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Mammography and Beyond: Developing Technologies for the Early Detection of Breast Cancer

A Non-Technical Summary

COMMITTEE ON THE EARLY DETECTION OF BREAST CANCER

Margie Patlak, Sharyl J. Nass, I. Craig Henderson, and Joyce C. Lashof, Editors

National Cancer Policy Board

INSTITUTE OF MEDICINE

and

COMMISSION ON LIFE SCIENCES

NATIONAL RESEARCH COUNCIL

NATIONAL ACADEMY PRESS
Washington, D.C.



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Page i Mammography and Beyond: Developing Technologies for the Early Detection of Breast Cancer A Non-Technical Summary COMMITTEE ON THE EARLY DETECTION OF BREAST CANCER Margie Patlak, Sharyl J. Nass, I. Craig Henderson, and Joyce C. Lashof, Editors National Cancer Policy Board INSTITUTE OF MEDICINE and COMMISSION ON LIFE SCIENCES NATIONAL RESEARCH COUNCIL NATIONAL ACADEMY PRESS Washington, D.C.

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Page ii NOTICE: The project that is the subject of this report was approved by the Institute of Medicine and the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. Support for this project was provided by the Breast Cancer Research Foundation, the Carl J. Herzog Foundation, Mr. John K. Castle, the Jewish Healthcare Foundation (Pittsburgh, Pa), the Josiah Macy, Jr., Foundation, the Kansas Health Foundation, and the New York Community Trust. The views presented in this report are those of the Committee on Technologies for Early Detection of Breast Cancer and are not necessarily those of the sponsors. For copies of this booklet, please contact the National Academy Press , 2101 Constitution Avenue, N.W. , Lockbox 285, Washington, D.C. 20055 ; toll-free customer service (888) 624-8422 ; fax (202) 334-2451 . $5.00 each for 1-9 copies $2.50 each for 10-49 copies $1.75 each for 50-99 copies $1.25 each for 100+ copies Shipping: Please add $4.50 per shipment plus $.20 per booklet to cover shipping and handling. To obtain additional copies of Mammography and Beyond (ISBN 0-309-07283-2 ) from which this booklet is derived, please contact National Academy Press (at the address above). For information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright 2001 by the National Academy of Sciences . All rights reserved. Printed in the United States of America. COVER: Rosalie Ann Cassell, Waiting for the Biopsy, 1998. 18” × 22.” Watercolor and ink. http://www.breastcancerfund.org/gallery_6.html. Art.Rage.Us. The Art and Outrage of Breast Cancer.

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Page iii THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

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Page iv CONTENTS 2 Introduction 6 Theory and Principles of Cancer Detection 9 Breast Cancer Detection Technologies in Development 15 Barriers to the Development of Breast Cancer Detection Technology 25 Summary 27 Glossary 30 Committee on Technologies for the Early Detection of Breast Cancer ABOUT THIS PUBLICATION The Institute of Medicine report Mammography and Beyond: Developing Technologies for the Early Detection of Breast Cancer evaluates the scientific evidence regarding the use of technologies for breast cancer screening and diagnosis, and examines the process by which new technologies are developed, assessed, and adopted into clinical practice. It contains a comprehensive list of references, and makes recommendations for further research, for improving the technology development process, and for making optimal use of the technologies currently available for breast cancer detection. The intent of this publication, which is derived exclusively from that report, is to make the information contained in the original report more accessible to women who are concerned about public policies regarding early breast cancer detection. In this publication, the Institute seeks to provide a short, easily understood version of that information to women. Joyce C. Lashof Chair Committee on Technologies for the Early Detection of Breast Cancer I. Craig Henderson Vice Chair Committee on Technologies for the Early Detection of Breast Cancer Sharyl J. Nass Study Director