The End of Mammography?

Posted on: December 22nd, 2023 by admin
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For the past sixty years, mammography – an X-ray of the breast – has been the “go to” method for the early detection of breast cancer in women who are otherwise healthy. In fact, it would not be an exaggeration to say that this imaging modality – first analogue, then digital, and more recently tomosynthesis – has extended the lives of millions of women worldwide. However, mammography has its drawbacks, including the woman’s exposure to ionising radiation, and the discomfort of the compression paddle squeezing her breast. This begs the question: Are there other screening methods on the horizon that don’t have these problems?

Today I review two methods that might just be able to challenge mammography. In November 2020, I highlighted the work of Judit Giró Benet from Barcelona who was awarded the James Dyson Award for her design of The Blue Box (seen above right). Her design uses proprietary electronic sensors and artificial intelligence (AI) to analyse a urine sample for the early detection of breast cancer. In a video interview with Dyson, Benet stated her device was 95% accurate, although that claim still needed to be proven.

Well, last year Benet and her team published what may come to be regarded as a landmark paper in Scientific Reports, that would appear to substantiate her claims. Since then, they have completed two further multi-centre studies on more than 900 patients with impressive results. Seen left, The Blue Box is compared to mammography for women younger than 50, showing clear superiority for sensitivity and accuracy. However, as we pointed out three years ago, this tool will not tell you where the cancer is located in the breast – that requires an imaging system.

In one of my earliest blogs, published in August 2012, I reviewed breast thermography which uses an infrared camera to measure differences in temperature, the rationale being that it might detect angiogenesis – the growth of small blood vessels into a tumour. Although approved by the FDA, one of the agency’s directors commented “there is simply no evidence that thermography can replace mammography.”

Well, in 2023 there has been a flood of papers extolling the benefits of thermography. One of these, published by Frontiers in Artificial Intelligence, compared a product called Thermalytix with mammography for 168 women with dense breast tissue (seen right, where PPV = positive predictive value). Interestingly, the system performed worse in women with fatty breast tissue compared to mammography. So, where does this leave us? My conclusion is that talk of mammography’s imminent demise is probably premature.

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