Spotlight shines on womens imaging at RSNA 11
It’s been two years since the U.S. Preventive Services Task Force rocked the breast imaging community with its recommendation that women between the ages of 50 and 74 undergo biennial screening and those ages 40 to 49 discuss the exam with their physicians. Since the recommendations were issued, centers have reported screening declines in the 25 percent range, and breast imagers have scrambled to educate women and physicians about the value of screening mammography. Read about the impact of the guidelines and learn how experts are coping in the September issue of Health Imaging.
Although some expected, or hoped, that the publication of final results from the Swedish-Two County Study showing a sustained 30-year mortality benefit among women invited for screening in the July issue of Radiology would tame the controversy, mammography has remained under fire.
For example, a study published Oct. 24 in Archives of Internal Medicine estimated the probability that screening mammography saved a woman’s life at “well below 10 percent,” and contended that survivor stories exaggerate the benefits of screening.
That study came on the heels of another published in the British Medical Journal on July 28 that reported the breast cancer mortality reduction in the Europe Union is primarily due to improvements in treatment rather than participation in screening mammography. However, the American College of Radiology and Society of Breast Imaging condemned the controversial study and provided additional evidence that screening mammography does save lives.
Moreover, other researchers have demonstrated that screening mammography is linked with less aggressive treatment. According to a study presented at the annual Breast Cancer Symposium held in San Francisco, Sept. 8 to 10, women diagnosed because of a palpable mass had a more advanced stage of cancer and were more likely to undergo mastectomy as opposed to breast conservation surgery.
The debate continued on the pages of Radiology in September with Daniel B. Kopans, MD, director of breast imaging at Massachusetts General Hospital in Boston, explaining that breast cancer treatment has the greatest chance for success during the clinically occult phase of the disease and estimated the likely extent of overdiagnosis is 10 percent or less. Meanwhile, Karsten Juhl Jorgensen, MD, of Nordic Cochrane Centre at University of Copenhagen, and colleagues wrote, “Overdiagnosis is substantial and certain and screening increases the number of mastectomies performed.” At the same time, researchers and providers have continued to explore roles of other modalities and have suggested that positron emission mammography offers prognostic value while MRI may merit a wider role in screening and surgical planning.
Finally, screening breast ultrasound is on the uptick with a handful of states requiring breast density notification and/or provision of additional screening exams including ultrasound, as detailed in the November issue of Health Imaging.
These issues and many more are on the docket at RSNA ’11. Be sure to read live coverage from the show at www.healthimaging.com and subscribe to our women’s imaging portal to stay on top of these key issues. And let us know how your practice is adapting its women’s imaging services.
Lisa Fratt, editor