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Summary Background Female breast cancer is the most commonly diagnosed cancer in the world, with wide variations in reported survival by country. Women in low-income and middle-income countries (LMICs) in particular face several barriers to breast cancer services, including diagnostics and treatment. We aimed to estimate the potential impact of scaling up the availability of treatment and imaging modalities on breast cancer survival globally, together with improvements in quality of care. Methods For this simulation-based analysis, we used a microsimulation model of global cancer survival, which accounts for the availability and stage-specific survival impact of specific treatment modalities (chemotherapy, radiotherapy, surgery, and targeted therapy), imaging modalities (ultrasound, x-ray, CT, MRI, PET, and single-photon emission computed tomography [SPECT]), and quality of cancer care, to simulate 5-year net survival for women with newly diagnosed breast cancer in 200 countries and territories in 2018. We calibrated the model to empirical data on 5-year net breast cancer survival in 2010–14 from CONCORD-3. We evaluated the potential impact of scaling up specific imaging and treatment modalities and quality of care to the mean level of high-income countries, individually and in combination. We ran 1000 simulations for each policy intervention and report the means and 95% uncertainty intervals (UIs) for all model outcomes. Findings We estimate that global 5-year net survival for women diagnosed with breast cancer in 2018 was 67·9% (95% UI 62·9–73·4) overall, with an almost 25-times difference between low-income (3·5% [0·4–10·0]) and high-income (87·0% [85·6–88·4]) countries. Among individual treatment modalities, scaling up access to surgery alone was estimated to yield the largest survival gains globally (2·7% [95% UI 0·4–8·3]), and scaling up CT alone would have the largest global impact among imaging modalities (0·5% [0·0–2·0]). Scaling up a package of traditional modalities (surgery, chemotherapy, radiotherapy, ultrasound, and x-ray) could improve global 5-year net survival to 75·6% (95% UI 70·6–79·4), with survival in low-income countries improving from 3·5% (0·4–10·0) to 28·6% (4·9–60·1). Adding concurrent improvements in quality of care could further improve global 5-year net survival to 78·2% (95% UI 74·9–80·4), with a substantial impact in low-income countries, improving net survival to 55·3% (42·2–67·8). Comprehensive scale-up of access to all modalities and improvements in quality of care could improve global 5-year net survival to 82·3% (95% UI 79·3–85·0). Interpretation Comprehensive scale-up of treatment and imaging modalities, and improvements in quality of care could improve global 5-year net breast cancer survival by nearly 15 percentage points. Scale-up of traditional modalities and quality-of-care improvements could achieve 70% of these total potential gains, with substantial impact in LMICs, providing a more feasible pathway to improving breast cancer survival in these settings even without the benefits of future investments in targeted therapy and advanced imaging. Funding Harvard T H Chan School of Public Health, National Cancer Institute P30 Cancer Center Support Grant to Memorial Sloan Kettering Cancer Center, and Breast Cancer Research Foundation.

