When nearly eight out of every 10 breast cancer biopsies — more than 1 million a year — come back as benign, the medical establishment can do better.

When 40,000 American women still die every year from breast cancer, the medical establishment can do better.

At least those are the beliefs driving two Northeast Ohio doctors to find better ways to screen for breast cancer.

Dr. Richard Barr, a Youngstown radiologist and professor of radiology at the Northeastern Ohio Universities Colleges of Medicine and Pharmacology (NEOUCOM) in Rootstown, is researching a new ultrasound procedure to reduce unnecessary biopsies. And Dr. C. William Loughry, a retired Akron City Hospital surgeon, is looking into a new type of screening that relies on air pressure, lasers and digital imaging.

Barr's concept, which he's develop
ing with Siemens Medical Systems, is known as ultrasound elasticity imaging.

The technique works by gauging how much the breast tissue moves when pushed, and if a lump is present, how hard it is. These two factors can help determine whether a mass is benign or cancerous.

''The way I try to explain it to people is, if you have a bowl of Jell-O with a marble in the middle of it and you push the Jell-O, the Jell-O will deform but not the marble,'' Barr said.

The procedure creates two images — one a typical ultrasound image, the other an elastogram. In comparing the two images, cancerous lesions appear larger on the elastogram than in the typical ultrasound image. Benign tumors tend to show up smaller on the elastogram.

In Barr's study of 80 women with 123 lesions, elasticity imaging correctly identified all 17 malignant lesions and 105 of 106 benign lesions.

The next step, said Barr, who practices at Southwoods X-Ray & MRI in Youngstown, is an international study with sites in London; Paris; Brisbane, Australia; Rochester, N.Y.; Winston-Salem, N.C.; and Youngstown. If the results are duplicated, as many as half of all breast cancer biopsies could be eliminated.

''Many women elect to have a biopsy because it's there and we can't be 100 percent sure,'' he said. ''We hope to get to the point where doctors can say, 'It is benign. We don't need to do a biopsy.' ''
Of the estimated 1.4 million breast cancer biopsies taken each year in the United States, about 80 percent turn out to be benign.

Eliminating half of those unnecessary biopsies would not just spare women the pain of a biopsy, but also ''the stress of waiting'' for results, Barr said.

The elasticity ultrasound would be used after a mammogram finds an abnormality.

''You've had a mammogram, you have a lump, now you want to find out, what is it?'' Barr said.

In about half the cases, the elasticity ultrasound may be able to say whether the lump is benign or cancerous. In the other cases, the women would still need a biopsy.

''This is not going to replace mammography,'' he said. ''What we're saying is, this is another tool to use.''

At Summa Health System, Loughry has been working on a better screening procedure for two decades, along with Daniel Sheffer, chairman of the University of Akron's biomedical engineering department.

The concept is known as bio-stereometrics and borrows from a procedure tire makers use to test for defects between the plies of aircraft tires.

To detect lumps in the breast, the woman lies face down on an examination table, her chest positioned over an opening in the table. Under the opening is a Plexiglas box, which will create a pressurized environment for the breasts. One image is taken without pressure. Another is taken with pressure.

The images look like topographic maps, with the air pressure and laser creating a wave-like series of markings. A lump, if one is present, would show up as a dense spot on the image.

The procedure has shown promise in limited testing.

In one study by Loughry and Sheffer, 400 women were screened. Fifteen tumors were found, but two were missed.

The procedure is quick, painless and uses no radiation, Loughry said. But to go beyond the testing stage, more studies need to be conducted.

''Our problem now is, we just can't get the volunteers to do it,'' he said.

The study is looking for women who are being sent for biopsies, but Loughry and Sheffer want to get the women before they actually have the biopsy. Most women in this circumstance, though, aren't interested in volunteering for a study.

''I think they just don't want to be messed with,'' Loughry said.

Ultimately, Loughry's screening may be able to detect breast cancer earlier than mammograms do.

''What we find (on the image), we can't say it's cancer,'' Loughry said. ''But we can say, 'You better get a mammogram to find out.' ''

But if women will be sent for a mammogram anyway, why not just start with the mammogram?

''That's what we're doing now,'' Loughry said, ''and we're not picking them up small enough.''

About 40,000 women still die from breast cancer each year in the United States. Plus, he said, women don't like mammograms, ''whatever the reason'' — discomfort, embarrassment, difficulty scheduling, expense.

''What we're trying to do,'' he said, ''is get more people screened.''