European Society of Breast Imaging’s recommendations on breast cancer screening

The European Society of Breast Imaging (EUSOBI), 28 national radiology organizations from Europe, and similar organizations from Turkey and Israel, have issued a position paper and recommendations on mammography and breast cancer screening examinations. The objective of the paper, published in European Radiology, is to give a clear message in favor of screening mammography to national and local governments, policy makers, referring physicians, and women in general.

The organizations recommend that national health services fund biennial mammograms for women aged 50 to 69 years as their first breast screening priority. The second-highest priority is to offer biennial screening to elderly women up to the age of 73 or 75. The third-highest priority is to offer annual screening to women of average risk aged 40 to 49 years.

Preference should be given to population screening programs on a territorial basis with double-reading. Programs with double-reading policies have been proven to have higher specificity and positive predictive value, lower cost, central data management, and structured quality controls.

Special screening strategies, including breast MRI, should be applied for patients with a 20% or greater risk of developing a breast cancer.

The organizations strongly recommend that facilities still using film mammography replace these modalities with digital mammography systems that also have the ability to add digital tomosynthesis. They cite the known advantages of higher image quality and lower radiation dose, no chemical pollution, image manipulation, and digital transmission and archival. The position paper references a number of clinical trials that show digital breast tomosynthesis (DBT) with mammography has diagnostic superiority over conventional digital radiography and when used, reduces the recall rate. They note that the technology will be a component of breast cancer screening in the near future.

However, the organizations have issued a caveat: DBT has not yet been proven to show a statistically significant and clinically relevant reduction in the interval cancer rate. Before DBT is routinely implemented by national screening programs, they caution potential implementers to evaluate the probable increase in reading time associated with the use of DBT in screening programs, and the potential effects on the sustainability of using the technology.

Other recommendations include proficiency tests for radiologists involved in screening mammography, and requiring a minimum number of exams read annually to ensure standardized reading quality. Core biopsy or vacuum-assisted biopsy should be used rather than fine-needle aspiration.

Lead author Professor Francesco Sardanelli, MD, of the Department of Biomedical Sciences for Health of the University of Milan told Applied Radiology that “this position paper is an important achievement in terms of harmonization of aims and priorities of breast cancer screening among a large number of different countries. Key points are the strong preference for digital mammography, the perspective of using DBT for screening, the dedicated pathways for high risk women, and the need for qualified breast radiologists. Moreover, the article gives clear messages to health authorities and to the female population.”

REFERENCE

1. Sardanelli F, Hildegunn SA, Alvarez M, et al. Position paper on screening for breast cancer by the European Society of Breast Imaging (EUSOBI) and 30 national breast radiology bodies from Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Israel, Lithuania, Moldova, The Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Spain, Sweden, Switzerland and Turkey. Eur Radiol. Published online November 2, 2016. (DOI 0.1007/s00330-016-4612-z).