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DBI Spanish Language Materials & Support

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News! The DBI Spanish language site SenosDensos.org is updated and more accessible. There has been a substantial increase in visits to DBI’s Spanish content and we are ready to address these educational needs!

In recognition of his long-term commitment to DBI Spanish language content development and expansion, we are delighted to announce that MAB member Dr. Daniel Lehrer, Breast Imaging Specialist and Medical Director at CERIM in Argentina, is now DBI Spanish Language Advisor. His tireless work assures that DBI content is, and will be, available to Spanish speaking women all over the world.

Research and MAB News

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New Research
Finding it early saves lives and money. New research out in Current Oncology, Capturing the True Cost of Breast Cancer Treatment: Molecular Subtype and Stage-Specific per-Case Activity-Based Costing details that “…the cost of BC treatment is many orders of magnitude less when BC is diagnosed at an earlier stage, and that costs increase exponentially with stage. The magnitude of difference in cost for treatment of late-stage compared to early-stage BC has been previously noted to be 3–4 times; however, our study shows a cost differential of up to 36 times in magnitude when DCIS is compared with stage IV.”

Welcome!
DBI welcomes new Medical Advisory Board members Dr. Sheila Appavoo and Dr. Lars Grimm and welcomes back Dr. Jennifer Harvey! Our hardworking volunteer MAB members contribute to and review all website content.

DENSE Trial 

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A study of women with extremely dense breasts, the Dutch DENSE trial, has shown that adding MRI to mammography every two years improves cancer detection and reduces interval cancer rates. In a secondary analysis published in Radiology, women in the top third of enhancing volume of breast tissue on MRI were twice as likely to develop breast cancer as those in the lowest third. As incoming DBI MAB member Dr. Lars Grimm points out in an accompanying editorial, it is important to consider combinations of breast density and other risk factors that qualify women as “high risk” and therefore eligible for continued screening MRI under current guidelines.

Nebraska insurance law, Just published

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State Insurance Law
Legislation for expanded breast imaging insurance coverage has been signed into law in Nebraska. Please see DBI’s Legislative Info for updated map and table details.

Just Published
In Cancer, coauthored by DBI MAB member Dr Sally Herschorn, Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone.  Many women at high risk of screening mammography failure do not currently undergo supplemental screening beyond mammography.  Health care provider and patient awareness of other breast cancer risk factors beyond breast density, including family history and prior benign biopsies, is important in identification of women at high risk of mammography screening failure (interval cancer or advanced breast cancer) who should be recommended for supplemental screening with ultrasound or especially MRI. It is important to recognize that limiting supplemental screening to women at intermediate- to high-risk by the BCSC model would fail to identify 30-40% of women with dense breasts who will experience interval cancer and about 60% of all women who will develop advanced breast cancer.

New Research

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Just published in Journal of Clinical Oncology, a case-cohort study, Long-Term Performance of an Image-Based Short-Term Risk Model for Breast Cancer. Conducted at Karolinska Institutet, the study showed an image-based risk model developed to predict short-term breast cancer risk can also be used to assess long-term risk for identifying women who may benefit from risk-reducing strategies and supplemental screening. The image-based model showed better accuracy in predicting 10-year risk than the Tyrer-Cuzick v8 model, a traditional lifestyle/familial-based risk model.

New Research

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Topic: Tech Performed Handheld Ultrasound After 3D
Just published in the Journal of Clinical Oncology, authored by Dr. Wendie Berg, and coauthored by Dr. Marcela Böhm-Vélez and others, Prospective Multicenter Diagnostic Performance of Technologist-Performed Screening Breast Ultrasound after Tomosynthesis in Women with Dense Breasts (the DBTUST).

  • The prospective multicenter study of technologist-performed handheld ultrasound screening after 3D mammography showed a modest added cancer detection rate from ultrasound of about 1 cancer per thousand screens each year for three years and 4% added false positive rate.  Many cancers missed initially were visible on targeted ultrasound, and other studies using automated ultrasound or physician-performed ultrasound, and studies in Asia and Canada have shown higher added cancer detection rates from ultrasound.  Contrast-enhanced approaches such as MRI or CEM are expected to produce far greater cancer detection. Many women cannot tolerate or access contrast-enhanced approaches and ultrasound is then a good option.

