Lessons Learned in the Early Adoption of Method of Detection Reporting

Until recently, no breast cancer database in the United States records how breast cancers are initially detected, and, therefore, current data lack the fundamental ability to link breast cancer outcomes to screening directly. Consequently, the magnitude and relative contributions that screening and treatment play in the reduction of breast cancer mortality are unknown, and the debate over breast cancer screening continues. To address these shortcomings, advocates have proposed that the Method of Detection (MOD) be documented with every breast cancer diagnosis. MOD data can then be abstracted to cancer registries to provide direct evidence of the impact of screening on breast cancer diagnoses and subsequent outcomes and thereby resolve the debate about the benefits of screening. Given the widespread support of MOD reporting, there is also great potential to improve and facilitate its clinical implementation. Barriers to MOD adoption include a lack of an organized national breast cancer screening program, the cost of implementation, a lack of radiologist MOD training, and technical lapses, among others. The American College of Radiology and the Society of Breast Imaging have addressed barriers to MOD implementation through educational opportunities and the Breast Imaging Reporting and Data System 6th Edition provides comprehensive education on the MOD program. However, consistent and accurate MOD reporting and linkage to tumor registries on a national level will require a multifaceted approach to achieve success. Ultimately, the information gained from the direct role of MOD will result in breast cancer screening recommendations built on science-based policy.