fifty and seventy five undergo a test for breast cancer. Basic mammograms are at the heart of early breast cancer detection. But in The Netherlands today digital mammograms are replacing the traditional techniques.
For the patient the method of taking the image remains the same. Patient D. Janssen Hopmans said: “For me it was the same than normal, there was not a different feeling. “It was a little bit painful, but we know that it’s always, and this is a short time… it doesn’t matter.” Although digital, the mammogram is produced in the normal way. But then the image can be enhanced…the radiologist can change the contrast for example to look deep into tissue. Radiologists can also easily send the image to other experts to examine. In The Netherlands they have launched the new system across the country. Ard den Heeten – director of LRCB, Expert and Training Center for Breast Cancer Screening said: “We have a roll-out at the moment of a digital screening system, so paperless. Digital workflow and digital images. So we store centrally and we use everywhere the same standards, we have a standard way of working all over the country” Around two millions women in The Netherlands now routinely have digital mammograms. And the results have been impressive in the fight agains breast cancer. Ard den Heeten – director LRCB, Dutch National (Expert and Training) Center for Breast Cancer Screening said:“there is a significant rise in the detection of breast cancer compared to the analog system, that’s not only on the early form with the calsification the so called DCIS the very early form of breast cancer, it is also in the small invasive tumors.” Each year a third of a million new cases of breast cancer are detected in the European Union. Doctors are not sure of the causes but are all agreed if the disease is detected early the chances of survival are much higher. Digital techniques are at the forefront of early detection. In Bremen in Germany..at the Fraunhofer Mevis Institute they specialise in medical imagery, computer analysis and other electronic wizardry. They are at the heart of the Hamam project which try to bring together the basic mammogram, combined with other 3 D imagery like MRI and ultrasound. Horst Hahn, (vice-director) Fraunhofer Mevis, Institute for Medical Imaging Computing said: “The task for the radiologists is to extract the relevant information from this large amount of data, within a very short time and with the high accuracy. “The computer can make new images from many images to see all the relevant information on one view, where you would have many views, or the computer can analyse the images or even quantify the images to help the radiologist to assess the information” Horst Hahn, (vice-director) Fraunhofer Mevis (Institute for Medical Imaging Computing) said: “One goal is to bring together all the information on one workplace, to be more efficient and to enable new combined assement of the different data, if a women for example had a mammography and a breast magnetic resonance imaging, an MRI examination, this new workstation shall enable a joined diagnostic of this two” Back in The Netherlands in the town of Nijemgen we are in the University of St Radboud. Here they use the techniques pioneered at Bremen. It’s cutting edge breast cancer detection through MRI. This morning they are examining women who are judged to have a high risk of developing breast cancer because the disease runs in the family. This patient is fifty nine years old and has an MRI scan every year. It is a relatively expensive commitment but it saves lives. Roel Mus, Radiologist, Radboud University Medical Centre said :“She has actually an expectancy in her life to get a breast cacinoma somewhere between 60 and 80%. With MRI we know that we see about 20% more tumour than with mammography and ultra-sound together”. There is a downside to MRI. A computer can sometimes detect anomalies in breast tissue and give a false reading of breast cancer, when there is none. But doctors agree MRI comes into its own when it comes to analysing difficult cases. It’s in this field digital techniques can make a huge difference in coming to an accurate diagnosis. Roel Mus, Radiologist, Radboud University Medical Centre said: “ One technique is not enough. MRI is much more sensitive than mammography, but then there’s another problem. One of the ways breast cancer can express itself is by microcalcifications, calcifications you can see on the photograph and you can’t see those cacifcations on a MRI. When I have a patient with a multi-focal tumors, with 3 or 4 tumors, everytime I have to send things overthere and to look at it. So, I would like to have everything in one workstation where I can do this type of parametric imaging, have my ultra-sound there, have my mammography there, that would be terrific.” Radiological researcher Nico Karssemeijer works alongside doctors in hospital..using ground breaking computer techniques to help in diagnosis. His scanning methods are on the cutting edge of early breast cancer detection. Nico Karssemeijer, Researcher at Radboud University, department of Radiology: “As you can see, this is a very wide transducer, this is pressed on the breast and the scanner moves in this direction, and makes in that way a 3-Dimensional ultra-sound of the breast. It’s much more efficient, much quicker, than what is used with hand held ultra-sound The big advantages of this system is that it’s much cheaper than breast MRI and if you compare it with mammography, this is harmless, because it is sound waves, there’s no risk for the patient with harmful radiation” Nico Karssemeijer, Researcher at Radboud University, department of Radiology said: “The current state-of-art that we can detect cancers earlier by imaging, but it may be possible that in the future blood test or other simpler methods are discovered where we can more effectively detect breast cancer earlier, and it might also be possible that much better cure for breast cancer is found” The women of Nijmegen are in their own way pioneers. And arguably they are helping all women of the world fight one of the most deadliest diseases.