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Madrid, 7 February 2024. It is important to recognise the warning signs of breast cancer. A new lump in the breast or armpit, swelling, itching or redness in the area are just some of the signs that can alert us that something is not going well. Even so, the important thing is to detect the tumour before it shows symptoms, for which it is essential to attend regular gynaecological check-ups, since early diagnosis of breast cancer has been shown to increase patient survival and improve quality of life.

In this sense, breast radiology units play a fundamental role, from where all the tests necessary to reach a definitive diagnosis are managed or carried out. The figure of the specialist breast radiologist has changed substantially in recent years, becoming an essential professional not only in the diagnosis and orientation of breast pathology but also in its treatment and follow-up. For this reason, Dr Silvia Pérez, head of the Breast Radiology Section at MD Anderson Cancer Center Madrid, stresses the need to have a radiologist you can trust.

"It is important to have this professional in your life and to always have the same radiologist specialising in breast cancer. We decide which tests need to be carried out and, once they have been undertaken, we are responsible for assessing them, monitoring the process and diagnosing," explains the specialist, who claims that radiology plays a fundamental role in the comprehensive management of cancer by providing accurate and detailed information about the illness.

"We give a probability of malignancy based on the tests carried out and, from that moment, we decide how many lesions are suspected and how many require a biopsy, as well as what type of biopsy procedure will be carried out," continues Dr Pérez. In this sense, she stresses the direct correlation between the radiologist and the rest of the professionals involved in the process. From the pathologist to the surgeon, the oncologist and the gynaecologist, who are the ones who will later decide on the treatment recommended for the patient.

If it is misdiagnosed radiologically, the entire approach that follows will be poorly undertaken.

The role of the radiologist is fundamental in planning breast cancer surgery. So says Dr Gloria Ortega, head of breast surgery at MD Anderson Madrid, who points out that breast cancer is currently diagnosed at very early stages. "This means that they are non-palpable tumours, only visible by radiological tests and, therefore, collaboration between the radiologist and the surgeon is essential when it comes to identifying and completely removing the lesions", she explains.

On the other hand, in more advanced tumours, Dr Ortega points out that chemotherapy is often used as an initial treatment, which results in a reduction in tumour size and even the disappearance of the lesions, which are only detectable by radiology techniques.

"There is a committee that brings together all the specialists and mainly discusses radiological imaging. This is crucial, since these images will determine the surgical approach and the strategy we will adopt with the patient. If the patient is wrongly diagnosed from the radiological point of view, all of us who come after her are wrong," adds Dr Laura García Estévez, head of the Breast Tumour Section at the same hospital, stressing the importance of this figure in the oncological process.

The role of AI in breast cancer diagnosis

Artificial intelligence (AI) has a lot to say in the field of diagnostic tests and is becoming an ally of radiologists. According to Dr Pérez, the use of this technology in breast cancer diagnosis consists of the application of software to radiological images, which serve as an assistant in the diagnostic or screening process. One of the fields where it is applied is in the mammograms that patients undergo during annual or biannual check-ups, where this software can act as one of the radiologists, even replacing them and only being analysed by the program.

Another field where AI is applied is in diagnostic tests such as ultrasound. "In our case, we use software which, by providing two images and clicking on each of them, gives us the level of suspicion associated with those images. Finally, it is also starting to be used for risk prediction, because, given that the software is fed by many images that we have previously given it, it analyses a mammogram and can calculate the approximate risk of that patient developing breast cancer in the next five years," she says.

In addition to improved diagnostics, faster image analysis and early detection, AI is solving one of the major problems facing the profession, the lack of specialised breast radiologists.