95% of patients surveyed in the USA would recommend facilities that use a SmartCurve system. 80 % of women who delayed their mammogram due to discomfort are less likely to delay future mammograms. The fear of pain or discomfort, historically associated with breast compression prevents many women from making regular breast screening appointments a priority. In fact, a recent survey of 10,000 women found that fear of physical discomfort was the top reason cited for avoiding a mammogram by women who never had one.This puts them at risk of early breast cancers being missed and more breast cancers being diagnosed at a more advanced stage. Breast pain experienced during a mammogram is directly related to the time spent under compression and the pressure distribution on the breast, two factors that must be addressed to improve the mammography experience. The SmartCurve system features a proprietary curved surface that mirrors the shape of a woman’s breast to reduce pinching and allow better distribution of force over the entire breast. The system also features proprietary image processing algorithms that ensure the preservation of image quality and accuracy. The SmartCurve system, combined with the fastest 3D™ mammogram available, makes the Genius exam the obvious choice for women wanting a more accurate exam that is also more comfortable. The system includes options to accommodate a majority of women and breast sizes and can be used with Hologic’s MammoPad® breast cushion for even greater comfort. In addition to providing women with increased comfort and the accuracy they have come to expect from the Genius exam, the SmartCurve system’s image processing algorithm ensures there is no change in positioning or workflow for radiologists and technologists administering the exam. Clinicians can feel confident they are offering patients an improved experience while maintaining efficiency within their facilities. Hologic is the world leader in breast cancer screening technology, and with that leadership comes a responsibility to develop products that provide optimal patient satisfaction without sacrificing clinical performance. Sheryl Crow, Genius exam spokeswoman, said, “I’ve already been telling women that the Genius exam is the best option for their annual screening. Now that it’s also a more comfortable exam thanks to the SmartCurve system, I’m urging women everywhere to stop making excuses and ask their doctors about the Genius exam today.”

If you could only pick one screening exam to recommend for women in a year — just one — which one would it be? Researchers from the Cleveland Clinic pondered this question and posted their findings in a modeling study published April 29 in JAMA Oncology.

A group of researchers led by Glen Taksler, PhD, wanted to find out if it could improve screening compliance by recommending a smaller number of screening exams in a year, focusing on the ones most likely to confer a mortality benefit.

The team’s conclusion? It’s actually more important for women who are eligible for lung cancer screening to undergo that test annually, compared with breast screening. The study results offer a “next best alternative” for women who have spotty cancer screening compliance, Taksler et al wrote.

“[Our] study of 20 million simulated U.S. women found that it was possible to reduce screening intensity to one carefully chosen test per year in women who were ineligible for lung cancer screening and two tests per year in eligible women while maintaining 94% or more of the maximum benefits,” the researchers wrote.

An important way of reducing cancer-related mortality in women is through screening, and guidelines exist for breast, cervical, colorectal, and lung cancer. But women’s adherence to these guidelines varies widely, according to the investigators.

Taksler’s group sought to evaluate the benefits and harms of women undergoing some, but not all, guideline-recommended cancer screenings by conducting a modeling study that used four mathematical models from the U.S. National Cancer Institute’s Cancer in Intervention and Surveillance Modeling Network based on data from 20 million simulated U.S. women born in 1965. For this study, the authors focused on cancer screening recommendations from the U.S. Preventive Services Task Force’s (USPSTF).

They modeled strategies for breast, cervical, colorectal, and/or lung cancer screenings across a variety of frequencies (one, two, three, or four types of screenings per year, or all eligible screenings every five years). Screening approaches included the following:

• No screening
• Screenings according to USPSTF recommendation:
  • Colonoscopy every 10 years
  • Fecal immunochemical test every year
  • Breast every two years
  • Cervical every five years
  • If eligible, lung cancer screening every year
• Screenings less often than USPSTF recommendations
  • All less often
  • Some when recommended by USPSTF but others less often or skipped

The researchers then assessed how many modeled life-years would be gained from these different strategies, stratifying the results by lung cancer screening eligibility and comparing the model analysis with 2018 screening exam adherence rates.

Taksler et al found that if women were eligible for lung cancer screening — such as due to a history of smoking — it was most important that they receive these exams annually. On the other hand, they found minimal negative effects from women skipping the occasional breast screening or delaying it by a year.

“Among lung cancer-eligible women, lung cancer screening was essential: Strategies omitting it provided 25% or less of the maximum benefits,” the group wrote. “The top-ranked strategy restricted to two screenings per year was annual lung cancer screening and alternating fecal immunochemical test with mammography (skipping mammograms when due for cervical cancer screening, 97% of maximum benefits).”

