Category: Breast Imaging

New Cancer Disparity Data Show Socioeconomic Impact

Posted on by Brian Casey

Cancer screening disparities continue to draw scrutiny in radiology. A new study in JAMA Network Open takes a closer look at why some people don’t get screened as often as they should – as well as the factors that contribute to cancer prevalence and mortality. 

There’s extensive research backing the lifesaving potential of the major cancer screening exams, and cancer mortality rates have consistently declined thanks to the combination of screening and better treatments. 

  • But the declines are uneven, prompting researchers to investigate reasons for the disparities, such as in a study earlier this month documenting geographic variations in cancer screening rates. 

In the new study, researchers from the ACR’s Harvey L. Neiman Health Policy Institute looked at how 24 measures like lifestyle, socioeconomic status, and environmental background affected breast, prostate, lung, and colorectal cancer, which account for 50% of new cancer cases.

  • In particular, they examined screening completion rates and cancer prevalence and mortality at the county level in a nationally representative sample of 5% of Medicare fee-for-service beneficiaries, of whom 87% were 65 years and older. 

There’s a lot to unpack in the study, but a few highlights are below as they relate to breast and lung cancer, the two cancers for which imaging-based screening is recommended. The top three factors affecting each (in order of importance) are…

  • Breast cancer:
    • Screening rates – Hispanic population share, levels of insufficient sleep, and poverty. 
    • Prevalence – uninsured status, obesity, and housing insecurity.
    • Mortality – non-Hispanic Black race, environmental justice index, and insufficient sleep.
  • Lung cancer:
    • Screening rates – air pollution exposure, lack of access to primary care physicians, and number of poor physical health days.
    • Prevalence – limited access to healthy foods, uninsured status, and severe housing problems.
    • Mortality – smoking, poor physical health days, and environmental justice index. 

While there are some obvious findings in the data (the connection between smoking and lung cancer mortality, for example), the dominance of socioeconomic measures may take some by surprise (or maybe not). 

  • But they do track with previous research finding that socioeconomic factors account for 40-50% of health impacts.

The Takeaway

The new study – as with previous research – reinforces what we know about the strong connection between socioeconomic status and cancer screening disparities. The new data should give clinicians and public health advocates more detail on the specific factors they need to focus on to improve screening compliance and reduce cancer’s burden on society.

Hologic to Go Private in $18.3B Buyout

Posted on by Brian Casey

Women’s imaging vendor Hologic will go private in an $18.3B buyout led by two private equity firms, Blackstone and TPG. The move is easily the largest acquisition in radiology this year – the question is how it will impact one of the biggest corporate success stories in women’s health. 

Hologic has a long history in medical imaging and was founded in 1985 to develop and market bone densitometry systems. It soon expanded into mammography, molecular diagnostics, and women’s health treatments.

  • The company went public in 1990, and has maintained its independence even as radiology underwent a period of consolidation in the 1990s and 2000s that saw most mid-cap firms get acquired by multinational OEMs.

Much of Hologic’s momentum was driven by the conversion of U.S. mammography facilities from standard 2D mammography to 3D digital breast tomosynthesis. 

  • This shift was led by Hologic’s Selenia Dimensions system, which in 2011 was the first DBT system to get FDA approval. Hologic rode its momentum to a U.S. mammography installed base market share approaching 70%. (Signify Research estimates Hologic currently has a 34% market share of the global mammography market.)

But as often happens to many market leaders, Hologic’s position began slipping in recent years. 

  • The multinational OEMs have improved their positions in women’s imaging, releasing DBT systems that are more competitive with Hologic’s offerings while also benefiting from multiyear purchasing agreements with large health systems in which mammography systems can be bundled with CT, MRI, and other equipment. 

Perhaps as a result, Hologic’s Breast Health segment has become a drag on revenue growth due to lower equipment sales. Breast Health revenues for the most recent Q3 period fell 5.8%, following a 6.9% drop in Q2 and a 2.1% decline in Q1. 

