Now is the time to include breast density in cancer screening guidelines

The time is right for a unified, organized approach toward updating breast cancer screening practices, according to an article published in the September issue of Radiology.

Christoph I. Lee, MD, of the University of Washington in Seattle, and colleagues argued specifically for a framework addressing issues of adjunct screening for women with dense breasts in the opinoin piece.

“We argue that building such a framework centered on comparative effectiveness research (CER) and patient-centered outcomes research is critical not only for addressing the needs created by new density legislation but also for collecting the evidence that will ultimately best inform individual risk-based discussions between patients and healthcare providers regarding breast cancer screening,” they wrote.

Lee and colleagues said recent U.S. Preventive Services Task Force recommendations—which stirred controversy by recommending against routine screening for women aged 40 to 49—along with the passage of the Patient Protection and Affordable Care Act have created an “unusual and fortuitous climate” for crafting change.

The authors wrote that the three main issues to be addressed were:

• Consensus: Before research initiatives can be identified, all key stakeholders must build consensus on an agenda, and this includes listening to patients. Lee and colleagues said the breast imaging community must welcome input from patient advocates, as well as other stakeholders like payers.
• Quality: Mandatory minimum quality standards must be established for newer adjunct technologies for breast cancer screening. “The subjectivity and variation in breast imaging remain beyond mammography, and satisfactory process measures must be created for the operation, maintenance, image processing, and reporting of screening breast [ultrasound],” wrote the authors. One suggestion provided by Lee and colleagues was the establishment of mandatory accreditation and certification for breast ultrasound facilities, which is not currently required by federal law.

• Cost: “Healthcare reform demands that new interventions be of higher value for lower costs to patients, the healthcare system, and society,” wrote the authors. As such, an understanding of the lifetime costs related to different screening strategies is essential.

Preliminary analyses can be performed based on models using available efficacy data, though the authors suggested that government payers could provide coverage for supplemental screening in exchange for evidence on outcomes and costs.

“Through early consensus building, standardized quality measures, and a focus on cost effectiveness, we can maximize the benefits of breast cancer screening for every woman,” summed Lee and colleagues.