Topic: Knowledge Gaps About Breast Cancer Risk Model Use/High-risk Screening
DB-i’s third research project just out in the Journal of Breast Imaging, Effect of an Educational Intervention on Women’s Health Care Provider Knowledge Gaps About Breast Cancer Risk Model Use and High-risk Screening Recommendations.

  • The research shows that important knowledge gaps regarding appropriate use of the Gail model versus the Tyrer-Cuzick model exist, and providers were unclear about what types of imaging to recommend for screening women at high risk of breast cancer. Nearly all knowledge gaps significantly reduced after web-based education based on DenseBreast-info.org content and reviewed in our CME course, Dense Breasts and Supplemental Screening.

Update: Find It Early Act

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The Find It Early Act, a federal bill for or expanded insurance coverage for no-cost screening and diagnostic imaging for women with dense breasts or at increased risk, can be accessed HERE. Please save and check this page for bill updates.

MAB Member Honored
Congratulations are in order! Dr. Paula Gordon has been appointed to the Order of Canada which honors citizens who make extraordinary contributions to the nation. Dr. Gordon was specifically recognized for “advancing ultrasound imaging and technology in the early detection of breast cancer, as a prominent radiologist and researcher.”

National Comprehensive Cancer Network (NCCN) News & More

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Patient health literacy is in the air! Following the news of DB-i’s health literacy review of website patient content, the NCCN has published new patient guidelines in patient-friendly plain language. The new guidelines were developed to help patients ask the right questions about when and how often to screen for breast cancer. The guidelines emphasize annual mammograms for all average-risk women over 40. Please visit the NCCN’s 2022 Breast Cancer Screening and Diagnosis guidelines to learn more.

Recently Published
A research article co-authored by DB-i Medical Advisory Board member Dr. Jean Seely was published in BMC Cancer, Randomized trial of surveillance with abbreviated MRI in women with a personal history of breast cancer– impact on patient anxiety and cancer detection. The study aimed to determine if surveillance mammography plus abbreviated MRI reduced psychological distress and if abbreviated MRI improved cancer detection rates as compared to mammography alone.

Educational Needs for European Providers and News Out of Canada

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Educational Needs of Referring Physicians

In the current issue of Radiology Today, our OB/GYN Medical Advisory Board members, Drs. Elizabeth Etkin-Kramer and DaCarla M. Albright, share their insights on the educational needs of referring providers, Women’s Imaging – Educational Needs of Referring Physicians in Managing Patients with Dense Breasts. Included is a Case Study in Education by Dr. Toula Destounis that details how her center addressed referring provider and community education when New York’s density inform law went into effect.

Canadian MAB Member News:

Congratulations to Dr. Paula Gordon, 2020 recipient of the Prix d’excellence – Specialist of the Year! Dr. Gordon, a tireless and engaged voice on the topic, is a medical advisor to both DenseBreast-info.org and patient advocacy effort DenseBreastsCanada.ca

New MAB Spotlight:  Dr. Jean Seely is Professor of Medicine in the Department of Radiology at the University of Ottawa. She is Head of the Breast Imaging Section at the Ottawa Hospital, Regional Breast Imaging Lead for the Ontario Breast Screening Program in Champlain region and Co-Chair of the Canadian Association of Radiologists’ Breast Imaging Working group and sits on the Executive board of CAR Mammography Accreditation Program. She is a Fellow of the Society of Breast Imaging. She is an Editorial Board member of Canadian Association of Radiology and Breast Imaging Journals. Her commitment is to reduce the mortality and morbidity of breast cancer and provide high quality breast imaging nationally and internationally. She is President of the Canadian Society of Breast Imaging. Her research interests include Breast MRI, breast cancer screening, quality in breast imaging and patient experience. We are delighted to have Dr. Seely on board!

