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New York State Radiological Society Breast Imaging Committee Quarterly Report April 2021

NYSRS Breast Imaging Committee submits comment on National Quality Forum Measures Application Program (MAP) measure under consideration (MUC)- Breast Screening Recall Rate

Thank you for the opportunity to comment on the proposal to include Breast Screening Recall Rates in the federal Hospital Quality Reporting Program. The NY State Radiological Society and the American College of Radiology Breast Commission are aligned in the below comments regarding inclusion of breast screening recall rates in the Hospital Quality Reporting Program.

 

Using recall rates alone provides only a limited assessment of a facility’s ability to appropriately screen women for breast cancer.  Additional measures such as cancer detection rate and positive predictive values provide a comprehensive, clinically meaningful basic level audit of a screening mammography program giving the radiologist/radiology department feedback to enable improvement, giving a more accurate picture of the quality of care provided and resulting in improved patient outcomes. The Mammography Quality Standards Act (MQSA) recommends standard use of this suite of measures by radiology practices. The ACR recommends that CMS consider a means for using this suite of measures in one of its quality programs rather than the isolated measure of recall rate. 

 

ACR Comments on USPSTF Breast Cancer Screening Draft Research Plan: link to ACR submitted comments below.

The American College of Radiology® (ACR®) has submitted comments in response to the United States Preventive Services Task Force (USPSTF) Draft Research Plan  (DRP) for Breast Cancer Screening. Reflecting input from the ACR Committee on Government Relations – Breast Imaging, Breast Imaging Commission and the Screening Leaders Group, the comments provide feedback to the task force on its proposed analytic framework, key research questions, contextual questions, study design and research approach. They also suggest several research papers that provide insights into important issues that should be considered as part of the development of screening recommendations. The comments also encourage greater transparency in USPSTF’s processes and urge that breast imaging experts be included throughout the Task Force’s development of its recommendations, noting that with the passage of the Affordable Care Act, the USPSTF was explicitly granted a prominent role in Centers for Medicare and Medicaid Services’ coverage decisions and in the establishment of preventive service coverage requirements for private insurers. “With such substantive policy issues at stake,” the comments stated, “the public trust demands that the USPSTF recommendation-development process be entirely transparent, consistent with other federal agencies that create policy and promulgate regulations.”

https://www.acr.org/-/media/ACR/Files/Advocacy/AIA/ACR-comments-to-USPSTF-DRP-final.pdf

 

21st Century Cures Act:  Effective April 5, 2021, new federal regulations required by the 21st Century Cures Act will change how and when we share data with our patients. The new regulations stipulate that patients must have immediate access upon request to certain data in their medical records when that data becomes available.
The regulatory guidance is very clear in that “blanket delays that affect a broad array of routine results” do not qualify for an exception under the new regulations. The rule is designed to give patients and their healthcare providers secure access to health information. It also aims to increase innovation and competition by fostering an ecosystem of new applications to provide patients with more choices in their healthcare. It calls on the healthcare industry to adopt standardized application programming interfaces (APIs), which will help allow individuals to securely and easily access structured electronic health information using smartphone applications.

The rule includes a provision requiring that patients can electronically access all of their electronic health information (EHI), structured and/or unstructured, at no cost.

 

The new regulations do include certain exceptions, the most notable being that results can be temporarily blocked when a clinician has concern that immediate release of the results would cause significant harm to the patient.

The rule means that patient records must be made available to patients immediately upon finalization.  This includes radiology and pathology results, which may be finalized in the evening or on weekends.

For us in breast imaging, the main concern is that following breast biopsies that we perform, patients will have access to their pathology results as soon as (or even sooner than) we do and may read them before we have a chance to perform concordance analysis and contact the patient.  We may consider telling patients about this at the time of the biopsy and having discussions about the availability of results and context.   Assuring patients that they will be contacted to discuss results as soon as we have a chance to review their pathology and their imaging, and that they may reach us at the provided phone number may help to alleviate potential stressors.

 

COVID RELATED ISSUES:

Management of Ipsilateral Axillary Lymphadenopathy POST COVID 19 VACCINATION

Multiple articles and guidelines published by subspecialists in breast imaging as well as expert panels in oncologic imaging including many members of our committee.  The clinical entity and management are particularly challenging for our subspecialty as it impacts the care of pts with new breast cancer diagnoses, pts undergoing current treatment, screening patients and breast cancer survivors.  Links to example publications below for reference.

Unilateral axillary Adenopathy in the setting of COVID-19 vaccine

Nishi Mehta, Rachel Marcus SalesKemi BabagbemiAllison D. LevyAnika L. McGrathMichele Drotman, and Katerina Dodelzon Clin Imaging. 2021 Jul; 75: 12–15. Published online 2021 Jan 19. doi: 10.1016/j.clinimag.2021.01.016 PMCID: PMC7817408 PMID: 33486146

 

SBI Recommendations for the Management of Axillary Adenopathy in Patients with Recent COVID-19 Vaccination

Society of Breast Imaging Patient Care and Delivery Committee Lars Grimm, Stamatia Destounis, Basak Dogan, Brandi Nicholson, Brian Dontchos, Emily Sonnenblick, Hannah Milch, JoAnn Pushkin, John Benson, Katia Dodelzon, Neha Modi, Roger Yang, Vandana Dialani, Vidushani Perera

https://www.sbi-online.org/Portals/0/Position%20Statements/2021/SBI-recommendations-for-managing-axillary-adenopathy-post-COVID-vaccination.pdf

