What is the best age to start breast imaging? How often should patients be screened? Do you even need to worry about mammograms if you do not have a family history of breast cancer? While these questions might seem simple, finding definitive answers is complicated. Even more troublesome is when entirely capable and trustworthy providers are also peddling information that is not informed.
According to ACR President Debra L. Monticciolo, MD, FACR, “Having regular mammograms will cut breast cancer death by at least 40% — likely more — and that is a huge impact on the most common cancer in women and one of the biggest causes of cancer death in women.” With more than 30 years of experience as a breast imager, Monticciolo has seen the grave impact misinformation can have.
According to Monticciolo, misconceptions persist that mammograms are excruciatingly painful, unnecessary, or only important for those with a family history. However, the bottom line remains the same: average-risk women should be getting yearly mammograms starting at age 40 — even earlier for African-American and Ashkenazi women. On top of that, tumors are more aggressive in younger women and early detection can mean the difference between life or death. “There are a lot of naysayers, but mammograms make a big difference,” says Monticciolo. “Early detection leads to better treatment options, less surgery, and better chemotherapy outcomes — something that is not widely understood by patients and their doctors.”
Monticciolo notes that to combat the misinformation, the ACR and the Society of Breast Imaging (SBI) have created the “Talking to Your Patients About Breast Cancer Screening” CME Toolkit — a free resource with customizable materials to help providers identify breast cancer screening and outcomes data, discern actual risks versus benefits, and discuss with patients when to be screened. The toolkit, compiled by a broad group of breast imagers around the country, was designed so that all the information could be digestible and accessible to its audience — both patients and providers. Radiologists are asked to share these materials with their referring providers, on their practice websites, and in their waiting rooms and lobbies. The toolkit will also be promoted directly to referring providers through a digital and social media advertising campaign.
“Providers may not know what to tell women regarding when and how often to be screened,” says Monticciolo. “We feel if women and their healthcare providers understand the facts, they are going to be better able to make an informed choice and we are confident that regular screenings will be that choice.”
Dana H. Smetherman, MD, MPH, FACR, chair of the ACR Commission on Breast Imaging, agrees. “Over the years, I have encountered not only patients but colleagues in other specialties, particularly in primary care, who do not understand why the ACR and SBI recommend starting mammograms at age 40,” says Smetherman. Smetherman believes that as a result of the new CME Toolkit, the national conversation around mammograms can start to shift in the right direction. “With every woman who is educated and provider that finds a deeper understanding of breast imaging, lives are saved,” she says.
Both Smetherman and Monticciolo believe the toolkit is going to continue evolving — with new information being added and plans to reach out to patient advocacy groups to incorporate their expertise. Their hope is to get the toolkit materials into the hands of medical students and radiologists-in-training to increase their knowledge of breast imaging right from the start.
“We want to make sure that the material and information is out there so that any patient who really wants to understand and make an informed decision is able to do that,” says Smetherman. “The most important thing is for patients to be well-informed and be their own advocates.”