Introduction to the special issue - Imaging-based screening: Radiology's increasing role in preventive medicine

摘要

The Patient Protection and Affordable Care Act fundamentally shifts priorities for US health care, with an increased focus on preventive medicine, in which screening asymptomatic individuals will identify the most deadly and costly of diseases, including cancer and cardiovascular disease, at their earliest stages, when intervention can decrease both patient mortality and the higher costs of treating advanced disease. Given tremendous technological advances over the past decade, radiology now stands to take on a higher profile and central role in US population-based screening. Nevertheless, if history serves us well, imaging-based screening will continue to be met with a host of controversies and challenges. Furthermore, both the Affordable Care Act and programs to comply with its requirements may lead to unintended consequences.No other US preventive medicine topic generates more controversy and emotional charge as breast cancer screening. The heavily debated revised recommendations from the US Preventive Services Task Force (USPSTF) in 2009 for biennial mammography starting at 50 years of age, rather than annual mammography starting at age 40, is just one example of the historically complex interpretation of the available evidence linking image-based screening to long-term patient outcomes. Reducing the divisive-ness requires representation of all stakeholders, giving voice to the myriad points of view.