DART BOARD OPENING REMARK
It is a great honor for me to write these short remarks about breast cancer screening and DART.
Mammogrpahy screening and the early detection of breast cancer is one of the major advances in women’s health over the last half century. In the U.S. the death rate from breast cancer had been unchanged dating back to 1940. Mammography screening began in the mid 1980’s, and soon after the death rate began to fall for the first time in 50 years. As more and more women participated in screening, and with improvements over time, deaths have continued to fall so that the death rate is now more than 40% lower than it would have been had the earlier trend continued. It is estimated that more than 600,00 lives have been saved since 1990. A recent major study in Sweden of almost a half a million women shows that therapy has improved, but that the most lives are saved when women participate in screening and cancers are found at a time when cure is possible.
I first became involved in breast cancer detection in 1978 when I was appointed to head the Xeroradiography Division at the Massachusetts General Hospital (MGH) which is the largest Harvard Medical School teaching hospital. Breast cancer screening in the U.S. was in its infancy. My Division performed 8 mammograms a day. Recognizing that Ultrasound and Computed Tomography could have important value in evaluating the breast I was the first to change the name of my Division to “Breast Imaging”. The name began to spread and the subspecialty of “Breast Imaging” within the specialty of Radiology was born.
As a new field there was not a lot of information so I set out to learn as much as I could from the few papers that I could find and the handful of colleagues around the U.S. who were working in the field. As we made new discoveries, we evolved the techniques and technology to constantly improve our ability to detect and diagnose breast cancer. In 1978 I came across a description of a concept called “Tomosynthesis”. At the time there was great concern over the radiation from mammograms (fortunately we now know risk was greatly over estimated and there is little if any risk to the breasts of women ages 40 and over). I realized that tomosynthesis could have major advantages for breast evaluation by removing the “noise” of normal breast tissue in front of and behind cancers that could hide their presence on conventional 2-dimensional mammograms. This could be done without increasing the dose. I realized that I could greatly improve the conspicuity of cancers. Unfortunately, I needed digital mammographic technology to test my idea and had to wait until the 1990’s for the development of digital detectors for mammography.
In 1992 my group and I began to assist General Electric in their effort to develop digital mammography. This gave us access to a digital detector and my group (Richard Moore my research Director, and Loren Niklason, PhD. our physicist) proved that we could apply tomosynthesis to the breast, and we developed the first system which I name Digital Breast Tomosynthsis (DBT). The result were better than I had hoped. We were able to see cancers that were not visible on 2-dimensional mammography and we realized that we could reduce recalls from screening using DBT because superimposed normal tissue shadows that can mimic a cancer are eliminated by DBT.
Mr. Moore in my group found a group at Brandeis University outside of Boston that was working on X-ray Crystallography. It turned out that some of the computer manipulations that they performed were similar to what we needed as we developed DBT. Tao Wu was earning his PhD with this group and had developed a maXimum likelihood iterative reconstruction technique that was well suited to improve on our basic “shift and add” method. Dr. Wu was able to adapt his work to a parallel processing system that we had assembled at the MGH. Having received his PhD. at Brandeis, Dr. Wu joined my group at the MGH and continued our DBT development. His efforts led to dramatic improvements in the reconstruction of our DBT images and greatly facilitated the detection of breast cancers.
In 2004 Dr. Wu received the prestigious Sylvia Sorkin Greenfield award for the best paper published in the journal “Medical Physics” in 2003 entitled “Tomographic Mammography Using a Limited Number of Low-Dose Cone-Beam Projection Images”. His work was a major advance in our ability to detect breast cancers earlier leading to thousands of lives being saved.
Leaving Academia Dr. Wu continued his DBT work at Hologic, Inc. honing his business and development skills. Three years ago he founded DART with the goal of making the earlier detection of breast cancer available to the women of China.
Dr. Wu graciously named his company after his mentor at Brandeis and along with me and Mr. Moore (DART stands for Dan, AleX, Rick and Tao). He has invited me to be a medical advisor to DART. The ability to detect early breast cancer is based on the quality of the images. When Dr. Wu assured me that he would develop a device with the best image quality, I agreed to serve.
As the DART system evolves, I will be writing material that will be published on the “Dart Board”. As with the game of darts, our goal will be to hit the “bullseye” (the center of the target) to provide readers with accurate, evidence based information about the importance of detecting breast cancer early. I will be happy to try to answer any questions that you might have about breast cancer and screening.
Dr. Wu has suggested that DART Imaging will provide my teXtbook “Breast Imaging” to some partners and friends. I am more than happy to sign these teXtbooks myself as encouragement and appreciation to those dedicated to breast cancer screening and saving women’s lives.
On this the third anniversary of DART Imaging, we wish to thank ZhongJi Investment and Bison Healthcare Investment for the help founding and developing DART Imaging. Thanks also to the team at DART Imaging who have worked so hard over the last three years leading DART Imaging to where we are today: Xu Chen, Xiaowei Chen, Jing Bai, Yafang Yuan, Kun Zhang, Xiutai Hu, Chao Liu, Bin Wu, Lipeng Hu, Chaohong Liang, Ruining Ren, Houcheng Su, Ziwen Wang, Shuhong Guo, Weitao Wang, YueXing Chang, Zihan Yang, Yu Chen, Wentao Zhang, Li Feng, JinXun Xiao, JiongYi Chen, Jianhui Tang, Ruiqiu Ouyang, Xiaobin Zhao, and Yan Shi.
This is just the beginning of a major effort to reduce deaths from breast cancer in China. I want to, particularly, thank Tao Wu for his vision, and incredibly hard work and effort in developing DART to provide eXcellent care for the women of China. I look forward to many more years of eXcellence as the DART system evolves to provide more and more women the lifesaving benefit of early detection.
Sincerely yours,
Daniel B. Kopans, M.D. F.A.C.R., F.S.B.I.
