Early diagnosis for reduced disease burden

From the IAEA Division of Human Health, Nuclear Medicine and Diagnostic Imaging Section

Breast cancer, infertility and osteoporosis

A comparison between conventional mammography (on the left) and a positron emission mammography (PEM) (on the right) showing more clearly the multi-focal nature of the tumour not seen in the conventional mammography image. (Photo: E. Estrada Lobato, IAEA)

In the first ten years of life, both death rates and causes of death are similar for boys and girls. It is around the age of 15 where different diseases begin to affect men and women differently. During the reproductive years, biological and behavioural differences lead to gender specific health challenges which require differing levels of attention and support from the international community.

There are many diseases that affect females more significantly than males; for example breast cancer, infertility, and osteoporosis. Breast cancer is the most common invasive malignancy in women in both the developed and developing countries. Early detection and diagnosis are key factors in reducing the disease burden of breast cancer. With the help of radiology and nuclear medicine, various screening and diagnostic techniques have been developed in order to improve survival rates. One of the most widely accepted screening techniques is the mammography, which uses X rays to create images of the breast. In sentinel node scintigraphy, a gamma probe is used to detect possible cancer containing lymph nodes. Hybrid PET-CT machines are of vital importance and are routinely used for cancer staging, creating a treatment plan, and for making observations during patient follow-up.

Infertility is a problem that affects both men and women, however it seems that female partners are more likely to be stigmatised. One imaging technique frequently used in diagnosing infertility is the hysterosalpingogram (HSG), where X rays are used to detect the flow of contrast material from the vagina to the fallopian tubes in order to visualise and diagnose blockages, malformations, or damage.

A common concern for most women reaching the age of menopause is the development of osteoporosis, which is three times more common in women compared to men. Osteoporosis is a major risk factor for fractures and is a significant cause of disability in women. With modifications to lifestyle and diet and early initiation of supplements, the severity of the disease can be significantly reduced. Therefore early diagnosis is of utmost importance. The Dual Energy X ray Absorptiometry (DXA) scan is one of the most widely used radiological techniques for estimating the bone mineral density. The DXA scan estimates the risk of developing osteoporosis as well as aids in its diagnosis and is used worldwide to reduce the burden of osteoporosis.

There is limited expertise in quality breast diagnostic and screening services in most countries. X ray mammography is the only test repeatedly proven to reduce the mortality rate for breast cancer, provided access to appropriate high quality imaging, treatment and care is available. A coordinated research project was organized by the Nuclear Medicine and Diagnostic Imaging, and Dosimetry and Medical Radiation Physics Sections of the IAEA Division of Human Health to help improve early detection and diagnosis of breast cancer. This was done by developing the capabilities of centres to detect and diagnose early breast cancer through X ray mammography, breast ultrasound and image-guided needle biopsy, thereby reducing breast cancer mortality and morbidity.

Professionals from Bosnia and Herzegovina, Egypt, India, Kenya, Macedonia, Mexico, Pakistan, Philippines, Slovenia, Turkey, Zambia, in cooperation with the United Kingdom and Australia, came together for a training workshop organised in an oncology centre in Slovenia. The aim was to help doctors gain knowledge on the newest and best developed techniques for early detection of breast cancer. The meeting was very successful and at the end of it, the doctors were able to implement the newly acquired knowledge in their respective countries.

PET/CT image clearly showing ovarian carcinoma with metastasis to the liver and chest. (Photo: E. Estrada Lobato, IAEA)

The picture shows a workshop in which professionals were trained during a meeting held in an oncology centre in Slovenia. (Photo: R. Kashyap, IAEA)