Diagnosing Breast Cancer Earlier: Medicine's Next Big Thing?
At some point in a woman's life, she may have an abnormal finding on a mammogram. If cancer can't be ruled out from an ultrasound or MRI, the next step is biopsy. Even though biopsies come up negative 80-percent of the time, it can still be a nerve-racking, painful experience. But what if there was a test that could diagnose cancer before an abnormality even shows up?
Quinstine Francis is a mother of five—a registered nurse—and a two time breast cancer survivor.
"I wasn't even fearful for myself but for my children because they need a mother," Francis told Ivanhoe.
Francis had eight cycles of chemo and 33 rounds of radiation. But she says what saved her was early detection.
"Because I went and did my mammogram is how I found it," Francis explains.
Now doctors are studying new ways that could detect breast cancer before it even shows up on a mammogram.
"This will help us hopefully detect abnormal molecules in the blood that will tell us you know what you're probably having cancer in the next five to 10 years is 100 percent," Atif Hussein, MD, Hematologist/Oncologist, Memorial Healthcare System, told Ivanhoe.
It's called mass spectrometry imaging. It's a technique that allows doctors to visualize the distribution of compounds by their molecular masses, and establish a chemical signature for different tissues.
"We are trying to identify those signatures of normal organs first before we move to try to discover abnormal tissues in our bodies," Dr. Hussein explains.
Dr. Hussein says this technique could eventually lead to a simple blood test—in a doctor's office.
"Potentially rapid non-invasive diagnosis of cancer decades before it shows in our body, I would call that a breakthrough," Dr. Hussein said.
"I can't imagine what that would do for us," Francis said.
Dr. Hussein says clinical trials still need to be conducted to judge how effective, specific and sensitive blood testing would be. He says scientists are still a long ways from using the procedure as a normal part of the cancer screening process.
BACKGROUND: According to Breast Cancer researchers in 2013 there were about 232 thousand new cases of invasive breast cancer. About one-in-eight women in the United States are predicted to develop breast cancer. But in 2000 the incidence rates in the United States started decreasing. The most common type of breast cancer is ductal carcinoma. This begins in the lining of the milk ducts or the thin tubes that carry milk from the lobules of the breast to the nipple. Invasive breast cancer can occur in men and women. But male breast cancer is rare. (Source:
SIGNS/SYMPTOMS: The causes of breast cancer could be inherited. The risk doubles for those who have a first degree relative who has been diagnosed. It is much higher for women who have inherited mutations in the genes called BRCA1 and BRCA2. The symptoms vary widely from a lump to swelling to skin changes. Many breast cancers have no symptoms at all. Risk factors include family history, reproductive history, lifestyle and environment. Treatments can include surgery, radiation, anti-estrogen therapy and chemotherapy. (Source: http://www.breastcancer.org/symptoms)
NEW TECHNOLOGY: Mass spectometry imaging could detect breast cancer before it shows up on a mammogram. Dr. Art Hussein says it's a rapid non-invasive diagnosis of cancer decades before it shows in the body. It's a blood test that helps the doctors visualize the spatial distribution of compounds by their molecular mass and then establish a chemical signature for different tissues. The technology can be used on the skin. It's non-invasive and there are no biopsies needed. If there is an abnormality in the breast the spectroscopy is used to try to see if the abnormality is part of the normal tissue, normal breast or if it is abnormal. If it is abnormal then the doctors would go in and check it. This way doctors can avoid doing biopsies on people with normal tissue and only focus on those with abnormal signatures. Hussein says this blood test could detect abnormal molecules in the blood that would alert patients that the probability of cancer in the next 5 to 10 years is 100 percent.
Atif Hussein, MD, Hematologist/Oncologist at Memorial Healthcare System talks about a new way to detect breast cancer before it even shows up on a mammogram.
Can you explain the MSI test to me?
Dr. Hussein: Spectroscopy is a technique that's used in so many disciplines in our lives. Actually it's the best way to differentiate between different tissues and metals and organs. It's now getting more usage in the medical field because spectroscopy depends on the interaction between light and tissues, the chemical structure of those tissues and you can establish what we call a chemical signature or a fingerprint for different tissue based on the spectroscopy. Therefore, certain metals have very different signatures. An organ like the liver has a different signature, an organ like the breast has a different signature and we are trying to identify those signatures of normal organs first before we move to try to discover abnormal tissues in our bodies.
