Slow and steady

Slow and steady wins the race. Two steps forward, one step back. These adages are maddening to anyone eying a breakthrough performance, but they certainly apply to women’s imaging applications. Take, for example, screening mammography, which has seen more than its fair share of obstacles during the last three decades. However, mammography is withstanding the test of time and prevailing over its critics. Some newer breast imaging modalities are following a similar, and perhaps smoother, path.  

Earlier in 2012, epidemiologists again attempted to condemn screening mammography, and published a study demonstrating a lack of mortality benefit to screening exams in The Journal of the National Cancer Institute. Experts rallied, and delivered a swift rebuttal.

In fact, a balance sheet model published in The Journal of Medical Screening demonstrated that the benefits of population-based screening outweigh the harms. Some of the harms cited by the U.S. Preventive Services Task Force and others include overdiagnosis and increased anxiety following screening exams.

Researchers addressed the concern about overdiagnosis as it relates to digital mammography and published a study Oct. 2 in Radiology. They reported the switch from film to digital mammography in large, population-based breast cancer screening programs improves the detection of life-threatening cancer without significantly increasing detection of clinically insignificant disease.

Other experts have focused on the benefits side of the equation. Consider, for example, a retrospective study published in August in Breast Cancer Research and Treatment. Researchers found that access to routine and regular screening can help close the racial gaps in breast cancer outcomes between black women and white women.

Meanwhile, even its fiercest advocates recognize that screening mammography is not a perfect screening exam. Dense breast tissue, for example, may obscure lesions on a mammogram. Other modalities may improve visualization among this population.

Legislation, regulation and advocacy appear to be somewhat in sync. Multiple states have approved breast density notification, and some require reimbursement for adjunctive exams, primarily ultrasound, for these women. Earlier this year, the FDA approved the first automated screening ultrasound technology for women with dense breasts. The American Society of Breast Disease and other experts are recommending that physicians share breast density information with their patients.

Other modalities are making headway as well. Cleveland Clinic recognized breast tomosynthesis as a game-changer in its annual list of top 10 up-and-coming technologies. Health Imaging examined these and other options earlier this year in “Move over Mammo,” a comprehensive analysis of adjunctive screening tools.

Will we ever see a breakthrough technology for breast cancer detection? I’m not so sure, but I am confident that a mix of solutions will win the day and that breast imagers will play the leading role. A large part of preparing for that leading role is the professional development provided at conferences such as RSNA 2012.

Health Imaging has selected a handful of sessions to help inform imagers. If you can’t make it to Chicago, please be sure to check out our live conference coverage online and in print. Subscribe to our monthly portals to stay on top of these topics.

Most importantly, please stay in touch and let us know how we can better meet your needs.

Lisa Fratt, editor