Emma B Antoine,1 Arelys M Rocha,2 Geraldine McGinty3 1School of Public Policy, Cornell University Graduate School, Ithaca, NY, USA; 2Department of Population Health Sciences, Weill Cornell Graduate School of Medical Sciences, New York, NY, USA; 3Departments of Radiology and Population Health Sciences, Weill Cornell Medicine, New York, NY, USACorrespondence: Geraldine McGinty, Departments of Radiology and Population Health Sciences, Weill Cornell Medicine, 1300 York Avenue, Ste F-100, New York, NY, 10021, USA, Tel +1 646 962 5952, Fax +1 212 746 8424, Email gbm9002@med.cornell.eduPurpose: The COVID-19 pandemic highlighted the importance of effective leaders across all spheres but especially in healthcare. Many Academic Medical Centers (AMCs) offer leadership programming, but these programs have been criticized for lacking impact. In developing a Master’s-level leadership course at an AMC, we sought to inform the curriculum with the values, both personal and shared, as well as the competencies defined as essential by a group of leaders who successfully steered their organizations through the pandemic.Methods: Study participants included selected leaders from a medical school, its hospital partner and parent university. We used a combination of semi-structured interviews, conducted virtually, and a rank-order survey to identify values and competencies to be used to inform course content.Results: Our surveyed leaders relied on personal values that prioritized the organization’s mission, aligning their teams around that mission and vision as well as leading with empathy and respect. As a group, these leaders valued a highly collegial and collaborative process as well as diversity and equity. Competencies essential to leadership, according to our participants, were the ability to create the environment that supports collaboration, including team development, and to uphold the organization’s mission.Conclusion: The surveyed leaders’ organizations treated some of the highest numbers of COVID-19 patients of any hospital system and needed to make difficult decisions in order to provide patient care safely. Study participants were therefore uniquely experienced health care system leaders currently meeting unprecedented challenges. Our study suggests that applying a values-based approach to the development of future leaders will positively influence the impact of leadership education in a Master’s-level healthcare leadership program.Keywords: healthcare, education, competency, pandemic

The goal of our paper is to explore the role of AI in understanding health disparities in cancer care and its potential role in resolving them. Multiple studies have shown that with the recent advances in AI, its integration in cancer care has the potential to impact earlier diagnosis and improve clinical decision making. While AI risks to further widen health disparities, some studies suggest that it represents an excellent opportunity for resolving them. With active engagement, incorporating AI in breast cancer care represents an excellent opportunity for elucidating and resolving health disparities; however, without deliberate effort, it risks to further widen them.

The aim of this study was to determine whether participation in Radiology Support, Communication and Alignment Network (R-SCAN) results in a reduction of inappropriate imaging in a wide range of real-world clinical environments.This quality improvement study used imaging data from 27 US academic and private practices that completed R-SCAN projects between January 25, 2015, and August 8, 2018. Each project consisted of baseline, educational (intervention), and posteducational phases. Baseline and posteducational imaging cases were rated as high, medium, or low value on the basis of validated ACR Appropriateness Criteria®. Four cohorts were generated: a comprehensive cohort that included all eligible practices and three topic-specific cohorts that included practices that completed projects of specific Choosing Wisely topics (pulmonary embolism, adnexal cyst, and low back pain). Changes in the proportion of high-value cases after R-SCAN intervention were assessed for each cohort using generalized estimating equation logistic regression, and changes in the number of low-value cases were analyzed using Poisson regression.Use of R-SCAN in the comprehensive cohort resulted in a greater proportion of high-value imaging cases (from 57% to 79%; odds ratio, 2.69; 95% confidence interval, 1.50-4.86; P = .001) and 345 fewer low-value cases after intervention (incidence rate ratio, 0.45; 95% confidence interval, 0.29-0.70; P.001). Similar changes in proportion of high-value cases and number of low-value cases were found for the pulmonary embolism, adnexal cyst, and low back pain cohorts.R-SCAN participation was associated with a reduced likelihood of inappropriate imaging and is thus a promising tool to enhance the quality of patient care and promote wise use of health care resources.

Health equity means that everyone has the opportunity to be as healthy as possible, but achieving health equity requires the removal of obstacles to health such as poverty, discrimination, unsafe environments, and lack of access to health care. The pandemic has highlighted the awareness and urgency of delivering patient-centered, high-value care. Disparities in care are antithetical to health equity and have been seen throughout medicine and radiology, including neuroradiology. Health disparities result in low value and costly care that is in conflict with evidence-based medicine, quality standards, and best practices. Although the subject of health equity is often framed as a moral or social justice issue, there are compelling economic arguments that also favor health equity. Not only can waste in health care expenditures be countered but more resources can be devoted to high-value care and other vital national economic interests, including sustainable support for our health system and health providers. There are many opportunities for neuroradiologists to engage in the advancement of health equity, while also advancing the interests of the profession and patient-centered high-value care. Although there is no universal consensus on a definition of health equity, a recent report seeking clarity on the lexicon offered the following conceptual framework: “Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”(1) This definition contrasts with that of health disparities that contribute to inequitable care as a result of demographic differences among populations such as those attributable to race, sex, access, residence, socioeconomic status, insurance status, age, religion, and disability.(2,3) In effect, the greater the health disparities and negative social determinants of health, the greater the health inequities will be.

