Mammography screenings are the cornerstone for screening women for breast cancer, but they often do not detect small tumors or tumors in women with dense breasts. That’s why other imaging tools such as MRI and contrast-enhanced digital mammography will play an increasingly important role in screening women for breast cancer, according to Dr. Elizabeth Morris, chief of breast imaging services and a professor of radiology at Memorial Sloan Kettering Cancer Center in New York.

Morris discussed the future of breast imaging during an American Society of Clinical Oncology/Radiological Society of North America joint session, which took place during the ASCO annual meeting this week in Chicago.

“The future is very bright and rosy as far as technology is concerned,” said Morris.

“Imaging has come a little bit far over the past decades, but we are still only doing mammography,” Morris added. “There is a real need to detect cancers that are small [less than 1 cm] before they metastasize. That would be the Holy Grail.”

An MRI is the best imaging tool for detecting breast tumors, but the imaging technique has several drawbacks, Morris noted. MRIs are expensive and time-consuming and patients often dislike the procedure.

In addition, there aren’t enough MRIs available to screen all the women with dense breasts or an elevated risk of breast cancer who could potentially benefit from it.

“There are too few magnets,” Morris said, showing the audience a U.S. map contrasting the widespread availability of mammography and ultrasounds versus the limited availability of the MRIs. “Let’s just face it, an MRI is not patient-friendly,” said Morris.

One possible option is an abbreviated protocol MRI, know as a fast MRI, which can be performed in three minutes and read by a radiologist in 30 seconds. A study published in the Journal of Clinical Oncology found that a fast MRI was comparable to a full-protocol MRI for detecting breast tumors

“This is a viable option for patients,” Morris said “There is less time on the magnet, with equivalent detection rates [to full-protocol MRIs] and no increase in false positives.”

Contrast-enhanced digital mammography is another excellent tool for detecting small tumors, Morris said. The imaging technique has been available for many years, but it is just beginning to be more widely used. In contrast-enhanced digital mammography, a woman is injected with an iodinated contrast agent. High-energy and low-energy breast images are taken and the low-energy image is subtracted from the high-energy image, leaving a clear image of any tumor.

“This is an interesting technique. It is cheaper [than an MRI], and the comparison to MRI so far appears to be excellent,” Morris said.

Molecular imaging, which captures image at the cellular level, is another technique that “can be potentially very powerful,” Morris said.

However, molecular imaging exposes a person’s entire body to a radioactive agent and it is both more time-consuming than fast MRIs and contrast-enhanced digital mammography and less effective at detecting small tumors.

“The final word for molecular imaging currently is no,” Morris concluded.

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