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ACS vice president assesses impact of breast cancer screening at RSNA

by David Dennis, Contributing Reporter | December 07, 2016
RSNA Women's Health X-Ray
#RSNA16
Robert Smith, vice president of screening for the American Cancer Society, presented an overview of the state and impact of breast cancer screening at an RSNA conference series addressing Hot Topics in Breast Imaging.

Comparing and contrasting studies, guidelines, and statistics associated with the ACS and the U.S. Preventive Services Task Force (USPSTF), Smith first highlighted perspectives on risk for women between the ages of 40 and 49 — an issue of considerable debate.

He asserted that breast cancer risk for women in their 40s is characterized by a period of lower risk in the early half, and higher risk in the later, adding that the logic for beginning screening at age 50 also extends to age 45.

“Considering risk in ten year age groups obscures important differences between large age-specific subgroups," Smith told the crowd.

Smith then cited mounting evidence for the benefits of mammography screening, including randomized trials, trend studies, incidence-based mortality studies, and case control studies. This included findings that a 58 percent reduction in breast cancer mortality can be achieved in screened versus unscreened women, and that 44 percent fewer breast cancer deaths occurred among women between 40-49 years of age who were screened, and 40 percent fewer deaths occurred for women between the age of 50 and 59 when screened.

Still, Smith cited studies showing that “primary care providers do not consistently follow recent USPSTF breast cancer screening recommendations despite noting that these guidelines are influential.”

“Low adherence to regular screening,” Smith held, “limits the potential to reduce breast cancer deaths.” Moreover, he contended, relying on point of care, "opportunistic referrals" by primary care providers is inefficient and should be replaced with registry-based reminder systems, which he said achieve much greater adherence outcomes.

Lack of reminder systems results in weak adherence to recommended screening intervals, said Smith, and therefore radiologists must work with primary care to insure high rates of regular screening.

In addition, since most radiologists have low screening volume and few opportunities for feedback on performance, he suggested working up a higher fraction of their own recalled cases as a way to create opportunities for feedback, and improved accuracy.

In conclusion, Smith said there are considerable opportunities to do better in the area of breast cancer screening.

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