ImportanceOut-of-pocket costs (OOPCs) have been largely eliminated for screening mammography. However, patients still face OOPCs when undergoing subsequent diagnostic tests after the initial screening, which represents a potential barrier to those who require follow-up testing after initial testing.ObjectiveTo examine the association between the degree of patient cost-sharing and the use of diagnostic breast cancer imaging after undergoing a screening mammogram.Design, Setting, and ParticipantsThis retrospective cohort study used medical claims from Optum’s deidentified Clinformatics Data Mart Database, a commercial claims database derived from a database of administrative health claims for members of large commercial and Medicare Advantage health plans. The large commercially insured cohort included female patients aged 40 years or older with no prior history of breast cancer undergoing a screening mammogram examination. Data were collected from January 1, 2015, to December 31, 2017, and analysis was conducted from January 2021 to September 2022.ExposuresA k-means clustering machine learning algorithm was used to classify patient insurance plans by dominant cost-sharing mechanism. Plan types were then ranked by OOPCs.Main Outcomes and MeasuresA multivariable 2-part hurdle regression model was used to examine the association between patient OOPCs and the number and type of diagnostic breast services undergone by patients observed to undergo subsequent testing.ResultsIn our sample, 230 845 women (220 023 [95.3%] aged 40 to 64 years; 16 810 [7.3%] Black, 16 398 [7.1%] Hispanic, and 164 702 [71.3%] White) underwent a screening mammogram in 2016. These patients were covered by 22 828 distinct insurance plans associated with 6 025 741 enrollees and 44 911 473 distinct medical claims. Plans dominated by coinsurance were found to have the lowest mean (SD) OOPCs ($945 [$1456]), followed by balanced plans ($1017 [$1386]), plans dominated by copays ($1020 [$1408]), and plans dominated by deductibles ($1186 [$1522]). Women underwent significantly fewer subsequent breast imaging procedures in dominantly copay (24 [95% CI, 11-37] procedures per 1000 women) and dominantly deductible (16 [95% CI, 5-28] procedures per 1000 women) plans compared with coinsurance plans. Patients from all plan types underwent fewer breast magnetic resonance imaging (MRI) scans than patients in the lowest OOPC plan (balanced, 5 [95% CI, 2-12] MRIs per 1000 women; copay, 6 [95% CI, 3-6] MRI per 100 women; deductible, 6 [95% CI, 3-9] MRIs per 1000 women.Conclusions and RelevanceDespite policies designed to remove financial barriers to access for breast cancer screening, significant financial barriers remain for women at risk of breast cancer.

What is Imposter Syndrome, whom does it affect, and when, and why is it important to recognize? In this multidisciplinary article, the phenomenon is defined and discussed by a psychiatrist, followed by strategic advice by a radiologist, interventional radiologist and radiation oncologist.

Despite numerous technological advances in imaging, sharing of images between institutions relies on outdated media and patient effort. This leads to unnecessary repeat imaging and patient anxiety. This is a multifactorial problem of misaligned incentives despite widespread availability of image sharing platforms. A multi-stakeholder effort will be needed to address this issue. The American College of Radiology led an informal effort known as "Ditch the Disk" which is now evolving to a more formal effort to bring professionals and industry together to advocate for a regulatory framework to support positive change.