  • Indeed, reports began surfacing in May 2025 that Blackstone and TPG were targeting Hologic for acquisition, with Hologic reportedly rejecting a $16.7B offer. 

The bid was apparently sweetened, with an acquisition price of $79 a share, a 46% premium from before the acquisition rumors started, for a total value of $18.3B. The buyout should close in the first half of calendar 2026.

The Takeaway

Hologic built itself into a radiology success story through a combination of technological innovation and an obsessive focus on a single market segment – women’s health. The question is whether that focus will continue under its new PE-led ownership.

Cancer Screening Rates Vary Geographically

Posted on by Brian Casey

Progress has been made in some U.S. regions in boosting adherence rates for cancer screening exams like mammography, but clusters of regional variation remain. That’s according to a new study in JAMA Network Open that offers hope for reducing access disparities in disadvantaged areas.

Disparities in healthcare access remain one of the nagging problems in the U.S. healthcare system. 

  • Previous studies have shown that racial background, socioeconomic status, and geographic location can all affect access to care, and ultimately, patient outcomes.

Nowhere is this more apparent than in cancer screening, where getting patients in for their exams has always been a challenge. 

  • Screening compliance rates (as of 2021) were approximately 76% for breast cancer, 75% for cervical cancer, and 72% for colorectal cancer. 

But how does geography affect screening rates, and has progress been made over time? 

  • To answer these questions, researchers analyzed geographic variations in rates for the three major cancer screening tests (breast, cervical, and colorectal) over a 22-year period. 

Screening data were analyzed at the county level from 1997 to 2019, with screening prevalence estimated over 3-5-year periods. For mammography screening, authors found…

  • Screening rates were highest in the Northeast (Maine, New Hampshire, Vermont, and Massachusetts).
  • Rates were lowest in the Southwest (Texas, New Mexico, and Arizona).
  • Geographic areas that shifted from low to high uptake had lower socioeconomic status and more non-White residents, suggesting the success of efforts to improve screening in disadvantaged areas. 
  • Counties that did not improve had lower socioeconomic status than counties that maintained high screening rates. 
  • Rural areas had persistently low screening rates, reflecting lack of access to facilities as well as transportation. 

The Takeaway

The new study on geographic variation in cancer screening rates offers encouraging news that – at least in some disadvantaged areas – improving screening uptake is possible. But more research is needed to find out why some areas fail to see improvement. 

Perils of Missed Mammography

Posted on by Brian Casey

Yet another study is illustrating the perils of missing mammography screening. New research in JAMA Network Open found that women diagnosed with breast cancer who missed their previous screening exam had signs of delayed diagnosis and worse clinical outcomes. 

Mammography screening is generally credited – along with improved treatments – with a steady decline in breast cancer death rates since the start of population-based breast screening.

  • But most studies on mammography’s effectiveness tend to compare women who participated regularly in screening with those who never did. 

That’s not really a realistic comparison these days, as mammography’s relatively high compliance rate means that most women are getting screened at least some of the time.

  • But what happens if women miss a screening exam? In a BMJ study published last month, researchers found that women who missed their first screening exam had a 40% higher risk of breast cancer death.

In the current study, researchers took a slightly different tack, looking at 8.6k women in Sweden whose breast cancer was detected on screening exams starting in 2015. 

  • In all, 17% of women missed the screening exam immediately before their cancer diagnosis. 

Compared to women who attended all screening rounds, those who missed their previous exam had higher adjusted odds ratio for…

  • Larger tumors ≥ 20 mm (AOR = 1.55).
  • Lymph node involvement (AOR = 1.28).
  • Distant metastasis (AOR = 4.64).
  • Worse breast cancer-specific survival (AOR = 1.33).
  • Lower 20-year breast cancer-specific survival (86% vs. 89%). 

What’s more, the program’s cancer detection rate per 1k screenings was sharply higher in the second screening round for women who missed the first round (7.35 vs. 5.59). 

  • This is most likely a sign that cancers that could have been detected in the first round instead were detected in the second round – another sign of delayed diagnosis.

