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Breast Imaging Expert Panel:
Using Risk to Triage Women to the Right Screening Tools Like ABUS
With an estimated 562,500 new cases per year, breast cancer remains the most common cancer impacting women across Europe.* National breast screening programs for women of average risk are offered in nearly all European countries based on the European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis, and EUSOBI attributes a 40% reduction in breast cancer mortality based on population-based screening.**

Mammography has been proven to save lives; however, there is growing recognition that population-based screening with mammography alone may not be enough.

Breast density is a critical factor in triaging women to the right screening tool based on their personal risk to increase the likelihood of early detection. Due to its clinical importance, breast density has been recently incorporated into Tyrer-Cuzick and Breast Cancer Surveillance Consortium risk models.

Athina Vourtsis, MD, PhD, Director and Radiologist at Diagnostic Mammography in Greece

Professor Fiona Gilbert, University of Cambridge, Cambridge, UK

PD Dr. Stephan Seitz, Gynecologist, University Medical Center Regensburg, Caritas Krankenhaus St. Josef

Ruta Briediene, MD, PhD, of Affidea and the National Cancer Institute, Lithuania
In advance of EUSOBI, four of Europe’s leading breast imaging experts ponder the question – can we reduce the cancers that might be missed due to dense breast tissue using risk-based screening protocols, triaging women to supplemental screening tools, such as automated breast ultrasound (3D ABUS)?
Q. Why do you believe that a risk-stratified breast cancer screening approach is needed?
Prof. Gilbert: As we get results from more trials designed to evaluate what cancers are found by which imaging modalities, we start to have evidence that shows benefit for using a risk-based approach rather than just our population approach. The next step is to look at how we would implement risk-based screening so that when women go to the imaging center, they know: ‘This is my risk. This is which imaging test I should be getting and how frequently.’ Hopefully within a five-year period, breast density measurement and risk assessment will be a more robust automated process.

PD Dr. Seitz: We are one of 21 academic centers assigned to deliver the high-risk screening program in Germany. The recommendation for all women at high risk is to perform an annual MRI and breast ultrasound starting at age 25 because of a potential early incidence and higher breast density in younger women, on average.
Dr. Vourtsis: In order to overcome the limitations of mammography for women with dense breasts, a risk-based strategy improving the utilization of supplemental screening approaches must be considered.
Q. What role does education play in advancing personalized screening approaches?
Dr. Briediene: We have to continually educate our patients that breast diagnosis is sometimes like a puzzle, where you need to use all the parts of a puzzle, from medical history, clinical exams, follow up information, mammography, ultrasound, MRI and histology results correlation. Recently, we introduced ABUS to our patients and their physicians as an important new technique, especially for dense breast evaluation. Working with “Women Go Tech” we launched a campaign called #differentyetstrong, where 50 members of "Women Go Tech" had ABUS exams and shared their experience and why it is important to find time for yourself and to take care of your own health.

Dr. Vourtsis: In the U.S., advocacy groups have improved awareness and understanding through breast density reporting legislation; however, further communication efforts are needed in Europe. Many women are still not aware of the composition of their breast and how increased breast density may lead to a delayed diagnosis. When this important information is not delivered to women, it compromises their access to supplemental screening and its benefits.
To help improve breast density education across Europe, Dr. Vourtsis has joined efforts with the U.S.-based non-profit DenseBreast-info as the organization’s European liaison along with Cheryl Cruwys, who serves as the European Education Coordinator.

Medically-sourced, DenseBreast-Info/Europe is the only educational website on the topic developed specifically for European medical healthcare professionals. Key features of DB-I Europe website:
Dense breast primer for healthcare professionals
Country-specific screening guidelines map
FAQs with literature citations
Screening flowchart
CME/CE: breast density: why it matters
Q. What feedback have you received from patients on ABUS exams?
Dr. Briediene: In the era of new medical technologies, patients must have the opportunity to access the newest imaging tools to get the best diagnostic results. ABUS is a perfect tool for screening and we have had very positive feedback from our ABUS patients – most of whom indicate the exam as painless, fast and informative. I believe that ABUS is a big step forward for personalized breast cancer screening in the dense breast population.

Dr. Vourtsis: We integrated the Invenia ABUS into our clinical practice in 2016 and have performed more than 5,750 exams. Well-trained technologists, adequate compression of the breast, and meticulous application of coupling lotion are key to produce an efficient ABUS examination and to improve performance, with a goal of earlier detection and better outcomes.

