Closing the Gaps in Breast Cancer Screening

Alyssa Cubbison, DO, ACR YPS Communications Liaison, authored this column.

YPS: EARLY TO RISE

The YPS is a community dedicated to representing and supporting early-career professionals — members under the age of 40 or within the first eight years of completion of training. The YPS Executive Committee works to develop valuable early-career member resources, amplify YPS issues and needs at the national level and provide a network of support to all members in this stage of their ACR and career journey. This is the first article in a new Bulletin series proposed and authored by YPS members — sharing their perspectives on challenges, opportunities and outcomes within an ever-evolving specialty.

Every October we observe Breast Cancer Awareness Month, dedicated to advocating for improvements in breast cancer screening and treatment. We reflect on the lives affected by this disease and those that can be saved through these advancements. In their daily practice, radiologists can play a pivotal role in saving lives. As masters of imaging, we are in a unique position to promote public awareness of how important imaging is in breast cancer detection. Screening mammography remains a cornerstone of breast cancer survival, allowing for early cancer detection. Every effort should be made to increase its use, and adherence to annual screening is vital to reduce mortality from breast cancer. Despite decades of advocacy and awareness programs, there are still gaps in patient access and knowledge regarding screening mammography and its benefits. Radiologists can help close these gaps through education and communication with patients and their health care providers.

Getting to Know Your Patients

A logical first place to begin is to gather information on the demographics related to your patients who are getting screening mammograms. This information can be obtained through electronic medical records, insurance claims and survey data. Evaluate gaps in screening frequency for patients in areas with geographic limitations, financial barriers, lack of reliable transportation and fear of diagnosis — all of which contribute to lower screening rates. Much of this information (age, address, risk factors, family history, etc.) will normally be obtained during the scheduling process, billing and imaging appointment. It is known that screening mammography remains underused by patients living in rural areas — a fact that can be at least partially attributed to reduced access to imaging care close to home.

Mobile mammography units are a potential solution. Their use has been shown in population studies to be an effective way to increase rates of breast cancer screening. Their implementation requires organizational and radiologist buy-in, a transparent unified mission and a trained team of radiologic technologists, a physicist, a program coordinator and medical director. Radiologists can partner with hospitals, medical clinics and nonprofit organizations to help with the planning and funding of a mobile screening mammography program. Another way to improve utilization of screening mammography is to offer travel reimbursement vouchers for patients with transportation difficulties through a grant or institutional funding.

Providing Information Is Key

Another vital contribution a radiologist can make to patients is the dissemination of information related to breast cancer. This can be in the form of pamphlets or direct provider contact at the time of their appointment in the clinic or mobile unit. Providing breast cancer statistics and symptoms to look for are key elements to any screening mammography visit. It is worth highlighting that one in eight women will develop breast cancer in their lifetime and that most women diagnosed with breast cancer have no known family history. Information on supplemental screening imaging tools for those patients with dense breast tissue is also essential. Omitting this information is a missed opportunity to educate and convince patients to make screening mammograms part of their yearly routine.

An important consideration is finding ways to provide this information to patients outside of your clinic or work environment. The outreach is intended for patients who have either had significant time elapse since their screening mammogram or perhaps have never had one. A practical approach is to offer educational pamphlets at medical centers such as OB-GYN offices and primary care facilities — as well as local high-traffic centers such as community centers or libraries. Providing multilingual resources as well as a phone number for scheduling can enhance participation.

Another approach to educational outreach is through a robust social media presence. Posts can include breast cancer-related statistics, signs and symptoms, dispelling breast cancer or radiation risk myths and offering supplemental breast cancer screening options such as breast ultrasound, MRI or contrast-enhanced mammography. Patient testimonies are a powerful way to personalize someone’s journey with breast cancer.

As physicians and advocates through ACR, we can champion insurance and policy reform on an individual level. Radiologists can use their skill set and voice to promote legislation that protects insurance coverage for screening and diagnostic mammograms. Breast Cancer Awareness Month is ultimately about ensuring patients have access to lifesaving imaging and treatments. As radiologists, we can help patients gain access to mammography to find breast cancer at its earliest, most treatable stage.