Quality and patient safety are essential to the practice of radiology. “Quality is our image” is the slogan for the American College of Radiology (ACR), which has embraced the quality and safety movement as a central tenet. The impact of advances in radiology on diagnosis and management of complex medical disorders cannot be understated. Nevertheless, these revolutionary technologies do come at a cost. Increasing utilization of advanced imaging in emergency departments throughout the country poses challenges both in terms of appropriate use and management of radiation dose. The indispensable place advanced imaging plays in diagnosis has necessitated guidelines and accountability to protect patients and radiology staff. In this series, we have created a concise discourse on what we have determined to be the essentials of the economics of quality and safety as it pertains to radiology. In this first article, we summarize the accreditation programs in radiology, their legislative background, and the associated financial and market responses that have subsequently resulted. We discuss the progression from historical predecessors to the passage of the Mammography Quality and Safety Act (MQSA), which served as a model for subsequent laws governing the quality and safety of other imaging modalities. These laws have had real economic implications for radiology practices seeking to meet new increasingly stringent guidelines. We also break down the costs of participation in the ACR accreditation and center of excellence programs.

Purpose of Review The emergency medicine and critical care needs of the COVID-19 pandemic forced a sudden and dramatic disruption of cancer screening and treatment programs in the USA during the winter and spring of 2020. This review commentary addresses the impact of the pandemic on racial/ethnic minorities such as African Americans and Hispanic-Latina Americans, with a focus on factors related to breast cancer. Recent Findings African Americans and Hispanic-Latina Americans experienced disproportionately higher morbidity and mortality from COVID-19; many of the same socioeconomic and tumor biology/genetic factors that explain breast cancer disparities are likely to account for COVID-19 outcome disparities. Summary The breast cancer clinical and research community should partner with public health experts to ensure participation of diverse patients in COVID-19 treatment trials and vaccine programs and to overcome COVID-19-related breast health management delays that are likely to have been magnified among African Americans and Hispanic-Latina Americans.

Breastfeeding has medical and economic benefits and providing an environment supportive of breastfeeding should be a priority in radiology to promote diversity, equity and inclusion. Most breastfeeding radiologists do not meet their breastfeeding goals and inadequate time for pumping is the most commonly cited barrier. The UCSF lactation credit model sets the standard for breastfeeding support in medicine by providing protected time without productivity penalties and it should be adapted and implemented across radiology practices to more fully support breastfeeding radiologists and radiation oncologists.

The diagnosis and treatment of patients with cancer requires access to imaging to ensure accurate management decisions and optimal outcomes. Our global assessment of imaging and nuclear medicine resources identified substantial shortages in equipment and workforce, particularly in low-income and middle-income countries (LMICs). A microsimulation model of 11 cancers showed that the scale-up of imaging would avert 3·2% (2·46 million) of all 76·0 million deaths caused by the modelled cancers worldwide between 2020 and 2030, saving 54·92 million life-years. A comprehensive scale-up of imaging, treatment, and care quality would avert 9·55 million (12·5%) of all cancer deaths caused by the modelled cancers worldwide, saving 232·30 million life-years. Scale-up of imaging would cost US$6·84 billion in 2020-30 but yield lifetime productivity gains of $1·23 trillion worldwide, a net return of $179·19 per $1 invested. Combining the scale-up of imaging, treatment, and quality of care would provide a net benefit of $2·66 trillion and a net return of $12·43 per $1 invested. With the use of a conservative approach regarding human capital, the scale-up of imaging alone would provide a net benefit of $209·46 billion and net return of $31·61 per $1 invested. With comprehensive scale-up, the worldwide net benefit using the human capital approach is $340·42 billion and the return per dollar invested is $2·46. These improved health and economic outcomes hold true across all geographical regions. We propose actions and investments that would enhance access to imaging equipment, workforce capacity, digital technology, radiopharmaceuticals, and research and training programmes in LMICs, to produce massive health and economic benefits and reduce the burden of cancer globally.

