Greg Freiherr, Industry Consultant
Greg Freiherr, Industry Consultant

Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group.

Blog | Greg Freiherr, Industry Consultant | December 19, 2012

Legislating Women’s Health: A Chance for Radiologists to Step In

States increasingly are mandating that physicians inform patients with dense breasts that mammography may miss some signs of cancer. This trend provides radiologists with a chance to take a more direct role in patient care.

Five states now mandate physicians to inform women with dense breasts that mammography may be of limited value to them. These states — Connecticut, Virginia, Texas, California and New York — require physicians to advise patients that complementary imaging studies, such as ultrasound or MRI, may be needed, if dense fibroglandular tissues are likely to obscure the mammographic signs of cancer. Their laws, however, do not say specifically who should inform patients — the physician who interprets the mammogram or the physician who regularly attends the patient.

This quandary is ready-made for radiologists. Because mammography is a screening exam, patients are seldom referred to radiologists for such studies. Instead the patients themselves typically make the appointments and are then informed by the radiologist of the results.

Only a month ago, radiologists were encouraged by the RSNA president to consider imaging patients on their own and to take a more active role in their care. The recognition of breast density as a complicating factor in women’s health presents the opportunity to act on this advice.

Radiologists can play a pivotal role in the care of women with dense breasts, according to Stamatia Destounis, M.D., an attending radiologist at Elizabeth Wende Breast Clinic in Rochester, New York.

“We want to do this right — we want to educate and inform patients without causing a lot of undue stress and anxiety and fear and we have to try to do (additional testing) that is appropriate in a cost-effective manner,” she told me.

Ultrasound and MRI are the two options. Ultrasound is low cost and widely available. But it is very sensitive and can produce false negatives demonstrated on biopsy. MRI might be indicated, if patients are high-risk due to family history or the presence of the BRC1 or BRC2 gene. This modality is also very sensitive and can lead to biopsies that are negative.

Clearly, to provide optimal care, several challenges must be met. One is to identify patients with dense breasts, identification that is heavily dependent on the skills of the interpreter. The second challenge is to choose the best method for additional testing. The third is correctly interpreting follow-on tests to minimize the number of biopsies.  The fourth is to maintain communication with the patient throughout the diagnostic process — to keep patients informed and not unduly alarmed.

Rhetorically, you might ask, who better to meet these challenges than radiologists? And what better time to act than now, when organized radiology is pushing its members to take a higher profile in the care of patients?

The question without an obvious answer is whether radiologists, who for so long have taken a back seat in the practice of medicine, will act on this opportunity.

Related Content

News | Artificial Intelligence | November 18, 2019
November 18, 2019 — Visage Imaging, Inc. (Visage), a wholly owned subsidi
 Mammography doctor
News | Breast Imaging | November 12, 2019
November 12, 2019 — Geisinger has partnered with...
Kubtec has made the Marcum Tech Top 40 (TT40) list of fastest growing technology companies in Connecticut
News | Radiology Business | November 06, 2019
November 6, 2019 — The Connecticut Technology Council (CTC) and...
The U.S. market is unique in that it formed over 55 percent of the global market in 2018

The U.S. market is unique in that it formed over 55 percent of the global market in 2018.

Feature | Mammography | October 30, 2019 | By Imogen Fitt
When breast imaging comes to mind, mammography is the undisputed current modality of choice.
2-D mole marker

2-D mole marker used in 3-D, Slice 1 of 59

Sponsored Content | Case Study | Breast Imaging | October 30, 2019
When it comes to the use of mammography skin markers in dig...
Breast Tomosynthesis Increases Cancer Detection Over Digital Mammography
News | Mammography | October 23, 2019
Screening digital breast tomosynthesis (DBT) results in “significantly increased CDR [cancer detection rates]” compared...
Advanced Radiation Therapy Upgrades AccuBoost Digital Brachytherapy Platform
News | Brachytherapy Systems, Women's Healthcare | October 23, 2019
At the 2019 American Society for Radiation Oncology (ASTRO) annual meeting, Sept. 15-18 in Chicago, Advanced Radiation...
GE Healthcare and Premier Inc. Developing One-stop Breast Clinic Model for U.S.
News | Mammography | October 21, 2019
GE Healthcare and Premier Inc. have announced a collaboration to develop a model to bring a same-day breast cancer...