Feature image: CARTI Cancer Center in Little Rock (Photo provided by CARTI)
Few professions are as forward thinking as medicine, where breakthroughs not only have the chance to improve lives but save them. The width and depth of oncology make it a field especially primed for constant innovation. New surgical tools, evolving diagnostic approaches and an ever-deepening understanding of the illness itself push researchers and health care providers closer to the ultimate goal for any disease — a cure — every year.
One area of particular interest is breast cancer, which, according to the American Cancer Society, accounts for about 1 in 3 new female cancers each year. From 2012 to 2021, the ACS noted that breast cancer incidence increased by 1 percent annually and had a steeper uptick among women under 50. On the other hand, the breast cancer death rate has dropped by 44 percent since 1989 due to advances in treatment and early detection, “resulting in approximately 517,900 averted breast cancer deaths.”
Arkansas’ own statistics show much work to be done. Per a 2023 press release from the Arkansas Department of Health, nearly 400 women die due to breast cancer, and more than 2,500 women are diagnosed with breast cancer each year in Arkansas. Breast cancer is the most common cancer for Arkansas women, yet the state ranks 32nd lowest for mammography.
DETECTION AND DIAGNOSIS
Dr. Yara Robertson, CARTI’s medical director of surgery, echoed the ADH’s sentiment. Breast cancer screening rates are steadily improving, she said, but the state still has a long way to go. CARTI’s Breast Center encourages patients to take a proactive approach by speaking to their providers about risk and necessary screenings, regardless of age.
Dr. Yara Robertson
“Last year, the U.S. Preventive Services Task Force took a step in the right direction, updating its recommendations to lower the breast cancer screening starting age to 40,” Robertson said. “However, the UPSTF missed vital early detection opportunities by failing to promote yearly screenings for women over 40 and not encouraging women with dense breasts to receive supplementary screenings with ultrasound or MRI or promoting risk assessments for patients under 40.”
The task force now recommends a mammography every other year for women ages 40 to 74. Previously, women were recommended to start this screening between the ages of 40 and 50. It seems hard to overstate the impact early detection can have; a 2024 report from the Arkansas Central Cancer Registry stated that “early diagnosis for a localized breast cancer diagnosis has close to a 100 percent five-year relative survival.”
In 2024, the U.S. Food and Drug Administration began enforcing a rule in the Mammography Quality Standards Act that requires radiology and mammography facilities notify patients about the density of their breasts. While not abnormal, dense breasts can make a mammogram more difficult to interpret, the National Cancer Institute states. Knowing one’s breast density enables more informed decision-making around other methods, such as breast ultrasounds or MRIs. Additional screening can increase the risk of a false positive, however, making it necessary for individuals to consult with their doctors to determine the best approach.
“Innovations in imaging and biomarker identification are at the forefront of [early detection] efforts,” said Dr. Sam Makhoul, medical director of clinical research at CARTI. “Among these advancements are multicancer early detection methods, which analyze fragments of cancer genomes in the blood. While not yet suitable for early breast cancer detection, these methods hold promise for identifying up to 20 different cancers simultaneously.”
Dr. Sam Makhoul
Breast CT scans have shown potential as an effective, more comfortable alternative to mammograms. The Koning Vera breast CT scanner does not use compression, making it an option for women whose aversion to the discomfort of a mammogram keeps them from regular screenings. The Genesis Imaging Center at Arkansas Heart Hospital in Bryant is the first in the state to offer the technology.
Koning Vera breast CT scanner (Photo provided by Arkansas Heart Hospital)
Dr. Bruce Murphy, CEO at the Heart Hospital, said the Koning CT scanner offers 90 percent higher detection rates for breast cancer compared to traditional mammograms and can identify lesions as small as 2 millimeters. A spokesperson for the hospital described it as a “consumer choice rather than a replacement for mammograms.” While mammograms are still the FDA’s screening tool of choice, patients with dense breast tissue or implants or those seeking early detection due to a family history of breast cancer might benefit from the more precise images of the Koning scanner.
During the scan, patients lie on their stomach with one breast positioned in an opening. With a 360-degree scan in seven seconds per breast, the Koning CT captures high-resolution 3D images. The detailed images allow visualization of dense breast tissue, implants and areas near the chest wall that mammograms can miss. With the possibility of identifying lesions two to three years earlier than a mammogram, Murphy’s hope is the Koning CT scanner will improve detection rates and patient outcomes, particularly for high-risk populations.
