New SBI and ACR recommendations suggest breast cancer screening should begin at age 40
The new recommendations from the Society of Breast Imaging (SBI) and the American College of Radiology (ACR) on breast cancer screening, published in the January issue of the Journal of the American College of Radiology (JACR), state that breast cancer screening should begin at age 40, and earlier in high-risk patients. The recommendations also suggest appropriate utilization of medical imaging modalities such as mammography, MRI and ultrasound for breast cancer screening. According to Dr Carol Lee the significant decrease in breast cancer mortality is a major medical success and is due largely to earlier detection of breast cancer through mammography screening. For women with the highest risk of developing breast cancer, screening technologies in addition to mammography have been adopted. The new recommendations include screening for breast cancer by mammography, MRI and ultrasound as well as considering risk factors. The average patient should begin annual breast cancer screening at age 40. High-risk patients should begin by age 30 but not before 25. According to Dr Lee, evidence to support the recommendation for regular periodic screening mammography comes from the results of several randomized trials (RCTs) conducted in Europe and North America that included a total of nearly 500,000 women. Overall, based on a meta-analysis of the RCTs, there was a 26 percent reduction in mortality. Mammography was the only imaging modality that had been proven to decrease mortality from breast cancer.
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NIH takes step to assess any possible risk associated with low-dose radiation exposure
Researchers at the National Institutes of Health (NIH) Clinical Center, USA, are incorporating radiation dose exposure reports into patients’ electronic medical records, an effort that they hope will lead to an accurate assessment of whether any cancer risk is associated with low-dose radiation exposure from medical imaging tests, according to an article in the February issue of the Journal of the American College of Radiology (JACR). The electronic medical record allows for the storage, retrieval and manipulation of medical records.
There is much controversy surrounding diagnostic medical radiation exposure. According to Dr David Bluemke, lead author of the article, one widely publicized appraisal of medical radiation exposure suggested that about 1.5 to 2 percent of all cancers in the USA might be caused by the clinical use of CT alone. Since there are no epidemiological data directly relating CT scanning to cancer deaths, scientific assessment must instead rely on the relationship between radiation exposure and death rates from Japanese atomic bomb survivors. Radiology and nuclear medicine at the NIH Clinical Center have developed a radiation reporting policy. All vendors who sell imaging equipment to will be required to provide a routine means for radiation dose exposure to be recorded in the electronic medical record. This requirement will allow cataloging of radiation exposures from these medical tests. In addition, radiation exposure will have to be tracked by patients in their own personal health record. This approach is consistent with the ACR and RSNA stated recommendation, that “patients should keep a record of their X-ray history.”
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New CATCH rule to determine need for CT scans in children with minor head injury
A new tool may help standardize the use of CT scans in children with minor head injury and help reduce the number of scans, according to a new study published in the Canadian Medical Association Journal.
More than 650,000 children with minor head injuries resulting in loss of consciousness, amnesia, disorientation and/or vomiting are seen each year in emergency departments at North American hospitals. CT scans are important for diagnosing serious brain injuries but they expose children to the potentially harmful effects of ionizing radiation and significantly add to health care costs.
A team of researchers from pediatric institutions across Canada have developed the CATCH rule (Canadian Assessment of Tomography for Childhood Injury) to guide physicians in determining whether a child with minor head trauma should receive a CT scan. The study involved 3866 children aged 0 to 16 years of age from 10 Canadian pediatric teaching institutions. The authors of the study conclude that the CATCH Rule, made up of 7 simple findings from the child’s history and physical exam, has the potential to both standardize the need for CT and reduce the number of CT scans performed in children with minor head injury.
www.cmaj.ca/