October 23, 2024
Breast cancer remains the most common malignancy among women and the second-leading cause of cancer-related deaths in the United States. As the fight against this disease evolves, nuclear medicine continues to play a crucial role in advancing both diagnostic imaging and treatment. Recent legislative efforts, such as the introduction of the Find It Early Act, aim to improve access to essential breast cancer screening technologies, particularly for women with dense breasts and those at high risk. At the same time, the Society of Nuclear Medicine and Molecular Imaging (SNMMI) is advocating for broader coverage of advanced imaging techniques, such as molecular breast imaging, and spearheading groundbreaking research initiatives through its Mars Shot initiative. These advancements will have a critical impact on patient care and outcomes.
Nuclear medicine has long been an essential part of the process of diagnosing breast cancer. Historically, the standard method for axillary staging in breast cancer was axillary lymph node dissection, which involved removing 10-40 lymph nodes and was associated with a significant risk (11% - 57%) of lymphedema, pain, loss of function and sensation, and limited range of motion. Nuclear medicine allowed targeted removal of only one or a few lymph nodes, in a procedure known as a sentinel lymph node biopsy (SLND). Since SLND was introduced 20 years ago, the risk of lymphedema has decreased by more than half (to 0% - 7%), sparing hundreds of thousands of women the debilitating effects and significantly improving their quality of life.
Now, nuclear medicine is improving the visualization of the primary breast malignancy through molecular breast imaging. The Find It Early Act, introduced in the Senate in September, seeks to ensure that health insurance plans fully cover screening and diagnostic breast imaging with no out-of-pocket costs for women with dense breasts or those at high risk for breast cancer. SNMMI has been a strong advocate for this bill and for the inclusion of molecular breast imaging as a critical screening option. After meeting with House and Senate sponsors to discuss the importance of molecular breast imaging, SNMMI was pleased to see its inclusion in the Senate version of the bill. This is a significant win for patients, as 71% of breast cancer cases occur in women with dense breasts, yet many are unable to access essential imaging technologies due to lack of insurance coverage and high out-of-pocket costs. SNMMI remains committed to monitoring the progress of this legislation and will continue to keep its members informed of any updates or calls to action.
The SNMMI is also developing the next generation of methods to detect and treat breast cancer. The SNMMI Mars Shot initiative was established to provide funding for visionary nuclear medicine imaging, radiopharmaceutical therapy, and data science research or projects. In its inaugural year, the Mars Shot Fund awarded four grants to researchers studying breast cancer. Each of these projects aims to develop tools or treatments that have the potential to significantly enhance patient care.
The researchers benefiting from the first round of Mars Shot grants include Craig Levin, PhD, who is developing a high-resolution PET imaging device for simultaneous visualization of multiple cancer biomarkers, Julie Sutcliffe, PhD, who is evaluating a new imaging agent to improve the detection of lobular breast cancer, and Randy Yeh, MD, who received funding for his project on HER2 PET imaging, which seeks to better predict responses to trastuzumab-deruxtecan in HER2-low breast cancer patients.
The Mars Shot also partnered with the Lobular Breast Cancer Alliance in 2023 to support research on invasive lobular carcinoma, awarding a grant to Marina Sharifi, MD, PhD, for her study on identifying endocrine therapy resistance through minimally invasive biomarkers. The two organizations are partnering for a second year to offer the $100,000 SNMMI-Lobular Breast Cancer Alliance Invasive Lobular Carcinoma Imaging Research Fellowship; the application is open through December 31.
Molecular imaging is also advancing the care of patients with advanced or metastatic breast cancer. SNMMI recently released appropriate use criteria for the use of 18F-fluoroestradiol (FES) PET imaging, which enables noninvasive, whole-body evaluation of estrogen receptors, a key biomarker for optimizing breast cancer treatment. Now approved by the U.S. Food and Drug Administration, FES can assist in the selection of patients appropriate for endocrine therapy, can evaluate lesions that are difficult or dangerous to biopsy, and can problem solve when other imaging tests are inconclusive.
Many additional developments in nuclear medicine for breast cancer are on the horizon. PET radiotracers are being developed to target other cancer receptors, such as human epidermal growth factor receptor 2 (HER2) and progesterone receptor. Additionally, some radiotracers may be useful in the targeted treatment of breast cancer. Recent research demonstrates successful treatment of metastatic breast cancer with somatostatin receptor (SSTR)-targeted radiopharmaceutical therapy. Additional research explores novel agents such as fibroblast activation protein (FAP)-targeted molecules, 18F-FDA PET/CT for systemic staging in newly diagnosed breast cancer patients, and 225Ac-NM600 to treat triple-negative breast cancer.
The SNMMI is proud of its history of improving breast cancer care and its innovations for the future. We stand committed to advancing breast cancer care and celebrate October as Breast Cancer Awareness Month.