Welcome to a New Feature of EBM Focus, “Focus on Expert Opinion!”
In the coming year, we’d like to highlight what experts think are the most important evidence-based developments in their field of expertise. We couldn’t have asked better than our first expert, Dr. Adena Scheer.
Dr. Scheer is an Assistant Professor of Surgery at the University of Toronto and researcher specializing in breast cancer as well as the topic editor for our DynaMedex topic: Breast Cancer Screening.
We asked Dr. Scheer several questions:
1. What do you consider the most important piece of evidence or guideline published in the past year?
The United States Preventive Services Task Force (USPSTF) Recommendation on Breast Cancer Screening, released April 2024.
Editor’s note: The USPSTF gives a “B” grade of recommendation for screening for breast cancer every 2 years between the ages of 40 and 74, but an “I” recommendation (for insufficient evidence) for adjunctive testing for patients with dense breasts, such as MRI, ultrasound, or contrast enhanced mammography. Supporting evidence for these recommendations can be found here.
2. What’s your clinical “take” on this evidence or guideline? (Do you agree or disagree with the conclusions/recommendations? Why?)
It’s interesting that the USPSTF took the stance that there was insufficient evidence to recommend for or against adjunctive testing based on breast density given that the Ontario guidelines took exactly the opposite. As of Spring 2024, Health Quality Ontario recommends supplemental screening for dense breasts based on their health technology assessment/systematic review.
The DENSE Trial in particular (found here, with second-round results found here) showed a reduction in interval cancer detection with supplemental MRI. In Ontario, Canada, we now recommend adjunct screening.
3. How will this publication influence practice and patient care? Will it have a large or small impact on your daily decision-making?
This will have a large impact on decision-making, specifically for practitioners in the United States. As of September 10, 2024, in the United States, letters will be required to tell a patient their breasts are “dense” or “not dense,” that dense tissue makes it harder to find cancers on a mammogram, and that it increases the risk of developing cancer. Patients with dense breasts will also be told that other imaging tests in addition to a mammogram may help find cancers.
In my practice, I recommend bilateral screening ultrasound yearly in conjunction with a mammogram for patients with dense breasts without a family history. For patients with dense breasts and a family history of breast cancer, I offer yearly mammograms and an MRI every other year.
For more information, see the topic Breast Cancer Screening in DynaMedex.
DynaMed EBM Focus Editorial Team
This EBM Focus was written by Dan Randall, MD, MPH, FACP, Senior Deputy Editor at DynaMed. Edited by Alan Ehrlich, MD, FAAFP, Executive Editor at DynaMed and Associate Professor in Family Medicine at the University of Massachusetts Medical School; Katharine DeGeorge, MD, MS, Senior Deputy Editor at DynaMed and Associate Professor of Family Medicine at the University of Virginia; Vincent Lemaitre, PhD, Medical Editor at DynaMed; McKenzie Ferguson, PharmD, BCPS, Senior Clinical Writer at DynaMed; Rich Lamkin, MPH, MPAS, PA-C, Clinical Writer at DynaMed; Matthew Lavoie, BA, Senior Medical Copyeditor at DynaMed; Hannah Ekeh, MA, Senior Associate Editor II at DynaMed; and Jennifer Wallace, BA, Senior Associate Editor at DynaMed.