Tips for Addressing Screening Concerns: "Harms of Screening".

Early detection decreases deaths from breast cancer. Yet, there are conflicting recommendations about screening mammography by major professional medical organizations, including the age and frequency with which women should be screened. The controversy over breast cancer screening is centered on 3 main points: the impact on mortality, overdiagnosis, and false positive results. Some studies claim that adverse psychological effects such as anxiety or distress are caused by screening mammography. The purpose of this article is to address negative breast cancer screening concerns including overdiagnosis and overtreatment, effect on mortality, false positive results, mammography-related anxiety, and fear of radiation.

Fibrocystic Changes of the Breast: Radiologic-Pathologic Correlation of MRI.

Breast MRI provides high sensitivity but modest positive predictive value for identifying breast cancers, with approximately 75% of MRI-guided biopsies returning benign pathologies. Fibrocystic change (FCC) is a descriptive term used colloquially by many radiologists (and falling out of favor with many pathologists) to refer to several benign entities encountered in the breast. Many of the benign entities believed to comprise FCC can show enhancement on MRI. Recognizing the pathologic correlates of these enhancing lesions should help guide management after such a result on MRI-guided biopsy. Premenopausal women may present with clinical symptoms attributed to FCC, including pain, nipple discharge, breast lumps, or discrete masses. Benign entities associated with FCC include proliferative lesions such as usual ductal hyperplasia and sclerosing adenosis, and nonproliferative lesions including cysts, apocrine metaplasia, and stromal fibrosis. Fibrocystic change can be diffuse or focal. Diffuse FCC usually presents as non-mass enhancement (NME), often with persistent kinetics. Focal FCC can present as an irregular mass or focus with variable enhancement patterns including washout kinetics. Following a benign concordant MRI-guided biopsy result of one or more of the above entities, follow-up with MRI in 12 months is reasonable. Accurate radiologic-pathologic correlation can be achieved when careful review of histologic findings is carried out in the context of MRI features.

Caring for the Deaf, Hard-of-Hearing, Blind, and Low-Vision Patients in the Breast Center.

Two heterogeneous populations with widely varying needs are being increasingly encountered in breast care facilities: blind or low vision patients and deaf or hard of hearing patients. The Americans with Disabilities Act and the Rehabilitation Act mandate that all governments, businesses, and not-for-profit organizations provide effective communication to those facing hearing, vision, or speech communication disabilities and that the provided communication is equally effective as that provided to those lacking communication disabilities. It is vitally important that breast center providers understand the requirements put forth by these acts in the provision of patient care, which includes interactions with the patient as well as their family members and partner. Breast center providers must identify each patient's individual needs and preferred method of communication. Options to assist in communication for the deaf or hard of hearing include the use of text conversations, preprinted or accessible video health care education material, and dedicated American Sign Language or video interpreters. Attention to breast imaging facility design, access to large print or braille documents, and the use of qualified readers can aid in improving access and communication for the blind or low-vision individual. All members of the breast health team, from scheduling staff to front office personnel, technologists, and breast imaging radiologists, should understand how to respectfully communicate with and identify the needs of patients facing these challenges.