Breast Cancer is the most common cancer among women worldwide[1]. But thanks to the efforts of scientists and product designers, this rate is falling. We now know more about breast cancer, and how to fight it, than ever before. Clinicians around the world are committed to diagnosing and treating breast cancer. Drs. Vourtsis and Tozaki share their perspectives and approaches to breast care for their patients around the world.

Dr. Athina Vourtsis, Radiologist and President of the Hellenic Breast Imaging Society in Greece, has worked in breast health for twenty years and has become one of the top experts in the field. Since 1997 she has focused exclusively on the diagnosis of breast diseases. She reads over 4,500 mammograms, performs over 3,500 breast ultrasounds and more than 200 interventional procedures every year.

At her private practice, Dr. Vourtsis uses latest technology that she feels gives her the best chance at spotting cancer at the earliest stage possible. To complement mammography examinations, she uses breast ultrasound as she feels this enables her to identify additional hard-to-spot tumors, especially in women with dense breasts.

“In Greece, we do not have a national screening program,” said Dr. Vourtsis. “This has given me the opportunity to integrate personalized breast imaging into my own practice.”

“In women with dense breasts, we know that mammography has certain limitations. In order to overcome these, it is necessary to implement breast ultrasound. I use the Invenia™  ABUS (Automated Breast Ultrasound System), and I feel much more confident in my interpretation and in the accurate diagnosis of the disease than I would have with mammography alone.”

“I believe it has opened a new horizon for breast cancer screening.”

Breast density is a measurement of the amount of fatty tissue versus the amount of fibrous tissue in the breast. The more connective tissue there is, the denser the breast tissue is and the whiter it will look on a mammogram. Both cancer and dense tissue show up white on a mammogram, so looking for tumors in women with this natural breast tissue variation can be like looking for a snowball in a snowstorm.

On ultrasound, cancer appears black, and stands out from fibrous tissue.  Developed to help doctors find cancers hidden in dense breast tissue, ABUS technology is designed for screening women with dense breasts as an adjunct to mammography. It has shown a 55% relative increase in detecting invasive breast cancers in women with dense breasts over mammography alone[2].

“Some cancers are obscured in mammograms of dense breasts, and can be missed. However, with ABUS, we find more breast cancers far sooner than we would have without ultrasound.”

Another factor helping more Greek women catch cancer earlier is raised awareness. “Greek women are very well-informed,” added Dr. Vourtsis. “Not just through the media, but also through the Panhellenic Breast Cancer Awareness Society, called Alma Zois.”

“Of course, if women feel a lump they will come in with anxiety. But we are seeing women being much more confident now, when they come to be screened. I’m pleased to say that most women I see are well aware of the necessity of ultrasound and the fact that it should be used to complement mammography if they have dense breasts.”

Dr. Mitsuhiro Tozaki, Director of the Breast Oncology Department at Sagara Breastopia Healthcare Group, is an expert in diagnostic imaging who works hard every day to raise the quality of breast cancer diagnosis in Japan. Based in Kyushu, southern Japan, the Breastopia Healthcare Group is a pioneer in women’s healthcare, including breast cancer diagnosis and treatment. Most recently, they have been engaged in a new experimental venture. They have opened a satellite clinic in Tokyo, which provides remote diagnostic imaging services. At the satellite clinic, Dr. Tozaki can give his invaluable second opinion and expertise to a total of nearly 2,000 mammograms and ultrasound images transmitted from the hospital in Kyushu.

These remote diagnostic centers have yet to become widespread in Japan. But Dr. Tozaki hopes that this kind of effort will expand nationwide. The ability to easily undergo breast exams at a clinic near home, and have the images read by specialists wherever they are in the country, would have major advantages, he said.

The fact is that at about 30% [3], the breast exam rate in Japan is very low for an advanced industrial nation.The sheer numbers of both breast cancer cases and deaths are on the rise. What’s more, according to a recent survey [4], only 1% of Japanese people are aware of dense breast tissue, a natural variation in breast tissue that can make it harder to detect cancer, despite the fact that 80% of Asian women aged 50 and under have high breast tissue density [5]. To help improve the situation, Dr. Tozaki joined forces with other doctors and breast cancer survivors to form the nonprofit organization, Breast Cancer Imaging Network (BCIN). While working with outside organizations such as “Are You Dense?” in the United States, Dr. Tozaki’s nonprofit provides accurate information on breast cancer and breast cancer exams while enabling doctors in the field to collaborate on efforts to make diagnosis easier, especially for women with dense breasts.

Regarding the extremely low level of awareness of dense breast tissue in Japan, Dr. Tozaki added: “Even in America, where disclosure to breast exam patients of their breast tissue density is mandated by law in some states, the awareness rate is only 48% [4]. So in a sense, Japan’s 1% awareness rate can be understood in that context. And yet, we are actively putting out information at BCIN, and there are healthcare facilities that have recently begun to distribute printouts to examinees, showing them what kind of breast tissue density they have. Knowledge of dense breast tissue enables a woman to take action on her own initiative. So I want to believe that this is going to spread in Japan.”

“To Japanese women, many of whom have dense breast tissue, I strongly recommend undergoing breast exams,” said Dr Tozaki. “I’m not denying screening by mammography. I’d simply want you to know what type of breast tissue you have since the resulting knowledge enables you to know what action you should take next. To every woman, I would like to suggest taking an active interest in your own health in this way.”

[1] U.S.A data Source: National Breast Cancer Foundation, Inc.

[2] Assessing Improvement in Detection of Breast Cancer with Three-dimensional Automated Breast US in Women with Dense Breast Tissue: The SomoInsight Study. (Authors: Rachel F. Brem, MD, László Tabár, MD, Stephen W. Duffy, MSc, Marc F. Inciardi, MD, Jessica A. Guingrich, MD, Beverly E. Hashimoto, MD, Marla R. Lander, MD, Robert L. Lapidus, MD, Mary Kay Peterson, MD, Jocelyn A. Rapelyea, MD, Susan Roux, MD, Kathy J. Schilling, MD, Biren A. Shah, MD, Jessica Torrente, MD, Ralph T. Wynn, MD, Dave P. Miller, MS)

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[3] OECD Health Data 2013

[4] GE Healthcare Survey, conducted in June – July 2015, targeting approximately 4,500 people over 18 years of age, in U.S., Brazil, England, Indonesia, Japan, India, China, Australia, Korea

[5] Jeffrey A. Tice et at, Ann Intern Med. Mar 4, 2008; 148(5): 337-347