During Sunday's plenary, Elizabeth Morris, MD, strongly advocated for radiologists to take ownership of screening of all cancers.
"It's clear that our current system isn't working well, especially for the most vulnerable patients," said Dr. Morris, chair of the Department of Radiology at the University of California, Davis (UCD) and a recognized expert in breast imaging.
Dr. Morris said breast MR is recommended for women with dense breasts and a normal screening mammogram, but only 2% of the population undergo the test. The utilization rate for the recently approved low-dose CT screening is just 6% of eligible patients.
"There's a disconnect between the available screening tests and why more people aren't availing themselves of the tests," she said.
She herself was eligible for a breast MR, but didn't schedule the screening because it was simply easier not to. As she was about to start a new job at UCD, she received a breast cancer diagnosis—despite receiving normal results from both a screening 3D mammography and breast US. Her 4 mm invasive lobular tumor was found only after tissue had been removed from her breast during surgery.
"I knew the first 90 days of a new job are important and that during that time I'd be undergoing radiation therapy and not fully myself," she said. "I chose to be open and honest with my UCD colleagues and in turn I got to know their stories as well."
The experience taught her that physicians can enrich patient care and their own well-being by opening themselves up to more meaningful and authentic connections—a practice that runs contrary to what physicians are taught in medical school.
"When we don't take the time to reassure a patient and provide them with access to information, we miss an opportunity for human connection," she said. "We need to start thinking of the imaging report not as our final product but as a springboard for communicating with our patients."
Dr. Morris also gained a greater perspective on how difficult it is for patients—especially underprivileged and minority populations—to understand and access cancer screening tests. "We need to work to provide greater access to screening, to build bridges with our colleagues and to communicate what tests are available to patients."
With a pandemic of breast cancer that is expected to increase by 50 percent in the next 20 years, Dr. Morris said there's no time to waste in making significant changes to the screening process. "We need to speed up, because there are too many lives to save," she said. "If we can identify all cancers when they are small enough to be treated with minimal therapy, cancer can become a chronic disease, not a fatal one."
As a solution, she proposes that radiologists manage the entire cancer screening value chain by notifying patients of their risk, recommending the appropriate testing and making scheduling as easy as possible. Addressing disparate guidelines is an important first step.
"Guidelines are based mostly on white populations and different groups make different recommendations based on their own biases," she said. "As radiologists, we understand the in's and out's of screening research".
"I believe the role of radiologists will expand significantly and we'll be taking greater responsibility for patients," she said. "Our future is bright."
Access the presentation, "Doctor as Patient: Imaging Cancer Survival for All," (Plenary) on demand at Meeting.RSNA.org.