 

Multidisciplinary Recommendations Regarding Post-Vaccine Adenopathy and Radiologic Imaging: Radiology Scientific Expert Panel

Anton S. BeckerRocio Perez-JohnstonSona A. ChikarmaneMelissa M. ChenMaria El HomsiKimberly N. FeiginKatherine M. GallagherEhab Y. HannaMarshall HicksAhmet T. IlicaErica L. MayerAtul B. ShinagareRandy YehMarius E. Mayerhoefer,

Published Online:Feb 24 2021https://doi.org/10.1148/radiol.2021210436

https://pubs.rsna.org/doi/pdf/10.1148/radiol.2021210436

 

TMIST Trial to continue with modifications.

https://ecog-acrin.org/news-and-info/press-releases/ecog-acrin-public-statement-regarding-the-tmist-breast-cancer-screening-trial?utm_medium=email&utm_source=marketo&utm_content=AIA_button&utm_campaign=ADVO-032021&mkt_tok=NTk4LVRSQS0yNDQAAAF77nuK0jTi86q1amS-XtboNoGHCeJkm47V0_37DLFuk6AOR9i_5m7232D_fcXZQ-9UX5J2Q-KMD0vCeowQPN-Ek8jf1L3P48y-nogFiqM

 

Breast Cancer Health Care Disparities

ACR and SBI issue comment refuting Jama article

JAMA Breast Cancer Screening Research Article and Editorial Misleading and Ignore Disparities

Study published March 15 in JAMA Internal Medicine claims that breast cancer centers are promoting mammography screening for women in their 40s, contrary to guidelines from the U.S. Preventive Services Task Force (USPSTF).

A breast imaging study and corresponding editorial published in the Journal of the American Medical Association were denounced by the ACR. The research letter by Patel et al , and accompanying editorial by Habib et al , published March 15 in the Journal of the American Medical Association (JAMA) Internal Medicine contain serious omissions of fact. The claim that facilities offering mammograms to women ages 40 and older are operating counter to recommendations of “national societies” is misleading at best. Also, 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 national medical societies most expert in breast cancer diagnosis and care, including the American College of Radiology® (ACR® ), Society of Breast Imaging (SBI) and American Society of Breast Surgeons  recommend that women start getting annual mammograms at age 40. Similarly, the American College of Obstetricians and Gynecologists  recommends women start mammography at age 40 and get tested every one-to-two years.

Full statement here: https://www.sbi-online.org/Portals/0/Position%20Statements/2021/ACR-SBI-statement-on-JAMA-study-march-15-2020.pdf?_zs=feEae1&_zl=PFOT7

Article: Research Letter

Assessment of Screening Mammography Recommendations by Breast Cancer Centers in the US

Neal S. Patel, MEng1Mark Lee, BS, BA1Jennifer L. Marti, MD1

Author Affiliations Article Information

JAMA Intern Med. Published online March 15, 2021. doi:10.1001/jamainternmed.2021.0157

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2777520?resultClick=1

 

Editorial: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2777518

 

Race, income, education affect women’s access to DBT screening

Routine breast cancer screening with digital breast tomosynthesis (DBT, or 3-dimensional mammography) may improve screening outcomes over traditional digital mammography (DM, or 2-dimensional mammography).13 Multiple prospective trials and observational studies49 demonstrate that DBT can improve the cancer detection rate while decreasing the recall rate from screening compared with DM screening at the population level depending on women’s age, breast density, and screening interval. Although diffusion of DBT screening in the US has been relatively rapid, it is unknown whether adoption has occurred equally across different populations.11 Populations with traditional disparities—Black race, Hispanic ethnicity, lower educational level, or lower income level—have historically experienced greater breast cancer morbidity and mortality than their less disadvantaged counterparts.1214 These populations have also historically been the last to benefit from newer medical technologies.

In this cross-sectional study, women of minority race/ethnicity and lower socioeconomic status experienced lower DBT access during the early adoption period and persistently lower DBT use when available over time. Future efforts should address racial/ethnic, educational, and financial barriers to DBT screening.

 

Comparative Access to and Use of Digital Breast Tomosynthesis Screening by Women’s Race/Ethnicity and Socioeconomic Status

Christoph I. Lee, MD, MS1,2 et al

JAMA Netw Open. 2021;4(2):e2037546. doi:10.1001/jamanetworkopen.2020.37546

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776561?resultClick=3

 

Physician Well Being:

JACR article on effects of COVID 19 Pandemic on breast radiologists:

Psychological distress was highest among younger and female respondents and those with greater pandemic-specific childcare needs and financial loss. Practice-initiated COVID-19-specific wellness efforts were associated with decreased psychological distress. Policies are needed to mitigate pandemic-specific burnout and worsening gender disparities.

COVID-19 and Breast Radiologist Wellness: Impact of Gender, Financial Loss, and Childcare Need

Milch et al. https://doi.org/10.1016/j.jacr.2021.02.022

https://www.jacr.org/action/showPdf?pii=S1546-1440%2821%2900157-5

 

 

 

Respectfully Submitted by
Donna D’Alessio, MD
Chair
Breast Imaging Committee
New York State Radiological Society
April 8, 2021

 

 

 

 

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