OBGYN Reach Out

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Referring Provider Reach Out

Patient breast cancer screening discussions typically rest on the shoulders of ObGyns. How can ObGyns and radiologists collaborate on patient screening? What are patient discussion topics and what resources are available? Please see insight in the OBG Management magazine article, How ObGyns Can Best Work with Radiologists to Optimize Screening for Patients with Dense Breasts, authored by our ObGyn MAB members Drs. Etkin-Kramer and Albright and Executive Director JoAnn Pushkin.

DenseBreastDay™
Our third annual #DenseBreastDay™ was another social media success! A round-up of the day’s activities and highlights are available HERE. Look for an expanded international effort in 2021!

Reminder: Free Access for October
A review article by Dr. Wendie Berg, Chief Scientific Advisor to DB-i, and co-authors has just been published in AJR. It is an up-to-the-minute review of realistic screening options for women with dense breasts. The review includes a comparison of cancer detection rates, recall rates, and barriers to implementation of tomosynthesis, screening ultrasound, molecular breast imaging, MRI, and contrast-enhanced mammography in women with dense breasts:  Screening Algorithms in Dense Breasts: AJR Expert Panel Narrative Review.

Medical Societies Share DB-I Resources

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A Resource for Medical Societies:
The Wisconsin Society of Radiologic Technologists joins other medical societies in sharing the DenseBreast-info.org resource with members. A snapshot of other medical societies around the world sharing the DB-i resource and educational tools include:

  • Alberta Society of Radiologists (Canada)
  • Argentine Society of Mastology
  • European Society of Radiology
  • Royal College of Radiologists (UK)
  • Washington State Radiological Society
  • Wisconsin Radiological Society

Canada:
DB-i medical advisor Dr. Paula Gordon’s Virtual Breast Screening Forum 2020 webinar, Screening Breast US – How I Do It,  (organized by CSBI/BC Radiological Society/Screening Mammography Program of BC), is available free to view. Topics include Canadian Task Force issues, risk/screening implications of dense breasts, supplemental screening, and automated ultrasound.

DB-i Research Interest And Medical Advisory Board News

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DB-i Research:

The publication of DB-i’s first research project, Radiologic Technologist and Radiologist Knowledge Gaps about Breast Density Revealed by an Online Continuing Education Course was the subject of articles in AuntMinnie and DOTmed Health Care Business.

As a woman’s breast imaging team and referring provider are often both involved in her mammogram and supplemental screening decisions, DB-i’s second study focused on identifying knowledge gaps among referring providers (details to follow).

Medical Advisory Board News:

Stuart Kaplan, MD, FACR, FSBI,  has new research published in The Breast Journal, COVID-19 on breast imaging case volumes in South Florida. A multicenter study.

Paula Gordon, OBC, MD, FRCPC, FSBI, medical advisor to both DB-i and advocacy group Dense Breasts Canada, was interviewed by CBC News: Dense Breasts Canada urges P.E.I. to take more steps to detect cancer.

News Update: Missouri Insurance Coverage, Advisory Board Honors

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Missouri Insurance Law
Signed on July 13th and effective 8/28/2020 but subject to individual policy applicability dates, the new law Includes coverage for:
  • A mammogram every year for any woman deemed by a treating physician to have an above-average risk for breast cancer in accordance with the American College of Radiology guidelines for breast cancer screening;
  • Any additional or supplemental imaging, such as breast magnetic resonance imaging or ultrasound, deemed medically necessary by a treating physician for proper breast cancer screening or evaluation in accordance with applicable American College of Radiology guidelines; and
  • Ultrasound or magnetic resonance imaging services, if determined by a treating physician to be medically necessary for the screening or evaluation of breast cancer for any woman deemed by the treating physician to have an above-average risk for breast cancer in accordance with American College of Radiology guidelines for breast cancer screening.
Copays/deductible/co-insurance may apply. For more detailed information about this or any state inform/insurance law, click HERE.
DB-i Medical Advisory Board News
We extend our congratulations to Dr. DaCarla Albright, now the Associate Dean for Student Affairs and Wellness at University of Pennsylvania, Perelman School of Medicine. And, kudos to Dr. Jiyon Lee who has just been named a Fellow of the Society of Breast Imaging!

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