Yearly, over 130,000 women in Europe, and half a million worldwide, die from breast cancer, even though screening and improvements in treatment have halved breast cancer mortality.
After breast cancer diagnosis, in general, treatment planning is based on the already acquired diagnostic images. Advanced methods, like magnetic resonance imaging (MRI), is only sometimes used for assessing tumor size and detecting additional tumors in the breasts immediately after diagnosis. At some institutions, MRI is also used midway and at the end of chemotherapy performed before surgery. This chemotherapy is used about one quarter of the cases before surgery to shrink the tumor and allow for surgery which does not need the removal of the whole breast. Currently this chemotherapy is planned based on what is discovered about the tumor from the biopsy. However, tumors are known to have regions that are different within them, resulting in regions that react differently to different drugs. This variability in chemotherapy response may be due to this tumor heterogeneity, which is not considered during treatment planning. As a result, less than half of the chemotherapy treatments result in the entire tumor disappearing. Therefore, there is a need to develop a method to identify all the different characteristics of every tumor. This would maximize the chances of achieving complete response from the tumor during pre-surgery chemotherapy, improving the chances of surviving breast cancer, especially in patients with the most aggressive tumors.
To achieve this, an imaging modality that can see what the tumor is made of, how it behaves and works internally, with smaller details and faster processes is needed. Therefore, in BREAST4D, we will develop a new breast imaging method, called 4D breast computed tomography (CT), based on the same concepts of body CT, which is now common in every radiology department, and 3D breast CT, a new imaging method to find breast cancer and determine the shape and size of breast tumors. However, 3D breast CT cannot determine what tumors are made of or how they function. In BREAST4D, we will develop the hardware and software necessary to create 4D breast CT, and perform the initial patient tests to show that it could be used to improve treatment planning and monitoring of response to treatment.
An imaging method such as 4D breast CT would result in a better understanding of the tumor nature and environment, allowing for treatment planning to be optimized, increasing the chances of achieving complete removal of the tumor. In addition, by repeating the imaging during chemotherapy, any changes in response or the fact that the tumor disappeared before the end of the planned treatment, could be seen and then the treatment could be modified, as needed. Finally, if an imaging method were able to predict or detect that the tumor completely disappeared during chemotherapy, then it would be possible to avoid any breast surgery completely. This high-risk clinical development has the potential largest pay-off: the avoidance of surgery on all patients that achieved complete chemotherapy response. In cases in which complete disappearance of the tumor has not been achieved, the information obtained from 4D breast CT would provide exquisite information for surgery planning, maximizing the chances that the entire tumor is removed while minimizing the amount of healthy tissue removed.
Therefore, 4D DCE-BCT may impact breast cancer treatment in all its phases: staging, treatment planning, response prediction and monitoring, and final outcome determination. With its unparalleled combined high spatio-temporal resolution, this imaging modality has the potential to allow for a precision medicine approach to breast cancer treatment, reducing mortality while minimizing morbidity.
