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Early-Stage Diagnosis of Breast Cancer: Amelioration in Approaches

Nidhi Manhas1, Lalita S. Kumar1, and Vinayak Adimule2

1 Indira Gandhi National Open University (IGNOU), School of Sciences, Maidan Garhi, New Delhi, 110068, India

2 Angadi Institute of Technology and Management, Department of Chemistry, Savgaon road, Belagavi, Karnataka, 590009, India

1.1 Introduction

Breast cancer (BC) has become one of the most prevalent malignant tumors in women and is increasing at an alarming rate. Based on the population growth, experts have predicted that by 2050, there will be roughly 3.2?million new cases per year globally [1]. Not only is the number of patients with BC rising all over the world, but also the age of affected patients is tending to be younger [2]. Many factors contribute to these circumstances including age, family history, lifestyle surroundings, and many others [1, 3, 4]. Although the relative risk of BC is inevitable, it is possible to reduce BC mortality rate. Its survival rate largely depends upon the woman's timely access to effective and affordable detection and treatment processes [5]. The World Health Organization (WHO) has also described two different but related approaches to reduce BC, i.e. early diagnosis, which is the recognition of symptomatic cancer at an early stage, and screening, which is the identification of asymptomatic disease in a target population of apparently healthy individuals [6]. In many developing countries, women are unaware about the BC because of which it is detected at later stages [7]. However, there are various organizations working for generating awareness and promoting self-examination of the breast among women. Such efforts will promote the early detection and will help in reduction of the BC mortality rate.

Even previous research has shown that early BC detection, if combined with appropriate treatment, could greatly reduce BC death rates in the long run. Therefore, detecting BC at an early stage is vital. There are different techniques used for its diagnosis. Presently, mammography (MG), breast ultrasound, and breast magnetic resonance imaging (MRI) examination are the most common diagnostic techniques available for the detection of BC [8, 9]. These procedures necessitate specialized equipment, skilled practitioners, and expert analysis but the cost of detection is significantly high. In comparison to these methods, biosensor detection is far more reliable and affordable [10]. Weaver and Leung have summarized the various definitions and applications of biomarkers in imaging BC [11]. On the one hand, breast tumor indicators are critical in the early detection of BC, the characterization of molecular subgroups, the selection of treatment options, and the assessment of survival [12-14], whereas biosensors, on the other hand, provide substantial benefits over standard tumor marker detection methods in terms of specificity, sensitivity, speed, and cost of detection [15, 16] such as chemiluminescence immunoassay [17], enzyme-linked immunosorbent assay [18], proteomics [17], molecular biology methods, and liquid biopsy. Several biosensors with improved sensitivity, selectivity, stability, and low cost have been created in the previous decade [19].

In this chapter, many diagnostic methods such as MG, ultrasonography (US), MRI, microwave BC detection techniques, and various biosensors will be discussed. We herein discuss their most recent advances, as well as their benefits and drawbacks. This will aid researchers and those working on BC diagnostic methods in selecting appropriate approaches for properly diagnosing BC in its early stages.

1.2 Imaging Techniques

The use of imaging techniques reveals the anatomy and position of malignant cells and provides clinicians with valuable clinical information. When contrast agents and high-energy rays are used in imaging procedures, unfortunately, patients may be harmed. As a result, we should discuss different imaging modalities and decide which one is best for BC patients. These techniques mainly include MG, US, MRI, positron emission computed tomography (PET), computed tomography (CT), and single-photon emission computed tomography (SPECT). The benefits and drawbacks of these imaging techniques are listed in Table 1.1.

PET, CT, and SPECT are not advised for diagnosing BC patients due to their high cost, limited practicability, and radiation damage [20]. However, in some circumstances, such as screening for metastatic BC and the presence of bone and lymphatic metastases, these techniques can be employed as additional diagnostic procedures for diagnosing BC. As a result, we solely discuss MG, US, and MRI, which are the primary modalities for detecting BC. These common imaging procedures will be summarized and evaluated to assist clinicians to serve their patients in a better way.

1.2.1 Mammography (MG)

MG is the primary method used for screening and diagnosing BC, and it aids clinicians in gathering clinical data on BC patients. This method is especially advantageous to women between the ages of 40 and 74. Early MG screening may reduce the death rate of BC patients by 30% to 40%, according to one of the earlier research [21]. However, MG has a significant rate of false-positive and false-negative results, especially in individuals with dense breasts (for subjects under 40?years old) [22, 23]. But with time, MG is progressing continuously and has shown good results in terms of diagnostic accuracy, sensitivity, and resolution. Presently, two key diagnostic methods are under practice for detection, i.e. contrast-enhanced mammography (CEM) and digital breast tomosynthesis (DBT) [24, 25]. CEM has been found to be superior to full-field digital mammography (FFDM) in terms of diagnostic accuracy and disease extent assessment, and its efficiency is also comparable to that of MRI as well as US [26-28]. When compared to FFDM, DBT also offers good performance in terms of specificity (96.4%, 57?229/59?381% versus 97.5%, 23?427/24?020, P?<?0.001) [29]. Computer-aided detection (CAD) is an artificial intelligence (AI) technique that has improved the sensitivity of the instrument and decreased human errors as well as false-positive and false-negative results in detection [30]. The combination of CAD with CEM and DBT can significantly improve the performance of these imaging techniques [31, 32]. In individuals who have no indications or symptoms of BC, a 3D MG is utilized to detect the disease as shown in Figure 1.1. The study demonstrated that combining 3D and traditional MG minimizes the need for extra imaging and has increased the accuracy of MVGG up to 94.3% [34]. Various algorithms have been proposed to enhance the MG images. After many experiments and selecting suitable settings, Montaha et al. suggested the BreastNet18 model, which is based on the fine-tuned VGG16. The accuracy of the algorithm grew to 98.02% of the proposed model [35]. Such type of research will help the doctors in efficient and accurate diagnosis of BC.

Table 1.1 Benefits and drawbacks of imaging techniques.

1. Standard for diagnosing BC patients
2. Suitable as a screening method for BC
3. Finding mammary gland calcification

1. Not for people under 40
2. Not for people with high gland density
3. No more than twice a year

1. Screening for young women
2. Noninvasive diagnostic method
3. Finding mammary gland inflammation

1. Not for small mass and a typical tissue
2. Affected by the examining doctor
3. Definition and resolution are not high

1. High sensitivity and specificity to invasive BC
2. Screening of high-risk groups such as family history of BC
3. For patients with breast-conserving surgery

1. Not for everyone such as patients with claustrophobia
2. Not for wide-scale screening
3. Not for BC staging

1. High sensitivity to BC recurrence and metastasis
2. Helpful for staging of the BC
3. High sensitivity to small breast tumor

1. High cost, not recommended as routine screening
2. Not for patients with hypersensitivity to developer

1. Supplementary diagnostic method for BC, such as identifying BC with or without intrapulmonary metastases

1. Not the first choice for diagnosing BC
2. Radiation damage
3. Poor...