JAMA Study an Insult to Breast Imagers, says ACR

Whitney J. Palmer

The assertion that breast imaging facilities are ignoring national guidelines to initiate screening mammography earlier and, potentially, benefit financially is offensive, the College says.

Earlier this week, researchers from Weill Cornell Medicine published a study in JAMA Internal Medicine that has sparked outrage within the breast imaging community – the notion that the overwhelming majority of breast centers do not follow national screening mammography guidelines has prompted backlash from the American College of Radiology (ACR).

According to the ACR, the Weill Cornell study is based on “serious omissions of fact” that can cause a great deal of confusion among women and their physicians.

In article, published March 15, Weill Cornell investigators estimated that 87 percent of breast imaging centers across the country are out of sync with national screening mammography guidelines since they promote beginning screening at age 40 with 81 percent supporting annual exams. These imaging centers, the researchers said, were disregarding guidelines from the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF) and could be benefiting financially by supporting screening guidelines that bring women in for services earlier.

Related Content: Most Breast Imaging Centers Are Not Following National Screening Guidance

The problem is that other leadership bodies, including the ACR and Society of Breast Imaging, already support annual screening mammography at age 40 – a detail omitted in the study. Those recommendations are based on data, and to intimate otherwise is highly distasteful, said Amy Patel, M.D., medical director of breast imaging at Liberty Hospital.

“To suggest what they did is extremely unfortunate. All organizations, regardless of recommendations of when to start mammography and frequency, acknowledge that annual screening mammography beginning at age 40 saves the most lives and life years saved,” she said. “Also, to suggest financial motivations is also extremely disappointing and those words can be damaging when we, as a breast cancer community, are working tirelessly to save the most lives and close the gap to healthcare disparities.”

Patel’s response echoes the official backlash from the ACR. In its own response letter, the College asserted the article could unnecessarily muddy the waters around breast imaging.

“The claim that facilities offering mammograms to women ages 40 and older are operating counter to recommendations of ‘national societies’ is misleading at best,” the ACR said. “To assert that financial incentives may be driving local site screening recommendations – with no evidence to back the claim – is outrageous and insulting to the medical professionals working to save lives from the nation’s second leading cancer killer in women.”

The College also pointed out that U.S. breast imagers largely reject the delayed or less frequent mammography screening called for by the ACR and USPSTF. These groups currently recommend bi-annual screening mammography starting at age 50.

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