Women who had missed their previous screening tended to be younger, unemployed, unmarried, and born outside of Sweden, and also had lower income. 

  • Women with these characteristics could be targeted for more intensive outreach, such as shorter invitation intervals or outreach after a missed appointment. 

The Takeaway

The new study once again highlights the importance of regular mammography screening in detecting breast cancer. Even one missed exam can have serious clinical consequences – highlighting the importance of identifying and contacting women who might be more prone to missed appointments.

Missing Breast Screening Boosts Death Risk

Posted on by Brian Casey

Missing a first breast cancer screening exam can be hazardous to your health. A new study in BMJ found that women who missed their first mammography screening had a 40% higher long-term risk of breast cancer death. 

Mammography screening has been shown to prevent breast cancer deaths by detecting cancer earlier, when it can be treated more effectively.

  • But breast screening adherence rates still aren’t as high as they should be, leaving women’s health advocates to wonder what they can do to spur better compliance.

In the new study, researchers investigated whether mammography compliance itself could be an early warning sign that women might not be taking screening seriously enough.

  • They analyzed data on 433k women invited to the Swedish Mammography Screening Programme from 1991 to 2020 and correlated clinical outcomes over 25 years with whether or not patients completed their first screening exam (32% didn’t).

Compared to women who missed their first mammography appointment, women who followed through with their exam…

  • Had a 40% lower risk of dying from breast cancer. 
  • Had lower breast cancer mortality rates per 1k women (7 vs. 9.9). 
  • Got nearly twice as many breast screenings over the study period (8.7 vs. 4.8 screenings).
  • Had similar breast cancer incidence rates (7.8% vs. 7.6%), a sign that non-participation delayed detection rather than increased incidence. 

What’s more, women who missed their first appointment were 32% more likely to have invasive cancer and had higher odds ratios for stage III and stage IV disease (OR = 1.53 and 3.61, respectively). 

Researchers concluded that women who missed their first mammography appointment were also more likely to miss future ones – putting them at higher risk of breast cancer death.

  • But a missed initial appointment also could serve as a warning to women’s health centers that these patients deserve extra attention, through tools as simple as more provider outreach or automatically scheduled second appointments. 

The Takeaway

The new findings offer – yet again – more support for the effectiveness of population-based breast screening in reducing breast cancer deaths. What’s novel is that they show that non-participation is an early warning sign that could activate a slate of more aggressive outreach measures to bring these women in. 

Mammo Risk Prediction Improves with AI

Posted on by Brian Casey

Artificial intelligence is beginning to show that it can not only detect breast cancer on mammograms, but it can predict a patient’s future risk of cancer. A new study in JAMA Network Open showed that a U.S. university’s homegrown AI algorithm worked well in predicting breast cancer risk across diverse ethnic groups. 

Breast cancer screening traditionally has used a one-size-fits-all model based on age for determining who gets mammography.

  • But screening might be better tailored to a woman’s risk, which can be calculated from various clinical factors like breast density and family history.

At the same time, research into mammography AI has uncovered an interesting phenomenon – AI algorithms can predict whether a woman will develop breast cancer later in life even if her current mammograms are normal. 

The new study involves a risk prediction algorithm developed at Washington University School of Medicine in St. Louis that uses AI to analyze subtle differences and changes in mammograms over time, including texture, calcification, and breast asymmetry.

  • The algorithm then generates a mammogram risk score that can indicate the risk of developing a new tumor.

In clinical trials in British Columbia, the algorithm was used to analyze full-field digital mammograms of 206.9k women aged 40-74, with up to four years of prior mammograms available. Results were as follows …

  • The algorithm had an AUROC of 0.78 for predicting cancer over the next five years.
  • Performance was higher for women older than 50 compared to 40-50 (AUROC of 0.80 vs. 0.76).
  • Performance was consistent across women of different races.
  • 9% of women had a five-year risk higher than 3%. 

