IOM mammography report: Improve access, boost number of medical personnel to interpret scans
Improving access to mammography and increasing the number of medical personnel who can interpret mammograms offer the greatest potential for immediately reducing the number of lives lost to breast cancer in the United States, says a new report from the Institute of Medicine (IOM) and National Research Council (NRC) of the National Academies.

In the report, titled "Saving Women's Lives: Strategies for Improving the Early Detection and Diagnosis of Breast Cancer," it notes that new technologies based on protein or gene profiling hold promise for providing more personalized screenings and identifying women at greatest risk for breast cancer. However, it remains to be shown whether these technologies will yield results that are reliable enough to be useful in the early detection of breast cancer, according to the committee that wrote the report.

More than 200,000 new cases of breast cancer will be diagnosed this year, and more than 40,000 women will die from the disease. The report points out that access to breast cancer screening relates to the current shortage of breast imaging specialists. Fewer radiologists are going into breast imaging, and mammography facilities are closing faster than new ones are opening, says the report.

To mitigate the shortage, the report suggests that facilities enlist specially trained non-physician personnel to pre-screen or double-read mammograms to expand screening facilities' capacity. Non-physician personnel would not make diagnoses, and every mammogram would be independently viewed by a breast imaging specialist.

Improving the quality of cancer screening may entail that the United States adopt elements of screening programs that have proved successful in Sweden, the Netherlands, and the United Kingdom, the report says. The United States also should consider such practices as requiring double-reads of mammograms, interpretation of mammograms in high-volume centers, and screening services that also integrate treatment, counseling, and other support services.

Tests are under way to assess the clinical value of ways to refine screening strategies for high-risk women and to improve the accuracy of mammographic interpretations, according to the report. These methods include digital mammography, CAD (computer-aided detection), ultrasound, and magnetic resonance imaging (MRI).

The report notes that research and discovery phases of new technology development are proceeding well. The weak link in development is the phase in which technologies are shown to improve health outcomes and that they can be used effectively in routine clinical practice. The report urges that more attention be paid to validating technologies and building a more robust system for assessing whether they will be useful in clinical practice

In addition, the report says that the actual risks of developing breast cancer needs to be better communicated to women so that they can make informed decisions about screening and their lifestyle.