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Commentary |
1 Department of Radiology, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Room 165-47, Los Angeles, CA 90095.
Received August 21, 2006; accepted after revision August 21, 2006.
Address correspondence to L. W. Bassett.
Keywords: breast cancer • breast imaging • mammography • women's imaging
In her commentary "The Art and Practice of Women's Imaging: Power and Potential," Marcia Javitt [1] validated the importance of women's imaging. In celebrating Breast Cancer Awareness Month, my commentary focuses on breast imaging.
In 1974, I joined the faculty of the UCLA Department of Radiology under the mentorship of Richard H. Gold, a national expert in musculoskeletal (MSK) radiology and mammography. In addition to learning about MSK imaging, I worked in the oneroom mammography section as needed. Due to the rapid growth of mammography, I was selected to be Director of Breast Imaging in 1976. By 1990, I was working full-time in breast imaging. This had not been my initial goal, but this reflects how radiologists of my era began their careers in breast imaging. We faced incredible challenges. In 1976, our residents did not rotate through mammography, indicating the subspecialty's low priority.
In the late 1970s breast cancer screening caught national attention. The American College of Radiology (ACR) established the Committee on Breast Imaging in 1983, the National Conference on Breast Cancer in 1986, and the Mammography Accreditation Program in 1989. The Society of Breast Imaging, founded in 1985, is now one of the largest radiology subspecialty organizations. Breast imaging became a separate section of the American Board of Radiology (ABR) oral examination in 1990. Congress passed the Mammography Quality Standards Act in 1992.
Why is breast imaging important? Today almost half of all American women have annual screening mammograms with an anticipated breast cancer mortality reduction of 30-40% based on scientific, evidence-based studies. Breast imagers oversee screening for breast cancer and supervise workups for abnormal screenings and women with clinical findings. We perform 95% of breast biopsies and manage the woman's care before, during, and after the biopsy. We determine the need for referral to surgeons or follow-up by the referring health care provider, under our guidance. At a time when all aspects of medicine are under scrutiny (including reimbursement), breast imaging makes women aware of the crucial role of the radiologist in their health care.
We provide the majority of referrals to breast surgeons, radiation oncologists, and medical oncologists. If a woman is satisfied with her breast imaging care, she will send her family members to the same health care system.
In 2005, the ACR established the Commission on Breast Imaging, with Carol Lee as its Chair, granting breast imaging a seat on the ACR Board of Chancellors. Recognition of breast imaging as an essential component of radiology services took a long time. The addition of the Women's Imaging section in the American Journal of Roentgenology further acknowledges the importance of women's imaging to our profession.
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