The algorithm’s inclusion of multiple mammography screening rounds is a major advantage over algorithms that use a single mammogram as it can capture changes in the breast over time. 

  • The model also showed consistent performance across ethnic groups, a problem that has befallen other risk prediction algorithms trained mostly on data from White women. 

The Takeaway

The new study advances the field of breast cancer risk prediction with a powerful new approach that supports the concept of more tailored screening. This could make mammography even more effective than the one-size-fits-all approach used for decades.

AI Boosts DBT in Detecting More Breast Cancer

Posted on by Brian Casey

A real-world study of AI for DBT screening found that AI-assisted mammogram interpretation nearly doubled the breast cancer detection rate. Radiologists using iCAD’s ProFound AI software saw sharp improvements across multiple metrics. 

Mammography screening has quickly become one of the most promising use cases for AI. 

  • Multiple large-scale studies published in 2024 and 2025 have documented improved radiologist performance when using AI for mammogram interpretation, with the largest studies performed in Europe.

Another new technology changing mammography screening is digital breast tomosynthesis, which is being rapidly adopted in the U.S. 

  • DBT use in Europe is occurring more slowly, so questions have arisen about whether AI’s benefits for 2D mammography would also be found with 3D systems.

To investigate this question, researchers writing in Clinical Breast Cancer tested radiologist performance for DBT screening before and after implementation of iCAD’s ProFound V2.1 AI algorithm in 2020 at Indiana University. 

  • Interestingly, the pre-AI period included use of iCAD’s older PowerLook CAD software. 

Across the 16.7k DBT cases studied, those with AI saw …

  • A sharp improvement in cancer detection rate per 1k exams (6.1 vs. 3.7).
  • A decline in the abnormal interpretation rate (6.5% vs. 8.2%).
  • Higher PPV1 (rate that abnormal mammograms would be positive) (8.8% vs. 4.2%).
  • Higher PPV3 (rate that biopsies would be positive) (57% vs. 32%). 
  • Higher specificity (94% vs. 92%).
  • No statistically significant change in sensitivity.

The findings on sensitivity are curious given AI’s positive impact on other interpretation metrics.

  • Researchers postulated that there was higher breast cancer incidence in the post-AI implementation period, which could have been caused by AI finding cancers that were missed in the period without AI.

The Takeaway

The radiology world has seen multiple positive studies on AI for mammography, but most of these have come from Europe and involved 2D mammography not DBT. The new results suggest that AI’s benefits will also transfer to DBT, the technology that’s becoming the standard of care for breast screening in the U.S.

How Do Patients Feel about Mammo AI?

Posted on by Brian Casey

As radiology moves (albeit slowly) to adopt clinical AI, how do patients feel about having their images interpreted by a computer? Researchers in a new study in JACR queried patients about their attitudes regarding mammography AI, finding that for the most part the jury is still out. 

Researchers got responses to a 36-question survey from 3.5k patients presenting for breast imaging at eight U.S. practices from 2023-2024, finding …

  • The most common response to four questions on general perceptions of medical AI was “neutral,” with a range of 43-51%. 
  • When asked if using AI for medical tasks was a bad idea, more patients disagreed than agreed (28% vs. 25%). 
  • Regarding confidence that medical AI was safe, patients were more dubious, with higher levels of disagreement (27% vs. 20%).
  • When asked if medical AI was helpful, 43% were neutral but positive attitudes were higher (35% vs. 19%).

The Takeaway

Much like clinicians, patients seem to be taking a wait-and-see attitude toward mammography AI. The new survey does reveal fault lines – like privacy and equitability – that AI developers would do well to address as they work to win broader acceptance for their technology. 

We’re testing a new format today – let us know if you prefer two shorter Top Stories or one longer Top Story with this quick survey!

Patients Want Mammo AI, But Mostly As Backup

Posted on by Brian Casey

Patients support the idea of having AI review their screening mammograms – under certain conditions. That’s according to a new study in Radiology: Imaging Cancer that could have implications for breast imagers seeking to integrate AI into their practices.

