IOM Study on Breast Cancer Released
The Institute of Medicine (IOM) and National Research Council have recently released a new report: Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. The study takes an in-depth look at what can be done to improve breast cancer screening and detection services in the U.S. with the ultimate goal of preventing deaths from breast cancer.
Breast cancer is the second leading cause of cancer death among women. More than 200,000 cases of breast cancer will be diagnosed in 2004 and, in the same year, an estimated 40,000 women will die of the disease. While there is still no way to prevent breast cancer and treatment for the disease is limited, the study finds that early detection remains the most promising way of surviving breast cancer.
According to the study, mammography is the best existing screening tool. While mammography has its limitations - between 5 and 17 percent of cancers go undetected, risks of false alarms are 1 in 10, and mammograms do not work equally well in all women - it is still considered the best available screening technology for breast cancer.
Keeping these statistics in mind, the study recommends broadening as well as improving the use of existing mammography technology in order to save more lives. In addition, more needs to be done to learn about the biology of the disease, to predict who is most at risk, and to encourage greater usage of imaging technology.
Unfortunately, while the need for mammographies is increasing, so is the rate of mammography facility closures. The aging US population results in an increase in the number of women seeking mammograms yet new facilities are not keeping up with the demand, and closings are becoming more and more common. This is in large part due to a shortage of breast imaging sub-specialists; while 20,000 radiologists in the US can interpret mammograms, only 2,000 are specialized in breast imaging. Surveys reveal that radiologists stay away from breast imaging due to the unattractiveness of the profession, fear of lawsuits, the growing costs of malpractice insurance, stress, and low reimbursement for long hours. The increase in facility closures has already resulted in increased waiting times for women seeking appointments and will clearly have ramifications for women's health if the process is not reversed.
The study suggests a reorganization of the US health system in order to increase access to screening services and ameliorate the quality of these services:
To reduce the personnel shortage, non-physician technicians could be trained to pre-screen or double-read mammograms. This has already been tried in other countries with much success.
Incentives need to be created in order to attract more doctors into the field. With a shortage of personnel, increased quality of care becomes even more important.
Developing more specific risk-assessment tools for women and finding ways to impart this knowledge to the public, including the media, is an important first step.
The implementation of new technology, such as computer-aided detection, must be made a priority. This includes assessing the effectiveness of procedures and communicating findings to promote the use of these new technologies in clinical practice.