Breast Imaging Today
The Chair of the National Conference on Breast Cancer gives the Bulletin a look at the big issues in breast imaging and tour of this year's program.
Chair of the 2014 National Conference on Breast Cancer (NCBC) Bonnie N. Joe, MD, PhD, chief of women’s imaging at University of California, San Francisco, discusses what’s new in breast imaging, weighs in on the 2009 USPSTF guidelines, and tells us the single reason that would make the trip to NCBC worth it.
Q: What are the hot topics in breast imaging right now?
Breast density and supplemental screening are definitely big issues, given the wave of density notification laws enacted recently. We’ll also be discussing overdiagnosis of breast cancer and the economics of breast imaging.
Q: How do you approach the 2009 USPSTF guidelines, which scale back screening recommendations?
I have serious concerns about these guidelines, which endorse screening every two years starting at age 50 instead of annually at age 40. I believe this will lead to cancer being detected at later stages in many women and could lead to approximately 30 percent more deaths from breast cancer.
I am certainly heartened by the news that many patients are choosing to ignore the 2009 guidelines and continue to follow the recommendations of specialty groups like the ACR and the American Cancer Society. Mammography is certainly not perfect, but it is the only imaging technique proven in large randomized controlled trials to reduce breast cancer mortality. The reality is that early detection is a first-line defense against breast cancer. And the good news is that even the most aggressive cancers are highly curable when caught at an early stage.
Q: Why did you choose breast imaging as your area of focus?
My interest began during my last year of residency, when one of my mammography attendings began discussing the need to start a breast MRI program at our institution. Under the mentorship of Kyongtae T. Bae, MD, PhD, and with strong support from Barbara S. Monsees, MD, FACR, I successfully obtained a research fellow grant from the RSNA Research & Education Foundation to support my first research project in breast MRI. Years later, at University of California at San Francisco, my current chair, Ronald L. Arenson, MD, FACR, challenged me with creating a new women’s imaging section. I naturally focused my efforts on breast imaging.
I greatly enjoy the patient interactions and the logical thought process inherent in breast imaging. I also value the integrated care teams surrounding breast cancer treatment. In addition, I’m excited about emerging technologies in the field, such as breast MR diffusion, digital breast tomosynthesis, and contrast-enhanced mammography. It is an exciting time to be a breast imaging radiologist.
Q: This year’s conference begins each morning with a plenary session. How are those structured?
We will cover three main themes during the morning plenary sessions: screening, breast imaging practice, and clinical skills: advanced imaging interpretation. On the first morning, we’ll focus on understanding breast density and supplemental screening with ultrasound, MRI, and other modalities. We’ll also have the Wendell Scott Lecture, titled “Perspectives on Overdiagnosis in Breast Cancer.”
The second morning session will cover updates to the new edition of ACR BI-RADS® (more information at www.acr.org/birads), medicolegal issues, and guidance for incorporating ultrasound and tomosynthesis technologies into your practice. Lectures on the politics of screening and the economics of breast imaging will top off the session.
The final morning will cover advanced topics such as screening interpretation at the threshold for recall, challenging MRI cases, and management of high-risk lesions. This session also includes a onehour case review with the experts. This will give participants a window into how top breast imagers analyze and review a case.
Q: And then in the afternoon, attendees participate in practical workshops. What types of sessions will be held?
The afternoon workshops aim to provide something of interest for everyone. A broad selection of topics will be available, such as calcifications, asymmetries, molecular profiling, economics, tomosynthesis, whole breast ultrasound, and breast MRI.
Q: What is your favorite part of this conference?
Since the meeting is relatively short (just two and a half days), it’s packed with relevant information. I tend to find all the lectures interesting and engaging. The NCBC program committee has done a great job putting this year’s program together.
However, the highlight of the meeting is probably the Wendell Scott Lecture. This year will be no exception — we have invited Daniel B. Kopans, MD, FACR, professor of radiology at Harvard Medical School and senior radiologist in the breast imaging division at Massachusetts General Hospital, to present an analysis on the controversial issue of overdiagnosis in breast cancer. I think this lecture alone would be worth the trip to Arizona!