Advanced imaging technologies play a central role in screening asymptomatic patients. However, the balance between imaging-based screening’s potential benefits versus risks is sometimes unclear. Radiologists will have to address ongoing concerns, including high false-positive rates, incidental findings outside the organ of interest, overdiagnosis, and potential risks from radiation exposure. In this article, we provide a brief overview of these recurring controversies, and suggest the following as areas that radiologists should focus on in order to tip the balance towards more benefits and less harms for patients undergoing imaging-based screening: interpretive variability, abnormal finding thresholds, and personalized, risk-based screening.

No abstract

Objective Among vulnerable women, unequal access to advanced breast imaging modalities beyond screening mammography may lead to delays in cancer diagnosis and unfavorable outcomes. We aimed to compare on-site availability of advanced breast imaging services (ultrasound (US), magnetic resonance imaging (MRI), and image-guided biopsy) between imaging facilities serving vulnerable patient populations and those serving non-vulnerable populations. Setting 73 United States imaging facilities across five Breast Cancer Surveillance Consortium regional registries during calendar years 2011–2012. Methods We examined facility and patient characteristics across a large, national sample of imaging facilities and patients served. We characterized facilities as serving vulnerable populations based on the proportion of mammograms performed on women with lower educational attainment, lower median income, racial/ethnic minority status, and rural residence. We performed multivariable logistic regression to determine relative risks of on-site availability of advanced imaging at facilities serving vulnerable women versus facilities serving non-vulnerable women. Results Facilities serving vulnerable populations were as likely (RR for MRI = 0.71 [95% CI 0.42, 1.19]; RR for MRI-guided biopsy = 1.07 [0.61, 1.90]; RR for stereotactic biopsy = 1.18 [0.75, 1.85]) or more likely (RR for US = 1.38 [95% CI 1.09, 1.74]; RR for US-guided biopsy = 1.67 [1.30, 2.14]) to offer advanced breast imaging services as those serving non-vulnerable populations. Conclusions Advanced breast imaging services are physically available on-site for vulnerable women in the United States, but it is unknown whether factors such as insurance coverage or out-of-pocket costs might limit their use.

Objective: To determine whether digital breast tomosynthesis (DBT) adoption was associated with a decrease in screening mammography capacity across Breast Cancer Screening Consortium (BCSC) facilities given concerns about increasing imaging and interpretation times associated with DBT. Materials and Methods: Facility characteristics and examination volume data were collected prospectively from BCSC facilities that adopted DBT between 2011 and 2014. Interrupted time series analyses using Poisson regression models with facility as a random effect were used to evaluate differences between monthly screening volumes during the 12-month pre-adoption period and 12-month post-adoption period (separated by a 3-month lag period) and to test for changes in month-to-month facility-level screening volume during the pre-adoption and post-adoption periods. Results: Across five regional breast imaging registries, 15 out of 83 (18.1%) facilities adopted DBT for screening between 2011 and 2014. The majority had no academic affiliation (73.3%, 11/15), were non-profit (80.0%, 12/15), and were general radiology practices (66.7%, 10/15). Facility-level monthly screening volumes were slightly higher during the post- vs. pre- adoption periods (relative risk [RR] = 1.09, 95% confidence interval [CI] 1.06–1.11). Monthly screening volumes remained relatively stable within the pre-adoption period (RR = 1.00 per month, 95% CI 1.00–1.01) and the post-adoption period (1.00, 95% CI 1.00–1.01). Conclusion: In a cohort of facilities with varied characteristics, monthly screening examination volumes did not decrease after DBT adoption.