How radiology is driving the breast continuum of care
Radiology is considered to be a connective thread throughout the whole continuum of care in breast cancer, and the first imaging step on the pathway. Radiologists have the initial responsibility of detecting breast cancer and play the critical role of breaking the news that it has been detected, as well as preparing the patient for the journey they are about to undertake.
It is essential that radiologists are using the right tools to ensure they can identify breast cancer lesions effectively. We believe that 3D mammograms should be regarded as the gold standard for mammography in the UK.
Recent research results support the case for 3D mammography. The phase one results of the TOSYMA trial funded by the German Government were published in April 2022 in The Lancet. The trial, carried out with 100,000 women, found that screening with digital breast tomosynthesis plus synthesised mammography, increased the detection rate of invasive breast cancer by 48% compared to standard digital mammography.[1]
The NHS should offer all women 3D mammography, to ensure that every woman’s mammogram is as accurate as possible, and they are given the reassurance of knowing that even the smallest cancer lesions will be spotted.
As with other areas across the breast continuum of care, radiology is feeling the strain of the staffing shortages being experienced across the world.[1] The UK radiologist workforce is short staffed by 29%, and need nearly 1,700 more fulltime radiologist consultants to ensure appropriate services.[2] Although the workforce increased by 6% in 2021, it is still not enough to address the overall shortfall and increased pressures on the healthcare system.[3]
However, radiologists cannot work in isolation. There are many disciplines that feed into the breast cancer pathway, and it is essential that there is collaboration and partnership at every step of the journey to deliver the best possible care.
Now, let’s explore the role of the patient and surgeon and how radiologists interact with them across the breast continuum of care pathway.
The patient: central to all decisions
Patients are the focal point of all decisions along the breast continuum of care. Crucially, all decisions considered should be based on a patient’s situation and experience, with clinicians ideally able to tailor treatment plans to each individual.
It should start with the screening process. The first time a woman is invited to breast cancer screening, she should be offered a full risk assessment, including factors such as breast density. This should be conducted using quantifiable breast density assessment software. This would make it possible to not only empower a woman to understand her own risk factors, but also to build a more efficient and effective screening programme focused on those most at risk.
When someone first receives a diagnosis, they are given a huge amount of information that they may not necessarily remember or understand. Breast cancer encompasses many different types of the disease,[3] and when you add the details of staging, it becomes a very complex picture. If the radiologist is breaking the news that breast cancer has been detected, it’s important that patients receive this information in simple, clear terms that demystify complicated medical terminology. They should also be given the opportunity to discuss the information, from the point of diagnosis and throughout their complete breast cancer care pathway with their HCP.
Surgeons: striving for efficiency and accuracy
Breast surgeons are reliant on their colleagues, including radiologists to prepare them as thoroughly as possible for procedures. Lesions can be small and difficult to locate – they need to work in step with radiology, which works to identify and mark them accurately for excision.
Surgical removal of a breast, or both breasts, can take a huge emotional toll on patients and their loved ones. Not only is it a major surgery, but the cosmetic and psychological impact can also be debilitating. Over recent decades, surgeons have been more concerned about over-treatment and have adopted more minimally invasive methods. Here, the interdisciplinary team is essential as the surgeon needs to have all information available to make a decision on the best course of treatment – the size and location of the lesions, their pathology and potentially the genomic profile of the patient for example.
Supporting innovation and advancing partnership
Radiology is at an exciting crossroad, with digital imaging technology continually evolving with new advancements. With the potential of artificial intelligence (AI) and deep learning on the horizon, radiologists can help shape the diagnostic tools of the future by working with companies to refine and optimise them using their real-world clinical insight. AI could help to speed up diagnoses and predict disease and treatment outcomes in the near future, but it is only with the support of radiologists, and the collaboration with surgeons, that this could become a reality.
Hologic’s commitment to the breast continuum of care extends beyond product innovation and puts partnership at its core. Innovation requires partnership between clinicians, scientists, engineers and technologists, who share a vision for patient care and a mission to improve breast cancer survival and patient outcomes.
Breast health is a fast-paced, constantly evolving field. At Hologic, we are hopeful about the future and relentless about our quest to use science-based evidence to keep up the pace and deliver better outcomes for the women we serve.
References
[1] Radiology Society of North America [Internet]. Radiology facing a global shortage. 2022. Available at https://www.rsna.org/news/2022/may/Global-Radiologist-Shortage Last accessed February 2023
[2] RCR Clinical radiology census report 2021. Royal College of Radiologists. https://www.rcr.ac.uk/rcr-clinical-radiology-census-report-2021#:~:text=The%20consultant%20radiologist%20workforce%20shortfall%20currently%20stands%20at,%283%2C166%20WTE%29%20by%202026%20factoring%20in%20rising%20demand. Last accessed September 2023
[3] American Cancer Society [Internet]. Types of breast cancer. 2021. Available at: https://www.cancer.org/cancer/breast-cancer/about/types-of-breast-cancer.html Last accessed February 2023
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