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

Category A

Category A

Feature | Breast Density | April 03, 2020 | By Dayna Williams M.D., Shivani Chaudhry, M.D., and Laurie R. Margolies, M.D.
Breast cancer is the most common cance
#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2
News | Mammography | March 25, 2020
March 25, 2020 — The...
The 2020 Society of Breast Imaging/American College of Radiology (SBI/ACR) annual symposium has been cancelled, and the event rescheduled for April 8-11, 2020, in Savannah, Ga. #COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SBI20
News | Society of Breast Imaging (SBI) | March 16, 2020
March 16, 2020 — The 2020 Society of Breast Imaging/American College of Radiology (...
DBT, sometimes called 3-D mammography, emerged in the last decade as a powerful tool for breast cancer screening

Images in a 57-year-old woman noted to have "good prognosis" invasive cancer detected at digital breast tomosynthesis (DBT) screening. (a) Craniocaudal view of the left breast obtained with the two-dimensional digital mammography (DM) portion of the DM/DBT screening study demonstrates a subtle area of distortion in the medial left breast. (b) Single-slice image from the left craniocaudal DBT portion of the screening study shows an area of bridging distortion (circle). (c) Electronically enlarged image of the area of concern seen on the left craniocaudal view in a single DBT slice as shown in b. (d) Targeted US scan demonstrates two small adjacent irregular solid masses. US-guided core biopsy yielded an invasive carcinoma of the tubular subtype that was estrogen receptor positive, progesterone receptor positive, and human epidermal growth factor receptor 2 negative. The results of the sentinel node biopsy were negative. Image courtesy of the Radiological Society of North America

News | Breast Imaging | March 11, 2020
March 11, 2020 — A new study published in the journal ...
SoftVue image stacks of sound speed, as shown for cases ranging across the four Breast Imaging Reporting and Data System (BI-RADS) breast density categories

Example: SoftVue image stacks of sound speed, as shown for cases ranging across the four Breast Imaging Reporting and Data System (BI-RADS) breast density categories ((a), fatty; (b), scattered; (c), heterogeneously dense; (d), extremely dense). Note the quantitative scale indicating that absolute measurements are obtained. Image courtesy of MDPI

News | Breast Imaging | March 10, 2020
March 10, 2020 — ...
The study concludes that a combination of Artificial Intelligence algorithms and the interpretations of radiologists could, in the U.S. alone, result in a half million women not having to undergo unnecessary diagnostic tests every year

Researchers who participated in the DM (digital mammography) DREAM Challenge.

News | Mammography | March 07, 2020
March 7, 2020 — The stu...
Christopher Comstock, M.D., ECOG-ACRIN Cancer Research Group study published in JAMA builds evidence for use of abbreviated MRI in women with dense breasts

Christopher Comstock, M.D., (Memorial Sloan Kettering Cancer Center) is the lead author of a paper in JAMA that reports that abbreviated breast MRI detected significantly more (almost 2 and a half times as many) breast cancers than digital breast tomosynthesis (3-D mammography) in average-risk women with dense breasts. Photo courtesy of Memorial Sloan Kettering Cancer Center

News | Breast Imaging | February 26, 2020
February 26, 2020 — According to a study
Women 75-plus May Not Benefit from Breast Cancer Screening
News | Mammography | February 25, 2020
February 25, 2020 — According to newly published research in an article titled...
Recognized as the “Pulitzer Prize of the business press,” the Jesse H. Neal Award finalists are selected for exhibiting journalistic enterprise, service to the industry and editorial craftsmanship
News | Radiology Business | February 19, 2020
February 19, 2020 — Connectiv, a division of The Software and Information Industry Association (SIIA), has announced