Objective Benefits of a diverse physician workforce are numerous and the impact of a lack of diversity has been highlighted with the COVID-19 pandemic. Despite the commitment of professional societies such as the American College of Radiology to diversity in Radiology, the field and its residency training programs remain the least diverse. With COVID-19 related suspension of in-person medical student rotations, our Department of Radiology redesigned and implemented a virtual radiology internship for underrepresented minority (URM) medical students. Methods A four-week virtual radiology internship was designed to provide clinical exposure to radiology and to allow students to gain an understanding of what a career in radiology entails. Course design included videoconference patient care sessions, didactic lectures, online modules, mentoring, and extra-clinical curriculum. Feedback from students was collected using online surveys assessing pre- and postcourse attitudes and understanding of a career in radiology and the students’ perceived aptitude for such a career, as well as course component evaluation. Results Three participants were enrolled in the inaugural clerkship. All noted exceptional educational course content and ample opportunities to build connections with faculty and residents—with mentoring seen as the highlight of the course. All indicated a significant shift in perception of the field and in declaring interest in pursuing a career in radiology. Conclusion Virtual radiology internship for URM students is a feasible paradigm to address potential impediments to diversification of the specialty by both engaging interested URM medical students in a career in radiology and arming them with the tools for a successful application to radiology residency.

Objective The coronavirus disease 2019 (COVID-19) impacted radiology practices in many ways. We aimed to estimate declines in imaging volumes and financial impact across different practice settings during April 2020. Methods The survey constituting 48 questions was conducted through members of the ACR and the Radiology Business Management Association (RBMA) during May 2020. Survey questions focused on practice demographics, volumes, financials, personnel and staff adjustments, and anticipation of recovery. Results During April 2020, nearly all radiology practices reported substantial (56.4-63.7%) declines in imaging volumes with outpatient imaging volumes most severely affected. Mean gross charges declined 50.1-54.8% and collections declined 46.4-53.9%. Percentage of reductions did not correlate with practice size. Majority of respondents believed that volumes would recover but not entirely (62-88%) and anticipated a short-term recovery, with a surge likely in the short-term due to postponement of elective imaging (52-64%). 15.6% reported that radiologists in their practices tested positive for COVID. Over half (52.3%) reported availability of personal protective equipment had become an issue or was inadequate. A majority (62.3%) reported that their practices had existing remote reading or teleradiology capabilities in place prior to the pandemic, and 22.3% developed such capabilities in response to the pandemic. Conclusions Radiology practices across different settings experienced substantial declines in imaging volumes and collections during the initial wave of the COVID-19 pandemic in April 2020. Most are actively engaged in both short- and long-term operational adjustments., Radiology practices across different settings experienced substantial declines in imaging volumes during the initial wave of the COVID-19 pandemic in April 2020, resulting in significant financial impact, thus requiring practices to make short-term and long-term adjustments.

Purpose The aim of this study was to assess the potential impact of ACR evidence-based advocacy on radiologist professional reimbursement from individual-provider CMS multiple-procedure payment reduction (MPPR) initiatives. Methods CMS Physician and Other Supplier Public Use Files and 5% research-identifiable file carrier claims files from 2012 through 2014 were used to identify individual-provider MPPR-eligible services for radiologists (group practice linking unavailability in either dataset precluded quantification of different provider discounting) and then compare actual payments to Medicare Physician Fee Schedule national professional reimbursement rates to identify MPPR-discounted services. Payments attributed to MPPR-affected services and average radiologist annual MPPR discounts were calculated to estimate incremental individual radiologist payment restoration as a result of evidence-based advocacy. Results Between 2012 and 2014, a mean of 803 to 836 advanced imaging services per radiologist were potentially affected by individual-provider MPPR discounting. Approximately 23% of these services were discounted by individual-provider MPPR, resulting in approximately $2,524 to $2,893 lost per radiologist per year. The MPPR rollback from 25% to 5% is thus estimated to return $55 million to $64 million to radiologists each year for the individual component of MPPR alone. Conclusions Individual-provider MPPR discounting resulted, on average, in more than $2,500 in lost payments per radiologist per year. Its rollback, associated with ACR evidence-based advocacy efforts, is estimated to return well over $50 million in Medicare professional payments to radiologists each year for individual-component MPPR discounting alone.

