From the July 2019 issue of HealthCare Business News magazine

Radiologists nationwide are adopting mammographic screening practice patterns according to evidence-based medicine, with payor gaps for DBT having been eliminated in many states. Today, 94 percent of women nationwide have insurance coverage for DBT, with dense breast inform legislation in 37 states and a new proposed federal mandate requiring uniform dense breast reporting. While this a huge milestone for breast health, there is still more forward progress to be made given recent setbacks such as the ACP recommendations.

Nearly three quarters of women diagnosed with breast cancer in the U.S. are of average lifetime risk. The ACP guidelines oppose extensive data supporting the initiation of screening at age 40 for women of average risk, and may confuse or misinform patients who are looking for resources and recommendations as they become more active decision-makers in their health. As supported by the American College of Radiology (ACR), the Society of Breast Imaging (SBI) and the American Society of Breast Surgeons (ASBrS), annual screening beginning at age 40 improves patient outcomes and results in the greatest decrease in breast cancer mortality. Nearly half of all lives saved via breast cancer screening are those of women between 40 and 60 years of age. Delay of screening until age 50 in a biannual paradigm would result in much later stages of diagnoses, when cancers are typically harder to treat and associated with poorer outcomes. The ACP guidelines also place outsized emphasis on the concept of overdiagnosis, a reductionist and inadequate approach, which overgeneralizes the complexity of breast neoplasms and discounts the fact that women would rather be called back than have restricted access to critical health services. The anxiety and economic burden from false positives are less psychosocially, economically and clinically impactful than late stage breast cancer diagnoses.

Despite the problematic ACP screening recommendations, there is unanimous, evidence-based commitment to annual screening at age 40 from the ACR, SBI, and ASBrS. Our role as breast imaging experts to educate and empower patients and referring providers in this era of conflicting recommendations is critical. Tremendous progress has been made of late in breast imaging and procedural technologies, with concomitant improvements in payor and dense breast inform legislation. Although regressive, the ACP recommendations can be used as a teaching tool, allowing us to educate our patients and referring providers on the ACR recommended screening guidelines. More importantly, the ACP guidelines reveal how we as a field still have not coalesced around a uniform methodology for screening patients according to their risk profile. I urge my colleagues across multiple disciplines to utilize the recent news as an opportunity to standardize breast screening protocols across societies, calling for annual screening with digital breast tomosynthesis for all women beginning at age 40 and continuing the momentum initiated by the recent FDA proposals.

About the author: Dr. Nila H. Alsheik is a diagnostic radiologist at Advocate Lutheran General Hospital in Park Ridge, Illinois.
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