The Institute for Health Quality and Ethics

President's Corner

February 11, 2012

Why Does the American College of Radiology Continue to Prevent Women From Making Informed Decisions About Their Own Medical Care?

The Institute for Health Quality and Ethics has a growing concern with what many women now perceive as bad faith on the part of the ACR when it comes to providing truthful, accurate, and complete mammogram results. This concern does not lie with the many competent and dedicated individual radiologists who work with patients to ensure access to the best screening for the early detection of breast cancer. The concern is with the national organization that claims to be dedicated to improving the field of radiology on behalf of both practitioners and their patients.

The ACR - as a national organization - has repeatedly expressed their opposition to informing women of their breast density in the patient notification report as required by the Mammography Quality Standards Reauthorization Act of 1998. (
Read Our Citizen Petition).

The ACR has recently confirmed their opposition to providing this information to women. (
Read the ACR statement and IHQE response) This should be concerning to members of Congress, the FDA, and, most importantly, to any woman who obtains a mammogram. The FDA has given the ACR nearly monopoly control over the accreditation of mammogram facilities nationwide. The ACR also develops the practice guidelines for radiologists and the sample patient notification letter utilized by radiologists and imaging facilities. Leaders of the ACR and its sister organization, the Society for Breast Imaging (SBI) also sit on the National Mammography Quality Assurance Advisory Board at the FDA. This has created a closed system with no checks and balances on the actions of the ACR, which we believe is endangering the lives of thousands of women.

For years, patient advocate groups have attempted to work with the ACR to ensure that women are provided truthful and accurate mammogram results as is required by federal statute and by all known medical ethical guidelines. It has become increasingly difficult to understand the ACR’s repeated resistance to informing women of their breast density and the impact of density on mammogram effectiveness, despite decades of evidence.

Many members of the ACR clearly do support informing women of their density and additional screening alternatives. Some breast cancer screening programs already offer women the option of additional screening if a mammogram alone is not effective for them. However, this practice is an exception, and not the rule. Furthermore, many talented researchers who are members of the ACR and its Imaging Network (ACRIN) have devoted their careers to improving breast cancer screening for women. However, despite the overwhelming evidence of the benefits of alternative screening, the ACR has continued to resist making this information widely available to those women who need it most. (
Read an ACRIN 6666 Press Release.)

On the national level, the ACR has refused to comply with an existing federal statute requiring patient notification of mammogram results. While a letter is sent to the nearly 40 million women who obtain mammograms, it does not contain necessary information on how effective the mammogram is, or alternatives which might be available for the 40% of women with dense breast tissue. (
Read the ACR Justification and IHQE Response.) The ACR has also devoted significant financial resources to defeat state legislation which would require patient reports to include material medical information about a woman's breast density, its impact on mammogram effectiveness, and potential screening alternatives. (Read Some Examples)

These actions on the part of the ACR (and other organizations that benefit financially from withholding this information) are leading more and more individuals to conclude that the significant revenue streams associated with nearly 40 million mammograms each year is too much of a temptation for the organization and some of its wealthiest members to change this practice without legal intervention.

We certainly hope that this is not the case, but only immediate and meaningful action on the part of the ACR will have any impact on this perception.

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