What is the technical name for it?
Dr. Hussein: Yes, it is a spectroscopy and there are different types of spectroscopy. There's infrared spectroscopy and others. It all depends on the type of light that you will use to interact with the chemical structure of the thing you are testing…whether that's a metal or an organ in our body. By using this interaction between the light and the chemical structure of the organ, you obtain a chemical signature or a fingerprint.
What could this possibly do for patients?
Dr. Hussein: The advantages of this technology are at least it is very fast and noninvasive. You can actually take a specimen of blood and you can test that specimen and learn what it contains depending on what cells it has. And as I said, every cell has this fingerprint. If we know the chemical signatures of normal cells in the blood, if we find one that is abnormal, then it will say oh go and check that out, there is something abnormal in the blood. This is a technology that can be used on our skin. There is actually studies now using it on the breast to try to identify the chemical signature of the breast. It's noninvasive. There's no biopsy. There are no needles. If a woman has an abnormality in the breast then you do this spectroscopy and try to see is this abnormality is part of the normal tissue, part of the normal breast or it is abnormal. And if it's abnormal that would alert you to maybe go in and check it. You avoid doing biopsies on people with normal tissue and only focus on those with those abnormal signatures.
Is it a blood test?
Dr. Hussein: Yes.
Would you be able to use it as part of a normal annual doctor's visit?
Dr. Hussein: Yes. This is a test where all you need is a specimen of blood. Every time you go to a doctor they take a specimen of blood to do blood counts and chemistries. So yes you really can do it, that's all that you really need. The problem with the test is once we find something abnormal, that fingerprint or chemical signature, what do you do with the information? Just because I found some abnormal cells in the blood does that mean that those blood cells are abnormal and they're going to cause trouble, or they are just abnormal and they are going to go away? Therefore, we're still really a long way from doing that routinely. But clearly if this technology proves to be helpful, it will revolutionize how we diagnose cancer and how early we can potentially diagnose cancer. This test needs to be optimized and then clinical trials need to be done to judge how effective it's going to be and how specific and sensitive. Just because you find abnormal cells doesn't mean that those cells are going to cause us trouble, therefore we're still a long way really from using it in our daily blood testing methods…but it's very promising.
So false positive would be a risk?
Dr. Hussein: Yes. I would worry about false positive more than the false-negative although there are false-negative. What if you had the cancer in an organ that doesn't shed those cells into the blood. Then you are not going to find them until that cancer shows in the blood. But seeing abnormal chemical structures in the blood is not really unusual and maybe our body takes care of them. What I will use the spectroscopy for is to follow these abnormalities. I will do a blood test in January and if in March it goes away then it went away but if in March it's worse than January and in June it's worse in March then you know there is something there and you'd better go and check it.
Say in Quinstin's case she got the mammogram and then she had wait 2 to 3 weeks to get the diagnosis
Dr. Hussein: Right.
How soon would this cut it down, instantly, the day after you get it?
Dr. Hussein: It has that potential absolutely. Actually if we can identify this chemical signature of not just if there is a cancer or not, what type of cancer it is, it is potentially possible that all you have to do is you do the test and the signature tells me this signature is that of a ductal cancer of the breast. I mean it's exactly like the signature. It's how it differentiates by the way it matters. If you bring me a piece of metal and you put it under a spectroscopy this test will tell me it has copper, it has iron, it has aluminum, it has different chemicals. If this test can differentiate not only cancer from non-cancer but what type of cancer it is, potentially, you don't even need to do a biopsy. But again we really are a long way from that.
So it has a potential to affect breast cancer, colon cancer, any type of cancer that you could possibly get. So we're talking billions of people that this could help?
Dr. Hussein: No question about it. Two out of three people unfortunately are going to develop some kind of cancer during their lifetime if they live long enough. And with this technology, you don't really need to apply it to blood, you can actually take a piece of the colon potentially or an abnormal polyp in the colon and test to see is this polyp is going to become cancer in the future. Because remember we do a lot of screening tests, we do mammograms, we do Pap smears, we do colonoscopies. Those tests discover cancer. Cancer has to already be there to find it. This technology takes the screening many steps earlier to find it when there is a molecular abnormality in the cell that the cell is starting to become cancer. And the time between the cell deciding to become cancer and it becoming cancer can be years therefore potentially yes, you can diagnose cancer years and years before we are able to do it now.