PD Dr. Seitz: ABUS is a very suitable technology for the early detection of breast cancer because of the global visualization of the breast. The storage of the complete data set to evaluate the breast at a later stage, to compare it with priors and to make a potential double reading in suspicious cases are the most valuable advantages in a breast center like ours.
Invenia ABUS 2.0: Improving detection and overall experience
As the breast care community continues to evolve protocols to personalize breast care for better outcomes, there is a growing need to develop a parallel path to advance technology. Supplemental screening with automated breast ultrasound (ABUS) transforms breast care from reactive to proactive, helping clinicians be more confident, and patients avoid potential delayed diagnosis. Invenia™ ABUS 2.0 is the only FDA-approved ultrasound supplemental breast screening technology, specifically designed for detecting cancer in dense breast tissue.

“The new Invenia ABUS 2.0 was designed to help improve the exam experience for both operators and patients, to enhance the reading experience for radiologists and to advance image quality through a new software-based image formation processor called cSound. We had a lot of input from users on the improvements they were looking for. The system’s new features and updates help further customize each exam, provide improved workflow and help bring the standardization and consistency that are needed in the screening environment,” says Luke Delaney, General Manager of Automated Breast Ultrasound at GE Healthcare.

The powerful cSound™ Imageformer, a software-based graphics processor, provides a reproducible and operator-independent acquisition method to achieve consistent, high-quality results. cSound imaging allows significantly more data to be collected and used to create every image. Traditional hand-held ultrasound parameters are automatically optimized, requiring no image manipulation and resulting in high image quality that is consistent from operator to operator with the touch of a button.

The gentle shape of the Reverse Curve™ transducer provides patient comfort, thorough contact and helps ensure comprehensive coverage. The 15 cm large field-of-view transducer is easy to position and maintains even compression while scanning. Exams can be customized with programmable scan protocols, adjustable scan depths and compression levels.

“Our experience working with the Invenia ABUS 2.0 is that the image processor is faster providing even more efficient image interpretation and reporting. The image quality has been upgraded providing higher contrast and higher spatial resolution and better penetration for larger and denser breasts. Since no two women are identical, this improves patient comfort while it improves image quality and decreases the creation of artifacts,” says Athina Vourtsis, MD, PhD, director and radiologist at Diagnostic Mammography in Greece.
Learn more about how Invenia ABUS 2.0 can help elevate your breast care.
GE Healthcare at EUSOBI
Educational Sessions
EUSOBI – 3-5 October, Budapest
No registration required, seating is limited.
Attend the GE Healthcare Sponsored Lunch Symposium, Saturday, 5th October, 12.30
Elevating personalized breast care: Take advantage of multi-modality approaches

Moderators: V. Lehotska, MD, Bratislava/SK; L. Martincich, MD, Candiolo/IT
Personalized and risk-stratified screening with Invenia ABUS 2.0 using latest cutting edge technology – A. Vourtsis, MD, Athens/GR
A six-year prospective evaluation of second-look US with volume navigation for MRI-detected additional breast lesions – A. Fausto, MD, Siena/IT
Extent of disease, management decisions, new tools – the one stop unit for breast diseases – C. Balleyguier, MD, Villejuif/FR
Attend the GE Healthcare Industry Workshop, Friday, 4th October, 9.45 - 10.45
Hands-on Automated Breast Ultrasound Workshop

Register to attend this interactive hands-on reading workshop to review clinical cases in a multi-modality approach. Attendees will also learn about the latest scientific evidence and some key highlights of the new innovative Invenia ABUS 2.0.
Speaker: Athina Vourtsis, MD, Athens/GR
Seating is limited – Register soon!
Upcoming events
JFR Paris – 11-14 October
Join our GE Breast Ultrasound Symposium on Saturday, 11th October
No registration required, seating is limited.
Implementation of new Ultrasound Technologies for Individualized Approach to Breast Care Symposium
Personalized and risk-stratified screening with Invenia ABUS 2.0 using the latest cutting edge technology – Athina Vourtsis, MD, PhD, Director and Founder of Diagnostic Mammography Center, Athens, Greece; Founding President of the Hellenic Breast Imaging Society European Liaison and Member of the Medical Advisory Board of DenseBreast-Info.org
Potential of AI in Breast Ultrasound with new AI-based softwares dedicated to hand-held and automated ultrasound – Magda Marcon, MD, Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
Six-year prospective evaluation of second-look US with volume navigation for MRI-detected additional breast lesions – Alfonso Fausto, MD, Department of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese AOUS, Siena, Italy
Invenia ABUS 2.0 is part of the suite of personalized breast care solutions from GE Healthcare. To learn more please click on the boxes below:
*Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2018). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available from: https://gco.iarc.fr/today, accessed [30 October 2018]. Statistics for Europe are based on WHO Europe region of 53 countries. Data for Andorra, Monaco and San Marino are not included

**Sardanelli, F., Aase, H.S., Álvarez, M. et al., Position paper on screening for breast cancer by the European Society of Breast Imaging (EUSOBI) and 30 national breast radiology bodies from Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Israel, Lithuania, Moldova, The Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Spain, Sweden, Switzerland and Turkey, Eur Radiol (2016). doi:10.1007/s00330-016-4612-z

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