Wendie Berg, MD, PhD, FACR

To improve the precision of breast cancer detection in women with a higher-than-average risk of breast cancer.

Impact

Women who have been treated for breast cancer are at increased risk for recurrence and second breast cancers. Unfortunately, current mammography is inadequate for detecting breast cancers in this population and the capacity for widespread MRI is limited and costly. Women with dense breasts also face limits in screening options since mammography can miss early lesions. Ultrasound, which is sometimes recommended for women with dense breasts, has a high rate of false positives and is also not widely available. Dr. Berg is assessing alternative methods of screening for these populations that could provide more precise results—this includes assessment of artificial intelligence to enhance ultrasound and comparing the sensitivity and specificity of 3D mammography (tomosynthesis/TO) screening alone versus 3D plus contrast-enhanced mammography (TOCEM). Since early detection of breast cancer improves outcomes and reduces the risk of recurrence or metastasis, Dr. Berg’s research will help optimize screening practices and has the potential to further reduce mortality from breast cancer.

Progress Thus Far

Dr. Berg has completed enrollment in a multi-year study (TOCEM) testing whether CEM and 3D mammography provide a feasible more effective and lower cost option of breast cancer detection than tomosynthesis alone or MRI. All patients have received their first year of screening while screening continues for cohorts of participants in their second, third and fourth years—all participants will undergo screening over four years. To date, the performance of CEM is similar to MRI, but with fewer callbacks and false positives. They have also found that patients had a better tolerance for CEM screening compared to MRI. The results of these studies will inform screening strategies by providing good estimates of cancer detection with annual CEM, interval cancer rates, and false positives. The team has initiated an added study to examine the utility of biennial screening CEM (BI-TOCEM) in women who have completed the initial three rounds of annual screening; all participants will continue to have annual 3D mammography.

What’s next

Dr. Berg and her colleagues will continue the TOCEM study with participants completing years two and three research examinations and clinical follow-up in year four. They will continue to recruit new participants to the BI-TOCEM study with a planned accrual of 1600 women. Results of these studies will help inform implementation of CEM in practice.