So I have an example, I personally I have breast cancer, every woman in my family has had breast cancer, their survivors. So if it was me, I'm 25, and even before I can get a mammogram or any of the other screenings I'm probably going to start soon. This I could do now and it would hopefully help prevent me developing cancer at age 40, right?
Dr. Hussein: Right. This would help us hopefully detect the abnormal molecules in the blood that would tell us your probability to having cancer in the next 5 to 10 years is 100%. You don't need to make a decision today but you'd rather make it before it even shows on a mammogram. Because cancer, once it shows on a test, although it's early, it may not be early enough and this tests actually can find it so early that you can prevent the cancer from even showing by doing something about it.
How big of a breakthrough do you think this is?
Dr. Hussein: There is so much funding, actually, to determine first the chemical signature and the fingerprints of normal tissue. That's going to take us time. I can give a technician a piece of the colon, normal colon, a piece of the breast, normal breast, a piece of the brain, normal brain and without telling them they will tell me this is colon tissue, this is breast, this is brain without even looking at it. Then once we have those normal fingerprints we will be able to identify the abnormal because now I know how the breast should look on the spectroscopy. If the spectroscopy shows something in addition, an abnormal signature or fingerprint usually it shows like a peak then I'm going to go and find what's wrong with that peak that's not normal. But we can take this test even further beyond that and the test can tell me yes, you have an abnormal peak, and abnormal tissue, and abnormal spot that we can tell you even what that abnormal spot is. It's a peak cancer, its cancer, it's cancer that's going to show in five years and that's really where the breakthrough is. I think the technology is very, very promising but it needs to be studied in a well controlled fashion.
So we're talking a possible huge game changer in terms of screening.
Dr. Hussein: Potentially rapid noninvasive diagnosis of cancer decades before it shows in our body, I would call that a breakthrough.
Do you have questions?
Dr. Hussein: It's so rapid, it's so noninvasive and it can revolutionize diagnosis absolutely. I hope it does, I actually read it has a multimillion dollar grant from the NIH.
They are spending all this money on it, it has to have huge potential.
Dr. Hussein: Yes, and they are actually doing a lot with the skin. Because sometimes if you have a spot in the skin you don't know if this spot in the skin is very aggressive cancer or precancer or not even cancer. But you can apply spectroscopy without removing it in the skin and actually it has been shown that it has the potential to differentiate what that spot on the skin is. Is it cancer or not, if it's cancer what type of cancer or maybe it's just fibrous tissue. Therefore this technology is being used in some patients now but not on a larger scale and not on the blood yet.
So the blood is the new part?
Dr. Hussein: That's exactly right. The blood is really the new part because the blood is almost the common tissue for all our body. Because the blood passes by the brain, by the heart, by the breast, by the colon, by the pancreas, by the bladder, you have the potential of those cells in these organs to shed into the blood and you can look at so many signatures in the blood to tell me you have an abnormal signature. It looks like it's coming from the colon, go and check the colon. It's amazing. It really is amazing technology and noninvasive.
It's kind of like a map.
Dr. Hussein: You're almost fingerprinting every part of your body. Like we now have the whole genome sequence. A spectroscopy will fingerprint every normal tissue in your body so that when there is an abnormality it will tell us there's an abnormality. And it could tell us where it's coming from because of its resemblance to some of the normal tissue. If the abnormality is abnormal but close to colon signature than maybe it's coming from the colon. But first we need to establish this fingerprint library of all our normal tissues so that when we find something abnormal we will know it's abnormal.
When you take the blood is it just like when you go in the doctor's office they would just take a fingerprint and that's how they would do it or they would have a specific spot?
Dr. Hussein: No they can take the blood from any part of your body but it's going to take more blood than just drops from a fingerstick. It is just taking blood from your vein in your arm. It's 2 to 3 cc's or ml's. Usually we take more than we need when patients come here and we usually throw away the blood. Some patients tell you I don't want to take blood ,what if there are cancer cells in the blood I'm taking. Will these cancer cells even cause trouble for somebody who takes blood? We don't think so, but do we know that for a fact? We really don't know. I mean can I imagine this becoming a screening tool on blood specimen? Maybe in a decade or two not anytime soon.
FOR MORE INFORMATION, PLEASE CONTACT:
Atif Hussein, MD
Memorial Healthcare System
Memorial Cancer Institute
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