Purpose The aim of this study was to investigate the natural history of untreated screen-detected breast cancer. Methods A prospective cohort survey of Society of Breast Imaging fellows concerning the appearance on subsequent mammography of untreated breast cancer detected on screening mammography was conducted. Results A representative sample of the 108 actively practicing Society of Breast Imaging fellows (n = 42 [39%]) participated, each reporting outcomes data from his or her entire screening mammography practice. Among all practices, 25,281 screen-detected invasive breast cancers and 9,360 cases of screen-detected ductal carcinoma in situ were reported over the past 10 years. Among these cancers, there were 240 cases of untreated invasive breast cancer and 239 cases of untreated ductal carcinoma in situ, among which zero were reported to have spontaneously disappeared or regressed at next mammography. Conclusions Among 479 untreated breast cancers detected on screening mammography, none spontaneously disappeared or regressed. An unknown percentage of these cancers represent overdiagnosis, but because all untreated screen-detected cancers were visible and suspicious for malignancy at next mammographic examination, delaying the onset of screening or increasing the interval between screenings should not reduce the frequency of overdiagnosis.

The rapid development of artificial intelligence (AI) has led to its widespread use in multiple industries, including healthcare. AI has the potential to be a transformative technology that will significantly impact patient care. Particularly, AI has a promising role in radiology, in which computers are indispensable and new technological advances are often sought out and adopted early in clinical practice. We present an overview of the basic definitions of common terms, the development of an AI ecosystem in imaging and its value in mitigating the challenges of implementation in clinical practice.

The growing use of social media is transforming the way health care professionals (HCPs) are communicating. In this changing environment, it could be useful to outline the usage of social media by radiologists in all its facets and on an international level. The main objective of the RANSOM survey was to investigate how radiologists are using social media and what is their attitude towards them. The second goal was to discern differences in tendencies among American and European radiologists. An international survey was launched on SurveyMonkey (https://​www.​surveymonkey.​com) asking questions about the platforms they prefer, about the advantages, disadvantages, and risks, and about the main incentives and barriers to use social media. A total of 477 radiologists participated in the survey, of which 277 from Europe and 127 from North America. The results show that 85 % of all survey participants are using social media, mostly for a mixture of private and professional reasons. Facebook is the most popular platform for general purposes, whereas LinkedIn and Twitter are more popular for professional usage. The most important reason for not using social media is an unwillingness to mix private and professional matters. Eighty-two percent of all participants are aware of the educational opportunities offered by social media. The survey results underline the need to increase radiologists skills in using social media efficiently and safely. There is also a need to create clear guidelines regarding the online and social media presence of radiologists to maximize the potential benefits of engaging with social media.

Bundled payments have been touted as mechanisms to optimize quality and costs. A recent feasibility study evaluating bundled payments for screening mammography episodes predated widespread adoption of digital breast tomosynthesis (DBT). We explore a similar model reflecting emerging acceptance of DBT in breast cancer screening.Using 4-year data for 59,094 screening episodes from two large facilities within a large academic health system, we utilized published methodology to calibrate Medicare national allowable reference prices for women undergoing screening mammography before and after practice-wide implementation of DBT.Excluding DBT, Medicare-normalized bundled prices for traditional breast imaging 364 days downstream to screening mammography are extremely similar pre- and post-DBT implementation ($182.86 in 2013; $182.68 in 2015). The addition of DBT increased a DBT-inclusive bundled price by $53.16 (an amount lower than the $56.13 Medicare allowable fee for screening DBT) but was associated with significantly reduced recall rates (13.0% versus 9.4%; P.0001). Without or with DBT, screening episode bundled prices remained sensitive to bundle-included services and varied little by patient age, race, or insurance status.Prior non-DBT approaches to bundled payment models for breast cancer screening remain viable as DBT becomes the standard of care, with bundle prices varying little by patient age, race, or insurance status. Higher DBT-inclusive bundled prices, however, highlight the need to explore societal costs more broadly (eg, reduced time away from work from fewer recalls) as bundled payment models evolve.