The Koning Vera offers clearer images and higher detection rates than traditional mammograms. (Photo provided by AHA)
The Koning device is only available at the Genesis Imaging Center for now, but given its accessibility and diagnostic accuracy, the technology seems primed for statewide adoption. Murphy said he is hopeful the expanded reach will come as more insurance providers offer coverage for the Koning CT screening method.
For those curious about the radiation used during screenings, health care providers and other experts offer a bevy of information outlining the pros and cons. The American Cancer Society writes that, measured in millisieverts, the average mammogram’s radiation dose is about 0.4 mSv. To put that into perspective, the average person in the U.S. is exposed to about 3 mSv of background radiation each year from their natural surroundings. The Koning CT scanner uses even less radiation than a mammogram. The average patient has little reason for concern, and exceptions are best discussed with one’s health care provider.
“The American College of Radiology notes that mammograms are the ‘only test shown to reduce breast cancer deaths,’” Robertson said. “For women 40 and over of average risk, the benefits of receiving their recommended annual mammogram far outweigh any possible harm of radiation exposure.”
TAILORED TREATMENT
For those who develop cancer, surgical breakthroughs and evolving therapies give patients more options before, during and after treatment. One example is in the realm of mastectomies, which can add layers of distress to an already emotional medical journey.
“A cancer diagnosis is often accompanied by uncertainty and a lack of control,” Robertson said. “For women facing the potential loss of their breasts — what many consider a core component of their femininity — these feelings may be even more pronounced.”
Breast reconstruction can provide some relief but has traditionally been unable to address the numbness that can result from severed nerves during the mastectomy. New surgical techniques such as Resensation aim to repair these nerves and may be able to restore feeling during the reconstructive procedure. Progress elsewhere in medical and radiation oncology is also improving the ability of physicians to pursue more effective, personalized care.
“Genomic profiling now enables us to identify high-risk patients who may benefit from intensive chemotherapy, while low-risk patients can often have their treatment de-escalated or even forgo chemotherapy altogether,” Makhoul said. “Certain genomic alterations also open doors to targeted therapies, providing new opportunities for cure.”
The focus in radiation oncology, he said, has shifted to the more tailored approaches. “Pinpoint” radiation targets tumors while sparing the healthy surrounding tissue, and genomic profiling can help some patients completely avoid radiation therapy. CARTI also embraces promising immunotherapy approaches, which could harness a patient’s own immune system to combat the disease.
On other experimental fronts, studies have suggested that some early-stage breast cancer patients might be able to forgo certain surgeries, as well. Makhoul pointed to research on ductal carcinoma in situ, or DCIS, an early form of breast cancer that affects the milk ducts in the breast. Active monitoring could be as effective as immediate surgery in preventing the disease’s progression into invasive cancer over a two-year period, he said, but researchers will need to perform more trials with longer follow-up periods to confirm those results.
“Our program is the only one in Arkansas to achieve [the American Society of Clinical Oncology Quality Oncology Practice Initiative] certification, a distinction that recognizes excellence in delivering safe, cutting-edge cancer therapies,” Makhoul said. “At every stage, particularly when standard-of-care options remain limited, our research department offers innovative treatment options designed to improve the chances of a cure or enhance the quality of life for our patients.”
REGIONAL LEADERSHIP
Meanwhile, at the University of Arkansas for Medical Sciences in Little Rock, Dr. Michael Birrer, vice chancellor and director of the Winthrop P. Rockefeller Cancer Institute, is heading an effort to become the state’s first National Cancer Institute-designated hospital. The NCI label reflects a level of leadership in research and care held by only 72 cancer centers in the country. As the tip of the spear when it comes to innovative therapies and breakthrough treatments, NCI-designated hospitals receive the majority of NCI funding and exclusive access to certain grants.
Dr. Michael Birrer
Birrer came to Arkansas after a stint as head of the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham — itself an NCI-designated hospital. He previously served as a professor of medicine at the Harvard School of Medicine and directed the gynecologic medical oncology program at Massachusetts General Hospital and the gynecologic oncology research program at the Dana Farber/Harvard Cancer Center.
In addition to its own philanthropic outreach, UAMS has the monetary and legislative support of the state, which in 2019 created an account for the deposit of NCI designation funds and has approved millions of dollars towards the university’s goal. It is a mutually beneficial exercise, since the recognition would not only be a source of pride, but an economic boon.
A 2024 UAMS press release estimated that NCI designation could generate an estimated $72 million in economic impact and around 1,500 jobs over five years.
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