By Susan Harvey, MD
In the healthcare industry today, providers and professionals have a duty to improve patient outcomes not only to save more lives, but also to decrease cost as well as lower the invasiveness of treatment. There are many ways to achieve this, and provider and patient education is one of the most critical, especially as technology advances, legislation changes, insurance models evolve and healthcare consumerism continues to rise. As October is Breast Cancer Awareness Month, now is a particularly important time to reflect upon the power of patient education for breast cancer screening specifically.
Consider the recent study published in the Journal of Women’s Health titled, “Physician Knowledge, Attitudes, and Practices Regarding Breast Density,” which demonstrated that healthcare providers are lacking knowledge of necessary breast screening information to share with patients. The study found that out of 155 respondents made up of attending-level physicians, primary care practitioners, radiologists, gynecologists and others, “almost half of the respondents (48%) were unaware of breast density laws, and two-thirds (67%) felt they needed more education about breast density and supplemental screening.” Additionally, “more than half of the respondents (62%) were unaware of the increased risk of breast cancer related to dense breasts,” and “compared to specialists, PCPs were less aware of their state’s breast density laws.”
These findings reinforce the need for healthcare professionals to keep up to date on breast cancer screening basics and for continuing medical education to include this topic.
Regarding patient education, initially establishing what age women should begin screening, and how frequently they should continue, is an important part of encouraging compliance. Complicating the situation, there are variable guidelines written by different organizations that create confusion for patients. The American College of Radiology (ACR) recommends that women should begin screening mammograms annually at age 40. Of course, this can vary depending on each patient’s personal health profile, such as history that could impact risk, which is what makes open dialogue with their informed and up to date healthcare providers so important.
In fact, the impact of breast tissue density in cancer screening is becoming a much more widely discussed topic for providers – and rightfully so. In March 2019, the U.S. Food and Drug Administration proposed a rule updating its regulations issued under the Mammography Quality Standards Act (MQSA) of 1992, which require uniform reporting of a patient’s breast density to patients and medical providers nationwide.
The rule emphasizes the importance of educating patients about their own breast density and the significance to their personal care. According to studies published in The New England Journal of Medicine and Journal of the National Cancer Institute, women with very dense breasts are four to five times more likely to develop breast cancer than women with less dense breasts. As a result, if women with dense or very dense breasts are aware of the impact on their risk of breast cancer, they may be more inclined to get screened and to consider supplemental imaging.
While it’s true that a woman must get a mammogram to determine if she has dense breasts or not, it’s also important for her to understand before that first mammogram what breast density is and how it can impact her screening experience and imaging options.
On a traditional 2D mammography image, dense breast tissue and cancer both appear to look like the same, white glandular tissue, causing a “masking effect” that can lead to not detecting a cancer. According to the FDA, the Genius™ 3D Mammography™ exam is the only mammogram that is FDA-approved as superior to standard 2D mammography for breast cancer screening for all women, including those with dense breasts. This is one important example demonstrating that image modality matters depending on the patient’s personal profile. Women are consumers of healthcare and do express an opinion when they decide on care; and as a result, patient education is necessary to help women make the right choices for their unique needs.
Another area worth discussion and a focus for patient education is what happens after the initial breast cancer screening. It’s important to explain the process in order to manage anxiety and stress about potential recalls and biopsies so that patients can feel as comfortable as possible with the process and make informed decisions with the breast imager’s input.
Typically, in the U.S., recalls for additional imaging do not lead to the diagnosis of cancer; and as a result, physicians can help manage their patients’ anxiety by educating them on the pros and cons of the options provided. Additionally, some women are happy to tolerate a breast biopsy, which is minimally invasive, even if they ultimately do not have cancer, because they’d rather take precautions to ensure they are protecting their health. By fully educating patients on the benefits of sampling suspicious lesions, what a breast biopsy entails and next steps should they have cancer or not, physicians can help engage women in their decision-making process.
There are many needs for provider and patient education regarding breast cancer screening, but the basics presented here should help serve as a reminder of some key points. Patients are no longer looking to their physicians to just make a decision for them – they are active participants in their courses of healthcare and partners with their physicians. It’s up to healthcare providers to actively gain the knowledge they need to educate patients to make the personalized choices for early cancer detection requiring minimal treatment to achieve a common goal for all: improving patient outcomes.
Susan Harvey, MD, is Vice President of Global Medical Affairs in the breast and skeletal health division at Hologic, inc.