To be published online Monday, Dec. 2, a special issue of the Journal of the American College of Radiology addresses imaging-based screening and radiology's increasing role in preventive medicine. Topics covered include breast density legislation, digital breast tomosynthesis (or 3-D mammography), lung cancer screening and computed tomography colonography (CTC) reimbursement. The December screening issue was guest edited by Ruth Carlos, M.D., M.S., from the University of Michigan, and Christoph I. Lee, M.D., M.S.H.S., from the University of Washington.
"Screening saves lives. Therefore, imaging-based screening represents a high-value clinical service that radiologists deliver day-to-day. In recognition of the importance of these services, the Affordable Care Act legislates the free provision of cancer screening, including the anticipated coverage of CT-based lung cancer screening. However, not all developments are necessarily positive. There are still coverage gaps, such as CT colonography. Further, legislative action is not just limited to mandating coverage, but also to legislating physician-patient conversations. Because of these controversies and because of continued development of imaging-based screening technology, we chose to focus our annual special issue on this critical topic," said Ruth Carlos, M.D., M.S., guest editor of the December screening issue.
Dense Breast Legislation in the United States: State of the States
Soudabeh Fezeli Dehkordy, M.D.; Ruth C. Carlos, M.D., M.S.
Dense breast notification legislation provides for direct patient notification. Inconsistency in the language of the laws and lack of legal provision for insurance coverage for additional testing may complicate the implementation of the laws.
The Density Conundrum: Does Legislation Help or Hurt?
Mary Lou Smith, J.D., M.B.A.
Dense breast legislation may not improve physician-patient communication about the risk associated with dense breasts and increase uncertainty about further screening.
Digital Breast Tomosynthesis and the Challenges of Implementing an Emerging Breast Cancer Screening Technology Into Clinical Practice
Christoph I. Lee, M.D., M.S.H.S.; Constance D. Lehman, M.D., Ph.D.
To move early adoption toward more appropriate adoption of digital breast tomosynthesis, radiologists must become engaged stakeholders to help guide future policies and best practice.
Controversies in Lung Cancer Screening
Ritu R. Gill, M.D., M.P.H.; Michael T. Jaklitsch, M.D.; Francine L. Jacobson, M.D., M.P.H.
This article reviews the controversies in lung cancer screening from a radiologic perspective.
The Challenges of CT Colonography Reimbursement
Abraham H. Dachman, M.D.; Judy Yee, M.D.
Existing data support upgrading the U.S. Preventive Services Task Force status of CTC and the long anticipated endorsement of screening CT colonography (CTC) by Medicare. Continued scientific data, legislative efforts and public education should be used by advocates of CTC.
"The articles of this special issue run the entire gamut of imaging-based screening, including screening for breast cancer, colon cancer, lung cancer and cardiovascular disease. Authored by leading authorities in cancer and heart disease screening, including patient advocates, these articles address the major challenges and controversies surrounding imaging-based screening from a variety of stakeholder perspectives. Given our growing role as central figures in preventive medicine, radiologists should have a working knowledge of the risks and benefits of each of these screening technologies," said Christoph I. Lee, M.D., M.S.H.S., guest editor of the December screening issue.