Q&A: What will be the hot topics in breast imaging at AHRA's spring conference?

AHRA’s 2016 Spring Conference is right around the corner, kicking off on March 15 in Chicago. Terry Bucknall, CRA, director of women's imaging services at Henry Mayo Newhall Hospital's Sheila R. Veloz Breast Center in Valencia, Calif., is one of many presenters scheduled to appear.

Bucknall spoke with RadiologyBusiness.com about her upcoming presentation, “2016 Hot Topics and Current Trends in Breast Imaging,” sharing her thoughts on both the present and the future of the breast imaging industry.

RadiologyBusiness.com: The latest USPSTF breast cancer screening recommendations were obviously a hot topic all of last year. What kind of impact do you think the final recommendations, and the back-and-forth that went along with them, have had on women?

Terry Bucknall: The recommendations create confusion and an emotional response from most women (and men) who understand that early detection is key in providing lifesaving treatment.

At first, some women are happy to hear that they may not need to be “squeezed” every year, but when they think about all of their family members and friends who have either been diagnosed or died in their 40’s, or have even been diagnosed themselves on a screening mammogram at an early age, they just can’t comprehend how this recommendation could possibly become a reality. Women value “life” and if a screening mammogram saves just one life, then there is value.

Young women tend to have more aggressive forms of breast cancer and 25 percent of breast cancer related deaths are in women in their 40s. Minority populations will also be impacted the most. Black women develop more virulent forms of breast cancer and if not detected at an early stage, the survival rate is very low. Breast cancer is the leading cause of death in Hispanic women. This population is likely to be hit the hardest.

A two-year moratorium on implementation of the USPSTF recommendations was put into place when Congress passed the $1.1 trillion, 2,000-plus page Omnibus Spending Bill in December 2015. How do you think those two years will impact the recommendations? Do you see changing in any way during that time, or is it more about the profession gaining two years to adapt?

TB: I think that the moratorium is a very good thing and gives us a chance to educate and spread the word that annual screening saves lives. Most professional radiology and breast related organizations (the American College of Radiology, the Society of Breast Imaging, the National Consortium of Breast Centers, and others) and many breast care professionals do not agree with the recommendations and have publically stated their disagreement. Individuals have started petitions on Change.org in an attempt to create awareness and support to change the American Cancer Society Recommendations that are a slight modification of the USPSTF, recommending women begin screening at 45 and at age 55 have biennial screenings, yet the ability to make a personal decision.

I am hopeful that there will be some pull back, but realistic that the statistical data that the recommendations are based on is not going to change based on the current method and approach of analysis. If the data were approached differently and not focusing on the “emotional risk” or “overdiagnosis” that women may experience with annual screening, I would hope to see a different outcome.

Until then, we as imagers will need to be proactive in evaluating our services and volumes and what we can do on a local level to educate, adapt and be vocal.

Do you think more and more states will continue implementing breast density laws? Is it just a matter of time until all states require such a law, or do you think some of that momentum may have slowed down? Can you explain?

TB: I think that the breast density legislation is going to continue to impact more states and, yes, it is just a matter of time until all states have legislation in place.

Currently there are 24 states that have reporting laws. Connecticut was the first to adopt legislation in 2009 and the adoption across the country has been fairly consistent since then. There are currently nine states working with introduced bills and four more states preparing to introduce a bill. Are You Dense Advocacy, Inc. has been the backbone of this legislation and has been instrumental to keeping the momentum alive.

What does the near future hold for breast imaging? Can you touch on any potential technological breakthroughs you see coming in the next 5 to 10 years?

TB: Breast imaging is one of the most exciting branches of radiology and continues to be one of the most exponentially innovative.

Tomosynthesis is still a growing modality. Hologic posts that there are currently more than 2,400 3D units installed in the U.S. In 2014, Fujifilm and GE received FDA approval for their units. The findings have proven positive that 3D mammography is a valuable tool. Along with the implementation of 3D mammography comes innovation to create additional imaging accessories such as dedicated biopsy devices and specimen imagers, all offering unique features.

Breast density is obviously opening doors for ultrasound devices that can efficiently scan and produce quality images to be placed into practice. The technology is worthwhile, but each center needs to evaluate how adding this technology will impact their practice and pocketbook. Proper breast density education has a positive potential for increasing this service line and affecting patient care and diagnosis.

MRI is the most sensitive commonly used tool and comes at a high price. I envision modified protocols and more cost-effective MRI in the future as well as a slow implementation of Contrast Enhanced Spectral mammography.

Breast CT has been “in-the-works” for many years. I think one of the most exciting modalities to watch in the future is the Cone Beam Breast CT. If this modality proves to be effective, it has the potential to be a good tool. I’m curious how this technology will be implemented.

It’s extremely important for administrators and radiologists to be aware of what is on the forefront in our field. It’s a huge decision to implement new technology. Some implementations, like 3D, are “no-brainers” after much investigation and research. The facility must feel confident in the value of the implementation and be able to plan for how the new modality will change the way day-to-day work is performed.

I wouldn’t be surprised if some very new and innovative forms of imaging pop-up that we have never heard of. I’m keeping my eyes and ears open.

This text was edited for space and clarity.