The findings could have to do with women’s preferences and logistical factors like the ability to take time off for testing, according to Taksler and colleagues.

“In an era of patient-centered care, it is important to respect patient wishes,” they wrote. “Patients may be eligible for up to 41 preventive services, of which four are cancer screenings, and may be time-limited, particularly after managing chronic conditions … If skipping an occasional mammogram makes it easier for [a woman] to obtain colorectal or lung cancer screenings (e.g., less time off work), then she likely would benefit from doing so.”

The study underestimates screening’s benefits, particularly for breast cancer, Dr. Sarah Friedewald of Northwestern University in Chicago told AuntMinnie.com via email. Friedewald is also a member of the American College of Radiology’s (ACR) Commission on Breast Imaging.

“The model for breast cancer screening in this study uses biennial screening, which underestimates the benefits of screening mammography,” she said. “All organizations — the USPSTF included — agree that the most lives are saved if patients are screened every year beginning at age 40. Therefore, this model significantly underestimates the benefits of screening mammography.”

In any case, it doesn’t make sense to discourage evidence-based screening, Friedewald noted.

“Patients should choose for themselves if they want to be compliant rather than organizations advocating against evidence, resulting in patient confusion,” she said.

A new study suggests that breast MRI may not be useful in screening women with certain types of high-risk breast lesions. The authors recommend using mammography instead.

Previous research has shown that breast MRI has screening benefits over mammography among women at high risk of cancer.

But a team led by Dr. Alison Laws of Brigham and Women’s is suggesting that mammography alone appears to be a viable way to screen women with so-called high-risk lesions like atypical ductal/lobular hyperplasia or lobular carcinoma in situ.

“Most high-risk lesion patients should be considered to have moderately elevated breast cancer risk, and management efforts should focus on adherence to conventional screening breast imaging with annual mammography as well as strong consideration for use of chemoprevention,” Laws and colleagues explained.

Current guidelines from organizations such as the American Cancer Society (ACS), the National Comprehensive Cancer Network (NCCN), and the American College of Radiology (ACR) recommend that women with a 20% to 25% lifetime risk of breast cancer — and those with dense breast tissue — undergo regular screening breast MRI as an adjunct to mammography.

Yet these groups acknowledge that the use of screening breast MRI in women with high-risk lesions may not be necessary, especially since it has downsides like false positives (that may then prompt unnecessary recalls and/or biopsies) and increased healthcare costs, according to the authors.

“Patients with high-risk lesions were under-represented in the landmark screening MRI studies, which primarily enrolled either those with pathogenic variants in breast cancer susceptibility genes or 20% to 25% lifetime risk by family history-based models,” they wrote. “Thus, the role of screening MRI for patients with high-risk lesions is unclear.”

Laws and colleagues conducted a study that included 699 women who presented at the Dana-Farber Brigham Cancer Center’s high-risk breast cancer clinic between 2015 and 2020 with atypical ductal/lobular hyperplasia (542) or lobular carcinoma in situ (157). The women were categorized into two groups: Those who had undergone mammography screening alone (540) and those who had undergone both mammography and breast MRI (159).

The researchers explored how the addition of breast MRI affected cancer detection and biopsy rates over a four-year follow-up period, accounting for factors like age, race, body mass index, menopausal status, breast density, family history, and lesion type. A total of 13 invasive or ductal carcinoma in situ (DCIS) cancers were identified among the study cohort, with eight of these discovered on mammography alone and five on mammography plus breast MRI.

The study results indicated that the adjusted breast cancer detection rate was the same between the two groups at four-year follow-up, at 3.6%. But they also revealed that breast biopsy rates were higher among women who had both screening mammography and MRI compared with those who had screening mammography alone — 30.5% compared with 12.6%.

“With short-term follow-up evaluation, we found that the rates of breast cancer detection were no higher with the use of screening MRI than with mammography alone,” the investigators wrote. “Breast cancer characteristics were favorable regardless of screening group, and more than half of the cancers that developed in those receiving breast MRI did not require MRI for detection.”

The takeaway? Don’t assume it’s necessary to add breast MRI into the screening protocol for women with high-risk lesions, according to the authors.

“We will continue to examine longer-term cancer rates and features as well as oncologic outcomes of this cohort, but these early findings lend uncertainty to the benefit of screening MRI for patients with high-risk lesions,” they concluded.