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This month's journal addresses one such important issue in an original research article, namely CAD versus second reading in screening mammography. Dr. Georgian-Smith and her fellow researchers compare the two forms of second reading in a retrospective study to assess for a reduction in false-negative cases by the primary interpreting radiologist. The commentary by Dr. Brem in this month's AJR further high-lights the importance of this topic.
Some of the researchers involved in the abovementioned articles also serve on the advisory panel of WIO. WIO boasts an advisory panel of more than 50 women's imaging specialists from all over the world with expertise in virtually all subspecialty areas and techniques in women's imaging. Recently, ARRS asked the panel to reflect and comment on what they believe are the most important unanswered questions in women's imaging today. Their responses included such questions as:
Since its inception in 2006, the Women's Imaging section of AJR has featured more than 100 articles, beginning what we hope will be a relentless effort to chip away at these unknowns. In addition to the highest quality peer-reviewed and CME-accredited articles, the ARRS holds symposiums and educational courses such as the upcoming Breast MRI course in Las Vegas, NV, in February 2008, and the half-day Breast MRI course during the ARRS Annual Meeting in Washington, DC, in April 2008. These meetings allow women's imagers firsthand access to information and face-to-face dialogue with the experts in the field.
The poll of the WIO panel revealed that a major area of concern to them and the women's imaging community at large is ovarian cancer, a silent killer. Ovarian cancer is the most deadly of all gynecologic cancers, and the fifth leading cause of cancer deaths among American women. An estimated 15,000 will occur in 2007 from this disease. In addition, more than half the women who are diagnosed with ovarian cancer will die within 5 years [1]. Currently, there is no cost-effective screening test for ovarian cancer. Laparotomy is still the first-line procedure for diagnosis and treatment. As with any surgical procedure, not only morbidity, but also mortality and expense are of concern. The entire medical community is in search of a better way.
The mainstream press also has picked up on our inability to predict and detect ovarian cancer in its earliest forms. Articles have appeared in newspapers and Websites worldwide citing the mortality rates of the disease, the low survival rate resulting from late diagnosis, the lack of definite early warning signs, and the heart-wrenching stories of patients' personal frustration and loss. The federal government named September as National Ovarian Cancer Awareness Month, acknowledging the magnitude of the problem.
Recently, the Gynecological Cancer Foundation (GCF) released a consensus statement listing possible early warning symptoms of ovarian cancer, but the list is composed of nonspecific findings. As listed by the GCF, those early symptoms are bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly, and urgent or frequent urination [2]. The very same signs and symptoms commonly are found in many benign disorders, with a relatively low prevalence of malignancy in the general population. In short, without new techniques and approaches, we are literally "looking for a needle in a haystack."
Some promising new developments have arisen, that may make inroads into improving detection of early ovarian cancer when it is potentially curable. These efforts include the combination of imaging studies with serum biomarker assays for screening high-risk women. However, as noted in the American Cancer Society's "Cancer Facts and Figures," 2007, for women at average risk of developing ovarian cancer, there is no accurate means of ovarian cancer screening at present [3]. We can and must do better.
In surveillance for recurrent tumor, researchers currently are investigating the use of molecular imaging. We already know that molecular imaging is useful in later stages of ovarian cancer. In a WIO article entitled "PET-CT for Gynecologic Cancers," the authors state, "PET-CT has been shown to be the most accurate imaging modality for detecting persistent or recurrent tumor in ovarian cancer patients who have undergone primary cancer debulking surgery and chemotherapy. Advantages of PET-CT include more sensitive and precise anatomic localization of lesions and differentiation of posttreatment fibrosis from neoplastic disease" [4].
In marrying morphologic imaging with molecular agents, we aim to find the cancer early. But that is not enough. The goal is to improve survival. In the next decade, the field of proteomics will enable us to better identify populations at risk for developing malignancy through gene expression. Molecular imaging will likely revolutionize tissue characterization and diagnosis, permit image-guided therapy, and enable monitoring response to treatment. With each advance, we are a little closer to the goal of reducing mortality.
This month, the Women's Imaging section contains seven articles that add to and refine our knowledge of women's imaging issues, including breast cancer, pregnancy complications, primary extrauterine ovarian choriocarcinoma, and other reproductive concerns. Though the months designated to heighten awareness of ovarian and breast cancers have passed, women's imagers remain vigilant. We have a duty to our patients that goes far beyond merely rendering an accurate radiology report. Women as patients expect to be "cared for" and "healed" and not just to be "imaged." As long as there are unanswered questions in women's imaging or any other specialty, radiologists will be searching for solutions. And the AJR with all its resources—both in print and online—will be a valuable tool in that search.
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