Is it cancer? Faster, more precise tests ease stress

Last fall, for one agonizing hour, Suzan Maddox was certain her breast cancer had spread to her lungs.

A chest X-ray ordered during her annual oncology check-up at Duke University Medical Center showed a suspicious dark spot. To Maddox's surprise, her oncologist immediately phoned the cancer center's radiology team and asked that they work her in for an unscheduled CT scan. Her painful hour began.

Scientists are trying to find ways to speed the delivery of news about cancer -- good and bad.

For many patients, follow-up tests take days, even weeks to arrive at a diagnosis, heightening anxieties and stress. While cancer screenings save lives by catching tumors when they are smaller and easier to treat, the high-tech imaging tools medicine relies on are imprecise. They can't tell whether a blob of cells is a malignant tumor or a harmless growth.

That means patients must wait for further analysis, often from a biopsy in which a small sample of tissue is cut out and studied.

"The vast majority of women who are called back with abnormal mammograms do not have cancer, but we are obligated to work them up and find out," said Dr. Etta Pisano, a UNC-Chapel Hill radiologist who has dedicated her career to improving breast imaging. "There is no such thing as a perfect test."

Mammography, the gold standard screening for breast cancer, results in many false positives. For every 1,000 women screened, up to 150 will have an abnormal mammogram, according to national statistics. Somewhere between two and four out of the 1,000 women will actually have cancer.

For lung cancer, the scans are notoriously unreliable. One recent study found that computed tomography scans found lung nodules -- which often lead to surgical biopsies -- in 70 percent of patients scanned, but only 3 percent of patients actually had cancer.

One new effort led by Duke University radiologist Dr. Edward Patz Jr., aims to develop a blood test, similar to the one that signals prostate cancer in men, for lung cancer. Patz's team reported earlier this month that it was 80 percent successful at telling patients with lung tumors from patients without them. Their method, which looks for four different blood markers associated with lung tumors, could eventually lead to a blood test for lung cancer.

Resolution in one day

Duke also has led the Triangle in working to make the anxiety-provoking process of sorting out abnormal cancer scans faster and less stressful for patients. Maddox, the breast cancer survivor, is a prime example. She knew whether she was dealing with a recurrence the same day her routine chest X-ray raised a red flag.

Within 30 minutes, Maddox got the more sophisticated scan and welcome news: the sinister spot wasn't cancer. It was a blood vessel the X-ray had gotten a strange view of.

"Thank God they were able to get me in that afternoon," said Maddox, 57. "That one hour when I didn't know was just torture. What would it have done to me if it had been one week?"

Duke strives, whenever possible, to work patients in for same-day follow-up scans and even biopsies, said Dr. Thomas D'Amico, medical director of clinical oncology at Duke. Even pathology studies are typically done on-the-spot, so there's no waiting for days to learn whether biopsied tissues are cancer.

"We're talking about whether these people have cancer," D'Amico said. "We're sensitive to what that means."

But Duke's system, which has cancer specialists and related clinicians all under one roof, is not the norm. Most patients must wait days or even weeks to get in for the follow-up scans, physical exams and biopsies that decide their fates.

Morgan Wilkinson of Apex knows all too well. In 2005, it took four or five appointments with Raleigh doctors over two or three weeks to discover that the blip on her mammogram was not cancer.

"After a while, I was like, 'Just give me resolution,' " Wilkinson said. "I just wanted an answer."

Dr. Lisa Tolnitch, a Raleigh surgeon who specializes in breast cancer, doesn't think it's right for women to have to work so hard just to find out whether they have cancer. She partnered with a Raleigh radiology practice three years ago to have a radiologist in-house. Since then, Tolnitch has offered patients same-day follow-up mammograms if their screening reveals an abnormality.

Getting patients back for biopsies, if they are needed, usually takes a few days, Tolnitch said. When everything lines up right and her patients can clear their own schedules, it's sometimes possible to go from screening to biopsy results in the space of a week, Tolnitch said.

Still worth the wait

Women who must wait longer can take comfort in knowing that the arduous process of getting answers truly saves lives. Breast cancer deaths have dropped steadily since the 1990s, according to the National Cancer Institute. Researchers credit early detection as one of the factors driving the trend.

"The goal of mammogram is to find cancers before they can be" detected with manual exams, Tolnitch said. "It's better to find it, if it is cancer, when it's smaller. The smaller the better."