For decades, the American College of Radiology (ACR) has been a vigorous advocate of quality breast imaging. Before there was a federal mandate for breast imaging accreditation, the College established a voluntary mammography accreditation program promoting standards for quality assurance and quality control. The ACR supported the enactment and subsequent reauthorizations of the Mammography Quality Standards Act (MQSA) – including the requirement for patient notification through summary letters. The ACR has developed voluntary accreditation programs for other breast imaging modalities that are not covered by the MQSA. The ACR supports the breast cancer screening guidelines promulgated by the American Cancer Society, and has invested considerable effort to encourage women and their health care providers to utilize screening to save lives.
The ACR recognizes that breast density has an impact on mammographic screening. The ACR’s BI-RADS lexicon describes four categories of breast parenchymal density and instructs radiologists to include this density information in the medical report. It is well known that greater breast density results in lower sensitivity for mammography. By including this information in the medical report, the referring health care provider is given a general idea of the likelihood that cancer will be detected or missed based on the parenchymal pattern. The ACR would support an FDA mandate that information on breast parenchymal density be included in the mammography report.
While the ACR supports and promotes the practice of patient education and encourages Americans to take charge of their own care, it is less clear how patients may interpret the same information if included in a patient summary. While the ACR is not opposed to including breast parenchymal information in the lay summary, we urge strong consideration of the benefits, possible harms and unintended consequences of doing so. In particular, we would urge consideration of the following:
The ACR recommends that all stakeholders proceed with caution in considering a statutory or legislative mandate to include breast parenchymal density information in the patient summary or to require that patients receive copies of their imaging reports sent to their ordering physician. It might be valuable to review the experience in the state of Connecticut, where a law requiring this communication has been in place long enough to gather and evaluate outcomes and effects. As always, the ACR is happy to work with legislators, regulatory agencies and patient groups to arrive at evidenced based imaging policies which save and extend lives.