HJAR Jul/Aug 2024

HEALTHCARE JOURNAL OF ARKANSAS I  JUL / AUG 2024 45 Stacy Smith-Foley, MD Breast Imaging Specialist The Breast Center at CARTI annual mammograms. Yet, research clearly shows the importance of patients following a yearly screening schedule. An American Society of Clinical Oncology study showed that annual mammograms reduced the mor- tality rate by more than 40%, whereas bien- nial screenings resulted in a drop of only 25%. If patients are unaware of these life- saving benefits, they may forgo their annual mammogram appointments — even though insurance is required to cover this yearly imaging starting at age 40. Asimilar gap exists in the USPSTF recom- mendations for women with dense breasts. Contrary to other organizations like the Society of Breast Imaging (SBI), the USP- STF failed to offer guidance addressing the 40% of women with this type of breast tis- sue, a factor known to increase their risk of breast cancer. As SBI noted, dense breast tissue “impairs detection of noncalcified cancers on mammography, which can re- sult in later stage at diagnosis.” Healthcare providers should talk to their patients with dense breasts about the potential need for 3D mammography and supplemental screening with ultrasound or MRIs, which can aid in early detection. The USPSTF stated, “Current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women 75 years or older.” Again, how are older women supposed to know what to do without guidance from their healthcare provider? In alignment with the American Cancer Society, The Breast Center at CARTI and others encourage women — whether in their 70s, 80s, or even 90s — to receive an- nual mammograms unless they have se- vere comorbidities that may limit their life TECHNOLOGICAL advances, novel target- ed therapies, leading-edge surgeries… The healthcare field constantly seeks innova- tion. As a breast radiologist for more than two decades, I have been fortunate to wit- ness this incredible progress firsthand. Take the growing adoption of 3Dmammography and the corresponding reduction in breast cancer mortality as a prime example. The deployment of this imaging tool is steadily changing the landscape of breast care. Amid the steady streamof lifesaving “wins” like high-resolution breast screenings, it can be tempting for healthcare providers to be- come consumed by the quest to push the envelope. But we must remember that the key to helping our patients live long, healthy, and, most importantly, good-quality lives is not dependent on innovation alone. Instead, it is about educating and empowering them to make informed decisions, including what tools and tactics may help them reduce and manage their risks. Whether in practice or in the grocery store aisle, women often ask me when they should get a mammogram. Their questions generally stem from confusion or a lack of access to medical guidance — sometimes from their doctors. Consider the long-stand- ing disconnect between leading organiza- tions like theAmerican Cancer Society and the U.S. Preventive Services Task Force (USPSTF) over the age to begin breast can- cer screenings. While the USPSTF recently updated the screening starting at the age of 40, gray areas in the recommendations remain, reinforcing the need for effective physician-patient communication. For instance, the USPSTF advises that women should receive biennial rather than expectancy. As I often tell my patients, “If you have breasts and birthdays, you have risk.” Clear and consistent communication is one of the most effective tools to ensure older patients receive the recommended screenings. The same goes for women younger than 40. It’s up to us as their healthcare provid- ers to have honest conversations with them about their risk of breast cancer. Discussions about proper breast care should begin well before they need to get their first mammo- gram. Unfortunately, the USPSTF did not offer recommendations for this population group, but ideally, women should receive risk assessments before age 25. This will allow patients at the highest risk of breast cancer — those with genetic predispositions, family histories, and other known factors — to begin their screenings sooner. The USPSTF’s recommendations are the latest reminder of the need for patient edu- cation — not only around breast cancer but also for diseases where proven risk reduc- tion and management tactics are available. I applaud the healthcare field’s incredible momentum over the last few decades, in- cluding our increasing use of screening tools like 3D mammography. However, I believe we cannot fully benefit from the lifesaving promise of these advances without empow- ering our patients to take advantage of them. With effective communication, we can equip them with the knowledge and confidence needed tomake informed choices for longer, healthier, happier lives. n Stacy Smith-Foley, MD, is a board-certified breast imaging specialist at The Breast Center at CARTI. Both are passionate about promoting breast cancer awareness and educating women about their risks.