Abstract CSF1-1: Breast Cancer Screening: The Radiology Perspective

Abstract

Rightly or wrongly, radiologists ‘own’ breast cancer screening, as it is a radiological procedure, administered by the radiology departments. As a result in the USA, radiologists are outraged at what is seen as misuse of published data showing the effectiveness of mammographic screening. In the USA, we do not have true population screening, and rely on women being informed, and having insurance coverage, to enable them to have an annual screening exam. There is no call/recall system, and we do not collect national statistics on breast screening and outcomes. Many low income women are not offered, what to many is a ‘life saving’ test, as a result of State budget cuts. In comparison with other countries, some of which have National Screening Programs (like the UK NHS BSP, the Netherlands and Sweden), there is support from epidemiology and public health departments, as screening is population based, and therefore a public health measure. The downsides with these programs are funding issues, with Cost-Benefit analysis being used, and QALYs (Quality Adjusted Life Years), to assist committees deciding affordable health policy for the nation. There are differences between Europe and the USA in recommendations for screening as a result, especially in terms of starting at 50 years and having a longer screening interval of 2 years. In late 2009, the US Preventive Services Task Force recommendations to abandon the guideline to start at age 40 for all women, and to recommend routine screening, unless high risk), until the age of 50 years, met with a storm of criticism by interested parties. The recommendations have largely been largely ignored, except by internists. However, in the current economic climate, it is becoming increasingly clear that decisions may have to be made on cost-benefit if health-care dollars are limited. The acknowledgment that health policy may have to change, is shown when compromises have to be made. This is demonstrated when screening policy is altered, for example, in the UK, where a decision was made to alter the screening target age, rather than reduce the interval between screens. (The NHS BSP is being extended in 2012 to cover women aged between 47 and 73). I will be concentrating on the screening guidelines and the different approaches taken between the USA and Europe. I will cover the screening of ‘Normal Risk’ women, and uphold the recommendations of the Society of Breast Imaging, American College of Radiology and the American Cancer Society. I will explain the ‘harms’ of screening and argue that screening recommendations should be made on evidence rather than on the numbers of lives saved. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr CSF1-1.