Mammography screening has been identified as one of the most promising use cases for AI, but clinical adoption has been sluggish for reasons that range from low reimbursement to concerns about data privacy, security, algorithm bias, and transparency. 

  • Vendors and providers are working on solving many of the problems impeding greater AI use, but patient preference is an often overlooked factor – even as some providers are beginning to offer AI review services for which patients pay out of pocket.

To gain more insight into what patients want, researchers from the University of Texas Southwestern Medical Center surveyed 518 women who got screening mammography over eight months in 2023, finding …

  • 71% preferred that AI be used as a second reader along with a radiologist.
  • Only 4.4% accepted standalone AI interpretation of their images.
  • 74% wanted patient consent before AI review.
  • If AI found an abnormality, 89% wanted a radiologist to review their case, versus 51% who wanted AI to review abnormal findings by radiologists.
  • If AI missed a finding, 58% believed “everyone” should be accountable, while 15% said they would hold the AI manufacturer accountable. 

Patient preference for use of AI in collaboration with radiologists tracks with other recent research. 

  • Patients seem to want humans to retain oversight of AI, and seem to value trust, empathy, and accountability in healthcare – values associated with providers, not machines. 

The findings should also be good news for imaging services companies offering out-of-pocket AI review services. 

The Takeaway

The new findings should be encouraging not only for breast imagers and AI developers, but also for the imaging services companies that are banking on patients to shell out their own money for AI review. As insurance reimbursement for AI languishes, this may be the only way to move mammography AI forward in the short term.

High-Risk Breast Clinics: A Smart Move for Imaging Providers

Posted on by Partner Content

High-risk breast cancer clinics are no longer just a good idea – they’re becoming a strategic imperative. These programs, focused on identifying and managing women at elevated risk for breast cancer, are proving their value clinically and financially.

For imaging providers, they present an opportunity both to improve care and grow service lines in a value-based care environment, while also differentiating themselves in increasingly competitive markets. A recently published white paper offers a full explanation of the benefits of high-risk breast clinics.

Treating late-stage breast cancer is extremely costly – $76,000+ in the final year of life alone – and it represents a major portion of oncology spend nationwide. 

  • By identifying high-risk patients early and offering enhanced surveillance with breast MRI, clinics can diagnose more cancers at early stages, when treatment is more effective and less expensive. 

Studies show MRI screening in BRCA1 carriers is cost-effective at ~$50,900 per QALY. 

  • This makes it a smart investment from both a patient and payor perspective.

Historically, preventive programs were considered cost centers. Not so with high-risk breast clinics. 

  • Once a patient is flagged as high risk, the care pathway includes reimbursable   genetic counseling and testing, supplemental imaging (MRI or contrast-enhanced mammography), biopsies, chemoprevention, and even risk-reducing surgeries. Each step creates downstream revenue for imaging centers and affiliated specialists – all while improving patient care.

Integration is key. Embedding risk assessment tools like Tyrer-Cuzick or AI-based models (e.g. Mirai) into the high-risk clinic’s imaging workflow enables automatic triage. 

  • Patients with ≥20% lifetime risk can be directly referred to the high-risk clinic. Some models now use short-term risk from imaging data alone to identify the top 5-10% women most likely to develop cancer within five years – significantly outperforming traditional tools in clinical studies.

Successful clinics rely on multidisciplinary teams. Advanced-practice providers manage most visits. Genetic counselors – in person or via telehealth – manage testing results and family history. Patient navigators coordinate follow-ups and authorizations. 

  • This team-based approach keeps physician time focused and costs under control, ensuring the clinic operates efficiently and sustainably.

The Takeaway

For imaging providers, high-risk breast clinics offer a powerful blend of patient impact and business growth. They reduce expensive late-stage cancers, drive high-value imaging, and create long-term patient relationships. In an era of value-based care, they’re not just a clinical upgrade – they’re a strategic advantage. Forward-thinking imaging leaders are recognizing this model as essential to the future of preventive breast care.

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