Breast Cancer Screening Today
New radiologist-created recommendations reinforce the importance of regular screening starting at age 40.
Who would have thought that getting the facts out — and getting them straight — on breast cancer screening would be difficult? There is strong evidence that regular screening results in a substantial reduction in breast cancer mortality for women age 40 years and older, and yet controversy continues.
I found myself nodding my head in agreement as I perused the cover story of an issue of the National Geographic a few years back. It was titled “The War on Science,” and subtitles included “vaccines cause autism” and “climate change doesn’t exist.” We could add to that “many breast cancers will go away on their own” and “chemotherapy is so good that we don’t need to screen.” These falsehoods fly in the face of what the actual data show, and yet stories of such claims persist in both the lay and medical press.
In the updated ACR® breast cancer screening recommendations for women of average risk,1 the ACR Commission on Breast Imaging presents a thorough review of the evidence, so that radiologists, primary-care providers, and patients can see the data for themselves regarding breast-cancer screening. It is clear that annual mammography screening starting at age 40 can decrease breast cancer mortality by about 40 percent. Other benefits of screening include less-extensive treatments for tumors that are found earlier (less-extensive surgery, less-toxic chemotherapy) and the ability to discover high-risk lesions, which can lead to treatments designed to decrease the chance of a subsequent invasive cancer.
There are risks associated with screening, each of which is explained in our new recommendations. We feel strongly that radiologists can play a key role in explaining and managing those risks for our patients. The ACR Breast Imaging Data and Reporting System (BI-RADS®) lexicon was the first of its kind and has helped breast imagers standardize lesion characterization and improved consistency of reporting. The BI-RADS auditing guidance has focused our attention on improving metrics such as recall rates and biopsy outcomes.
The ACR’s National Mammography Database (NMD®), a component of the National Radiology Data Registry®, is now the largest national registry of mammography in the United States (and possibly the world), containing over 12 million exams from more than 200 facilities. The NMD benchmark data most closely reflects what U.S. radiology practices receive from their on-site performance audits. These tools from the ACR can be used to improve our practice and to optimize outcomes for our patients.
Our efforts to improve quality have not gone unnoticed. The ACR Mammography Accreditation Program, also the first of its kind, was the basis for the Mammography Quality Standards Act, enacted by Congress in 1992. We demonstrated to our peers and our patients that we can take the lead on advancing quality. This ACR program is largely responsible for the high level of mammography image quality that exists in the United States today.
One of the most rewarding aspects of breast imaging is the personal care we give our patients. Breast imagers are well aware of the value of patient-facing interactions. By putting the patient first, we elevate our approach to our work. It is tremendously fulfilling and effective. This, of course, is not limited to breast imagers. Radiologists have been improving the lives of patients with imaging for decades. But we can always be reminded to enhance this effect by increasing our visibility with our patients.
Finally, the ACR is working hard to ensure that all women have access to the life-saving technology that we offer. The United States Preventive Services Task Force (USPSTF) used selective and, therefore, incomplete evidence to formulate its recent recommendations. If implemented, these recommendations would potentially limit mammography use. Our economics and government relations teams worked tirelessly to gain support for H.R.3339 — Protecting Access to Lifesaving Screening Act (PALS Act), which places a moratorium on the most recent USPSTF guideline recommendations. The PALS Act will allow women age 40 and older coverage for screening mammography without co-pay until 2019. We were able to present the evidence for screening, and our members of Congress responded. Knowledge is power.
As we go forward, the ACR will continue to get the facts out. Other non-ACR guidelines calculate the benefits-risks ratio for women. We disagree with that approach. We feel that women should be well informed and then be allowed to weigh the benefits and risks for themselves.
Decisions about screening should be made by women, not for women. We are confident that if women fully understand the benefits, as well as the risks, of mammography screening, they will choose annual screening starting at age 40. Please read our updated recommendations, and help our providers and our patients make an informed choice.
Guest Columnist Debra L. Monticciolo, MD, FACR, Chair of the ACR Commission on Breast Imaging.
1. Monticciolo DL, Newell MS, Hendrick RE, et al. Breast cancer screening for average-risk women: recommendations from the ACR Commission on Breast Imaging. J Am Coll Radiol. In press.