Adopting the right technology and innovation can yield improved patient access and outcomes as the industry navigates the backlog of elective procedures from screening to surgery. This was the overarching theme of the recent webinar, “Catching Up with Catching Cancer Early.” In the session, sponsored in part by Volpara, leaders and panelists from Targeted Medical Education (TME) explored the importance of maintaining a focus on population health. Panelists included Dr. Peter Beitsch; Dr. Barry Rosen; Dr. Walton Taylor; Dr. Pat Whitworth; and hospital administrator Noel Pugh, PhD.
“Being a woman and 40 years old has been the standard definition for breast cancer risk that initiated the screening process for years; however, we can do better,” said Dr. Beitsch. “TC8 [Tyrer-Cuzick version 8 risk model] with breast density is a step forward for risk stratification, but it’s really COVID-19 that may change the concept and bring risk-adapted screening to the fore.”
In addition to implementing physical and workflow changes to include social distancing, panelists urged the industry to look for ways to rethink the breast cancer screening and diagnostic process itself. For example, if risk assessment identifies women who are at higher risk of developing breast cancer, there will also be women who are at a lower risk, which provides the opportunity to adjust the screening process and intervals. Though all the panelists support the concept of risk-adapted screening, moving away from population screening needs to be better understood as current risk models still have shortcomings in terms of being tested across all populations. According to Dr. Whitworth: “We have models that can identify women at high risk and we can customize screening protocols for that woman. However, we don’t have a lot of evidence about increasing screening intervals.”
Several panelists suggested that the use of innovative technology such as artificial intelligence (AI) to review findings on an individual mammogram may help, particularly if COVID-19 returns. Dr. Rosen highlighted how an AI tool that helps him read 50 percent faster can also be used to review past exams and risk stratify patients. “Why wouldn’t we want to use AI to help find interval cancers? We can often go back and see the start of that cancer earlier. AI can be the bridge to help get BI-RADS 3s down and drive supplemental imaging in women with dense breasts.”
In addition to discussing breast density to stratify women for advanced imaging, panelists reflected on the need for better genetic testing guidelines. Referencing the study, “Underdiagnosis of Hereditary Breast Cancer: Are Genetic Testing Guidelines a Tool or an Obstacle?,” published in the Journal of Clinical Oncology, Dr. Beitsch discussed that while an estimated 10 percent of cancers likely result from hereditary causes, less than 10 percent of all BRCA1 and BRCA2 carriers have been identified, and that the majority of individuals at risk have not received genetic testing, in part because they do not meet the family history criteria of current testing guidelines. The results of this study suggest that a substantial modification of the scope and intent of existing genetic testing guidelines should be expanded immediately to include genetic testing of all patients with breast cancer.
As a consequence, this breakthrough paper led the American Society of Breast Surgeons (ASBrS) to recommend that for any patient affected by breast cancer, genetic testing should be made available. Testing would facilitate informed decision making for patients and their family members, and thereby activate surveillance and risk-reduction options.
Closing out the discussion, the panel concluded that ultimately, COVID-19 represents an inflection point—that breast screening cannot be done the same way as it was done in the past. Risk assessment integrating breast density, risk-adapted screening, and increased use of AI and genetic testing offer a better path forward. Healthcare will be different, and the change will be for the better.