In recent months, organized medicine has been consumed by the anticipated transition to the 10th iteration of the International Classification of Disease system. Implementation has come and gone without the disruptive effects predicted by many. Despite the fundamental role the International Classification of Disease system plays in health care delivery and payment policy, few neuroradiologists are familiar with the history of its implementation and implications beyond coding for diseases.

Objective The aim of this study is to examine recent trends in adherence to continuous screening, especially the rate of subsequent screening mammography following an initial screening before and after the U.S. Preventive Services Task Force (USPSTF) revised its guidelines on breast cancer in November 2009. Methods We retrospectively analyzed Medicare fee-for-service claims data to: 1) compare rate of subsequent screening mammography over 27 month periods for 317,150 women screened in either 2004 or 2009; and 2) examine patterns of subsequent screening by age and race. Results When adjusted for age, race, state of residence, county-level covariates, and clustered on ordering provider, the rate of subsequent screening decreased in 2009 relative to 2004 (OR = 0.75; 95% CI: 0.74–0.76). Adjusted odds ratios are similar for alternative follow-up windows (15 months, 0.71; 24 months, 0.70; 30 months 0.75). The decline was mostly attributable to women 75 and older who are now less likely to return for a subsequent screening. Although USPSTF guidelines call for 24 months, approximately half of women continue screening at 12-month intervals in both cohorts. Conclusions The rate of subsequent screening mammography has declined after 2009. Older women seem to follow the revised USPSTF guideline, but confusion by physicians and patients about competing guidelines may be contributing to these findings.

OBJECTIVE. The goals of the 2010 Patient Protection and Affordable Care Act (ACA) can be summed up by the Triple Aim, as defined by the Institute for Healthcare Improvement: Improve population health, optimize the patient experience, and reduce the costs of care. CONCLUSION. Despite recent reimbursement reductions, radiologists have increasing opportunities to participate in value-based payment programs and should leverage those opportunities.

The purpose of this study was to review screening mammograms obtained in one practice with the primary endpoint of determining the rate of detection of breast cancer and associated prognostic features in women 40-44 and 45-49 years old.The retrospective cohort study included women in their 40s with breast cancer detected at screening from June 2014 through May 2016. The focus was on cancer detection rate, pathologic findings, and risk factors.A total of 32,762 screens were performed, and 808 biopsies were recommended. These biopsies yielded 224 breast cancers (cancer detection rate, 6.84 per 1000 screens). Women 40-49 years old had 18.8% of cancers detected; 50-59 years, 21.8%; 60-69 years, 32.6%; and 70-79 years, 21.4%. Among the 40- to 49-year-old women, women 40-44 years old underwent 5481 (16.7%) screens, had 132 biopsies recommended, and had 20 breast cancers detected (cancer detection rate, 3.6/1000). Women 45-49 years old underwent 5319 (16.2%) screens, had 108 biopsies recommended, and had 22 breast cancers detected (cancer detection rate, 4.1/1000). Thus, women 40-44 years old had 8.9% and women 45-49 years old had 9.8% of all screen-detected breast cancers. Of these only a small percentage of women with detected cancers had a first-degree relative with breast cancer (40-44 years, 15%; 45-49 years, 32%) or a BRCA mutation (40-44 years, 5%; 45-49 years, 5%), and over 60% of the cancers were invasive.Women 40-49 years old had 18.8% of all screen-detected breast cancers. The two cohorts (40-44 and 45-49 years old) had similar incidences of screen-detected breast cancer (8.9%, 9.8%) and cancer detection rates within performance benchmark standards, supporting a similar recommendation for both cohorts and the American College of Radiology recommendation of annual screening mammography starting at age 40.