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There can be few operations more traumatic that a mastectomy. But one man who believes that their incidence can be much reduced is Dr Ali Akgun. I met Dr Akgun at Oxfordshire’s Rutherford Appleton Laboratory, where he showed the machine that could enable women to have a scan, a biopsy and treatment all in one outpatient session.

The machine is a Magnetic Resonance Imaging (MRI) scanner. Unlike normal MRI scanners which are large tubes that completely enclose the patient, this is a just a white ring, the size of a huge tractor wheel with a hole in the middle. The patient lies on a bed with just the top part of the body within the ring, the breast at the centre.

A scan is taken which is seen on screen by the surgeon, who sits close to the patient’s head. If the surgeon spots cancerous lesions, he can perform a biopsy guided by the image on screen. Crucially, the patient does not have to be first removed from the scanner before the biopsy is performed, as is the case with the long tunnel-like scanners

The results of the biopsy could be made available within a matter of minutes, allowing the surgeon to proceed to the final stage, treatment. Here Dr Akgun envisages a cryogenic form of treatment, again guided by the on-screen image, that essentially freezes rather than burns the cancerous cells and thus does less collateral damage.

So a woman with breast cancer could have the problem diagnosed and treated at one out-patient session. This sounds a great idea, but the adoption of new medical technology proceeds with understandable caution and Dr Akgun’s company, Specialty Scanners*, which floated on Ofex (now Plus Markets) in 2000 at a valuation of £6m is yet to make its first sale.

This is in part because, on the advice of doctors, the company embarked upon the design of a machine capable of scanning only one breast, only to have to return to the drawing board when the doctors then decided that a machine capable of scanning both breasts at once would be more useful.

MRI better than X-ray

At present breast-cancer screening is being done mostly using X-ray mammography. This is carried out at eighty centres across the UK, under the aegis of the NHS’s National Breast Screening Programme.

From the age of fifty all women are routinely offered free breast screening, and the programme is recognised to have reduced the death toll from this disease. X-ray machines cannot detect cancerous lesions as effectively as MRI. But they continue to be used for various reasons. They can be transported and set up just about anywhere – breast screening has been offered in supermarket car parks. They can cope with the one and a half million women who opt for screening each year. And of course X-ray machines are cheaper to buy, although the extra cost of MRI scanners could end up saving health services money by catching cancer at an early stage.

MRI is better able to spot dangerous breast lesions at an earlier stage, when they are much smaller and therefore more easily treatable. Evidence for this was provided by a five year long German study, the results of which were published last year in the Lancet Medical Journal, involving 7,319 women.

The aim of the German study was to investigate the sensitivity with which ductal carcinoma in situ, an early stage form of breast cancer, is diagnosed by X-ray mammography and by MRI. Of the 167 women who were found to have this condition and had undergone both X-ray and MRI pre-operatively, 56% of these cases were diagnosed by the former and 92% by the latter. The difference was even more marked for particularly aggressive, high-grade cancer cases: MRI picked up 98% while standard X-ray mammography spotted just 52%.

The German study follows another, reported again in the Lancet, back in 2005. This study of 649 women was devised by Specialty Scanners’ chairman Professor Martin Leach. Breast cancer can be hereditary. Around 2% of breast cancer is due to gene mutations BRCA1 and BRCA2, and women with one of these come from families where there have been previous incidences of breast cancer.

More than half of them will develop breast cancer by the age of seventy and it is this that persuades some of them to opt for a mastectomy. In Professor Leach’s study MRI managed to identify 77% of tumours in women at high genetic risk, compared to 40% using X-ray mammography. It was particularly effective for women known to carry the breast cancer gene mutations BRCA1 gene mutation, for whom it detected 92% of tumours, compared to just 23% using XRM.

As a result of this evidence breast cancer specialists have concluded that MRI outperforms X-ray mammography and are beginning to advocate the much wider adoption of MRI. In particular they argue that it should be used for young women, especially if they are known to be at specific risk of contracting breast cancer. Younger women tend to have more dense breasts, making the use of the more sensitive MRI especially advantageous over X-ray mammography.

MRI has been endorsed by the American Cancer Society and by the UK’s National Institute for Clinical Excellence (NICE), which in October 2006 recommended that young women at high genetic risk of breast cancer should be offered yearly MRI scans. Now the matter rests with the Health Minister Alan Johnson, who has just launched the new NHS Cancer Reform Strategy. This promises that the Breast Cancer Screening program will be extended to all women aged between 47 and 73, and that an extra £100m will be invested in new digital mammography equipment.

But this still leaves the question of what will be offered to those younger women at risk. The Cancer Reform Strategy gives the NHS Breast Screening Program responsibility for this, including a promise of access to MRI, in line with NICE’s updated guidelines and it is expected that this new system will be in place from 2009. With existing MRI scanners fully employed for the diagnosis of other illnesses, this presents an opening for Specialty Scanners’ dedicated MRI breast scanners.

As well as addressing the needs of younger women at risk, Dr Akgun is hoping that Johnson, guided by ‘Cancer Tsar’ Professor Mike Richards, will commit to MRI scanning of women aged between 47 and 73. And he is also hoping that a new Breast Cancer Centre to be built in collaboration with a leading UK hospital will help to convince them. This £3.2m development, half of which has been funded by the UK Government’s Technology Strategy Board, will for the first time allow Specialty Scanners to showcase its new MRI scanner - and to prove that one-stop shop diagnosis and treatment of breast cancer is not just a pipedream.

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