Debra L. Monticciolo M.D.

Monticciolo, D.L. (2020). “Current Guidelines and Gaps in Breast Cancer Screening.” J Am Coll Radiol 17(10): 1269-1275

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Breast cancer is the most common nonskin cancer in women and the second leading cause of cancer death for women in the United States. Mammography screening is proven to significantly decrease breast cancer mortality, with a 40% or more reduction expected with annual use starting at age 40 for women of average risk. However, less than half of all eligible women have a mammogram annually. The elimination of cost sharing for screening made possible by the Affordable Care Act (2010) encouraged screening but mainly for those already insured. The United States Preventive Services Task Force 2009 guidelines recommended against screening those 40 to 49 years old and have left women over 74 years of age vulnerable to coverage loss. Other populations for whom significant gaps in risk information or screening use exist, including women of lower socioeconomic status, black women, men at higher than average risk of breast cancer, and sexual and gender minorities. Further work is needed to achieve higher rates of screening acceptance for all appropriate individuals so that the full mortality and treatment benefits of mammography screening can be realized.

Monticciolo, D.L. (2020). “Priscilla F. Butler, MS – Pioneer in radiation dose assessment and image quality.” Clin Imaging Aug 22;S0899-7071(20)30310-7. [Epub ahead of print.].

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Few people have had the impact that Priscilla “Penny” Butler, MS, has had on radiological technique in the United States. Being a woman leader in medical physics is equally rare. Penny forged both new avenues for women and new ideas for all during her long and productive career in the radiological sciences. She has done so with such grace and humility as to always remain accessible to those with whom she worked and served. This year, Ms. Butler was awarded the American College of Radiology Gold Medal, the College’s highest honor. She is only the 10th woman to receive this recognition, the first being Madame Marie Curie in 1931. In this editorial, we celebrate Ms. Butler for her ground breaking roles in radiological dose assessment and image quality. [No abstract; excerpt from Editorial.].

Monticciolo, D. L. (2020). “2020 ACR Presidential Address: Quality, Ownership, and Our Role as Physicians.” J Am Coll Radiol Jul 6;S1546-1440(20)30643-8. [Epub ahead of print.].

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A story from long ago reminds us of the importance of quality in our practices, of taking ownership of our patients, and of our role as physicians. The coronavirus disease 2019 (COVID-19) pandemic has disrupted our practices. Before the pandemic, many practices were stretched thin by the amount of work that needed to be done. The work stoppage in many locations brought an unwelcome pause but gives us time to reflect on our practices. How can we maintain quality when high volumes return? The role of artificial intelligence, and our role in its development, needs to be considered. At the same time, we need to take more ownership of the patient and be more help to our referring providers. Our own ACR staff are great examples of taking ownership. Finally, we must recognize that patients and their families are important for optimal patient care. Making that connection is significant. Let us start where we began-in the service of our patients as their physicians. This role is rewarding and, together with a focus on quality and taking ownership, can lead to successful practices that are good for everyone, including ourselves.

Dietz, J. R., M. S. Moran, S. J. Isakoff, S. H. Kurtzman, S. C. Willey, H. J. Burstein, R. J. Bleicher, J. A. Lyons, T. Sarantou, P. L. Baron, R. E. Stevens, S. K. Boolbol, B. O. Anderson, L. N. Shulman, W. J. Gradishar, D. L. Monticciolo, D. M. Plecha, H. Nelson and K. A. Yao (2020). “Recommendations for prioritization, treatment, and triage of breast cancer patients during the COVID-19 pandemic. the COVID-19 pandemic breast cancer consortium.” Breast Cancer Res Treat Apr 24. [Epub ahead of print].

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The COVID-19 pandemic presents clinicians a unique set of challenges in managing breast cancer (BC) patients. As hospital resources and staff become more limited during the COVID-19 pandemic, it becomes critically important to define which BC patients require more urgent care and which patients can wait for treatment until the pandemic is over. In this Special Communication, we use expert opinion of representatives from multiple cancer care organizations to categorize BC patients into priority levels (A, B, C) for urgency of care across all specialties. Additionally, we provide treatment recommendations for each of these patient scenarios. Priority A patients have conditions that are immediately life threatening or symptomatic requiring urgent treatment. Priority B patients have conditions that do not require immediate treatment but should start treatment before the pandemic is over. Priority C patients have conditions that can be safely deferred until the pandemic is over. The implementation of these recommendations for patient triage, which are based on the highest level available evidence, must be adapted to current availability of hospital resources and severity of the COVID-19 pandemic in each region of the country. Additionally, the risk of disease progression and worse outcomes for patients need to be weighed against the risk of patient and staff exposure to SARS CoV-2 (virus associated with the COVID-19 pandemic). Physicians should use these recommendations to prioritize care for their BC patients and adapt treatment recommendations to the local context at their hospital.