Spreading The Word

An online pilot program prepares breast imagers to combat misinformation about breast cancer screening.

SpreadtheWord

October 2015

As controversy continues to swirlaround mammography, patients and referring physicians often struggle to make sense of the conflicting information about this life-saving screening.

To combat this confusion and train radiologists to educate their patients and colleagues about the value of breast cancer screening, the ACR Commissions on Quality and Safety, Breast Imaging, and Economics joined together. Their goal: launch the Leadership Course in Breast Screening, a nine-week webinar series that arms imagers with the skills to clearly and effectively communicate the value of breast cancer screening.

“This course was conceived as a way to pass on the knowledge and experience gained by our leaders in breast imaging over the previous three decades. Those leaders bring a perspective that we thought would be useful to those newer to the field,” says Debra L. Monticciolo, MD, FACR, current chair of the Commission on Breast Imaging and chair of the ACR Commission on Quality and Safety at the time the course was created.

Monticciolo, along with Barbara S. Monsees, MD,FACR, former chair of the ACR Commission on Breast Imaging, and Geraldine B. McGinty, MD, MBA, FACR, chair of the Commission on Economics, chose topics ranging from evidence of mammography’s benefits to the economics of breast imaging.

One of the challenges that radiologists will have to overcome in advocating for breast cancer screening is the U.S. Preventive Services Task Force 2015 draft guidelines for screening mammography. Participants learned to clearly present information about the structure and methodology of trials, while explaining how these factors can impact the results. McGinty adds, “We have to be vigilant because we’re seeing people publishing nonsense not only in scientific journals,but also in mainstream outlets like the LA Times and the New York Times.” 

In addition to giving radiologists a strong basis of information to share, faculty also stressed the need for patience and persistence when advocating for breast screening. “You have to get a clear, crisp message across, but you also have to maintain the energy to keep responding and not give up,” McGinty says.

“Women’s lives are at stake. Breast cancer is a major killer, and mammography is the only method that allows for early detection. Cancers are easier to treat and more likely to be cured when they are found early,” Monticciolo says.

“Mammography has been proven to significantly decrease deaths from breast cancer. We need to make sure that women understand that.”

7 Facts About Breast Cancer Screening

Debra L. Monticciolo, MD, FACR, provides her takeaways from the course. Consider sharing the list with patients, colleagues, family, and friends.

1 The most lives are saved with annual mammography beginning at age 40. Women in their 40s account for about 40 percent of the years of life lost to breast cancer.

2 Screening saves more years of life for women who get screened every year rather than every other year.

3 The reduction in breast cancer mortality from mammography is significant and has been proven in multiple studies involving millions of women yet it is routinely understated in the press.

4 When presenting research results, being invited to screening is different from being screened. Not all women who are invited to screening actually go through with it. Population-based studies show that breast cancer death decreases by 25–31 percent among women invited to screening, but women who are screened will reduce their chances of dying of breast cancer by 36–48 percent.

5 Entities like the U.S. Preventive Services Task Force underestimate the benefits of mammography and overstate the risks. Radiologists are interested in saving the most lives.

6 Most false positives from mammography are resolved with only additional imaging. Less than 2 percent of women will be recommended to have minimally invasive needle biopsy as a result of screening.

7 Overdiagnosis has been overstated. Studies that properly account for lead time and underlying incidence trends show that the overdiagnosis rate is 1–10 percent, nearly all of which is ductal carcinoma in situ (the presence of abnormal cells inside a milk duct in the breast). The risk of overdiagnosis is small and is outweighed by the mortality benefits of screening.


 By Abby Short, freelance writer for the ACR Bulletin

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