A state law taking effect Jan. 1 will require all mammography patients to be notified if a test reveals "dense breasts," a risk factor for breast cancer that decreases the likelihood of detecting the disease through typical scans.
For patients who need follow-up screening, Edward Hospital in Naperville this fall began offering a procedure that could improve diagnostic accuracy -- without a trip inside an MRI machine.
New to the region, the procedure, called molecular breast imaging or MBI, offers another method to detect a disease that is the second-most common cancer in the U.S. behind skin cancer. Breast cancer occurs in roughly 239,100 people each year and kills 41,450 women and men annually, according to the Centers for Disease Control and Prevention.
Developed by Mayo Clinic, MBI has been in use for decades, but with limited availability. Edward Hospital began using a MBI machine in September under the direction of Dr. Darius Gilvydis, a diagnostic radiologist and medical director of breast imaging, to help check for cancer in women and men for whom a mammogram is not conclusive.
The machine works by employing gamma cameras that can spot the presence of a radioactive tracer agent. Patients are injected with a low dose of the tracer before they sit for 45 minutes with each breast stabilized in a device that takes images of their tissue. Cancerous cells absorb the tracer, so tumors show up as hot spots on the resulting images.
The procedure has been cleared by the FDA, and providers say the amount of radiation in the tracer agent is safe for routine screening, though it has led some doctors to shy away from its use.
"Patients find this to be a much more comfortable experience compared to MRI or mammography," Gilvydis said. "We're not compressing the tissue as much as we want to suppress motion."
Gilvydis said MBI is best when used as a complement to a mammogram because it provides new images from the same angles and better differentiates between dense but noncancerous breast tissue and cancerous tumor tissue. Dense breasts have more connective tissue than fatty tissue, which can make even large tumors difficult to spot on a mammogram.
For 35 percent to 50 percent of mammogram patients who are found to have dense breasts, getting a follow-up scan through MBI, or more common methods such as an ultrasound or MRI, can detect potential cancers earlier.
That's why Gilvydis is an advocate of the state law Gov. Bruce Rauner signed in August, which requires all mammogram providers to notify patients in a letter if they are found to have dense breasts.
At Edward, MBI is the preferred additional screening method for patients with dense breasts; those who feel pain despite a mammogram that identifies no cancer; those who have had breast augmentation or reduction; and those who are unable to undergo an MRI because of an implanted device incompatible with the machine or because of fears such as claustrophobia.
Completing a mammogram -- which Gilvydis said is recommended for all women beginning at age 40 -- but receiving a report of dense breasts or an inconclusive finding can be quite stressful.
"Having a solution and a step to help them deal with the breast density will help lower anxiety," Gilvydis said.
That's been the case for Rockford-area resident Carole Lago, a breast cancer survivor who began experiencing recurring pain in recent months, years after beating the disease with which she was diagnosed in 2005. She went in for a mammogram that found no cancer, but her doctor recommended additional testing because of her pain. Lago said she endured an MRI once as a follow-up to a mammogram.
"The idea of getting into that tube again was just not going to happen," she said.
She started looking for facilities that offer open MRIs for breast testing but couldn't find any.
Her research eventually led her to Edward in Naperville, where her grandchildren were born. Told of the availability of molecular breast imaging, she gave it a try and found the two-hour procedure "well worth it."
"This was probably the most stressful but the easiest one to do because they were specifically looking for cancer," Lago said.
Gilvydis said the vast majority of patients who undergo MBI receive negative results for cancer that prove true 98 percent of the time.
Lago, for example, got a negative result, and doctors determined her pain is due to side effects from previous radiation treatments.
"When they cleared me," Lago said, "that was the best."
When Edward added the MBI machine to the nuclear medicine department within its radiology unit, Gilvydis said, it became the first hospital in Illinois and the second in the Midwest to offer the technology.
Neither the Advocate nor Northwestern Medicine health systems offer molecular breast imaging, but they use other follow-up screenings for dense breast patients or those with inconclusive mammograms.
Within the Advocate system, providers have been notifying patients of dense breasts since 2014, spokesman Nathan Lurz said, and long have offered automated breast ultrasounds and MRIs.
Northwestern Medicine chooses not to offer MBI because of the tracer agent.
"The radiation dose is extremely high, and we can gather the same information from breast MRI, which is our preferred method of imaging," said Dr. Sarah Friedewald, a diagnostic radiologist at Northwestern Medicine. "Molecular breast imaging is not a new technique. It has been available for many years. A few centers have adopted the technology, but it is unlikely to become the standard of care."
While each follow-up screening method has its pros and cons, the radiation with MBI is enough of a drawback for many facilities to shy away, says Spring Piatek, an advanced oncology clinical nurse specialist with the High Risk Breast Clinics at Northwestern Medicine Central DuPage and Northwestern Medicine Delnor hospitals.
But for Edward and other hospitals offering the test, MBI's upside in patient comfort and ability to spot cancers makes it a valuable technique. Oncologists and physicians are aware of the machine and are referring patients to seek it when initial screenings leave some detail to be desired.
"Being at the forefront of women's health care, especially breast cancer imaging," Gilvydis said, "is important to this hospital."