National Wellness Month encourages people to focus on self-care, and we’d like to take the time this August to share how the team at RadX Imaging Partners—and all radiologists nationwide—help contribute to wellness and promote longevity through evidence-based preventive imaging.

You may already know that radiologists are the doctors who read and interpret diagnostic imaging tests to help you achieve an accurate diagnosis of a health condition. But radiologists are also now involved in preventive care and can help people detect potential health problems before they become life-impacting or life-threatening.

Mammography: A Success Story with Evolving Impact

The most well-known preventive imaging test is the mammogram. In 2023, 79.8% of women aged 50-74 years had a mammogram within the past 2 years, demonstrating strong uptake of this life-saving screening.

The Power of Early Detection: Perhaps the most compelling argument for mammography screening is that when caught in its earliest, localized stages, the 5-year relative survival rate is 99%. This dramatic survival advantage underscores why regular screening is crucial – breast cancer is highly treatable when detected early, before it spreads beyond the breast. Unfortunately, approximately 66% of breast cancer cases are diagnosed at a localized stage, meaning there’s still room for improvement in early detection rates.

The evidence for mammography’s effectiveness continues to strengthen. A synthesis of high-quality studies found a 26% breast cancer mortality reduction from screening programs. More recent data from Sweden shows even more promising results: We found a 41% reduction (with a narrow 95% CI) in cancers that were fatal within 10 years after diagnosis among women who participated in screening and a 25% reduction in the incidence of advanced breast cancer.

Surprising Finding: Each year, breast cancer causes approximately 40,000 deaths among women in the United States, yet there are significant disparities. Black women have a rate of self-reported mammography screening similar to or higher than that for all women (84.5% vs 78%, respectively, in the past 2 years), based on 2020 data, but still experience higher mortality rates due to barriers in follow-up care and treatment.

Breast MRI: Beyond Traditional Screening

Breast MRI is a test used to screen women who are at high risk for breast cancer, women with implants or women who may be pregnant. It is typically recommended as a supplemental screening test to mammography, or in the case of women who are pregnant, a way to screen for breast cancer without the risk of radiation exposure to the unborn baby.

The 2024 USPSTF guidelines now recommend starting mammography at age 40, marking a significant shift in screening recommendations based on evolving evidence about breast cancer incidence in younger women.

DEXA Bone Densitometry: The Silent Disease Detector

DEXA bone densitometry testing is another great preventive imaging test, suitable for all women over 65 as well as men of the same age with low testosterone levels. The statistics are striking: A T-score between -1.0 and -2.5 is considered low bone density, sometimes referred to as osteopenia. A T-score -2.5 or below is considered osteoporosis.

Critical Impact: The risk for bone fracture doubles with every SD below normal. Thus, a person with a BMD of 1 SD below normal (T-score of -1) has twice the risk for bone fracture as a person with a normal BMD. This exponential increase in fracture risk makes early detection crucial.

Underutilized Screening: Despite the World Health Organization defined osteoporosis in postmenopausal White women as bone density at the hip or lumbar spine that is 2.5 standard deviations or lower, many eligible individuals remain unscreened. The test uses a very slight increase in possibility of future cancer, similar to the risks from x-rays, making it extremely safe.

Prenatal Ultrasound: Comprehensive Maternal-Fetal Health

Prenatal ultrasound is a test that is used to help pregnant women evaluate their baby during pregnancy. It can monitor the health and development of the fetus as well as the mother’s reproductive organs as a safe and non-invasive way to ensure a smooth pregnancy.

Low-Dose Lung Screening: Dramatic Mortality Reductions

Low-dose lung screening has emerged as one of the most impactful preventive screening programs. The NLST reported a relative risk reduction in lung cancer mortality of 20% (95% CI, 6.8%-26.7%), with 247 deaths from lung cancer per 100,000 person-years in the low-dose CT group and 309 deaths per 100,000 person-years in the radiography group.

Surprising Statistics: The American Lung Association estimates that screening eligible individuals will reduce the annual death rate from lung cancer by up to 20%, potentially saving up to 25,400 lives each year if all USPSTF-eligible individuals were to undergo LCS. Yet screening rates remain dismally low.

Number Needed to Screen: The number needed to screen with low-dose CT to prevent one death from lung cancer was 320, making it one of the most efficient cancer screening programs available.

The AI Revolution in Preventive Radiology

Coronary Calcium Scoring: Perhaps the most exciting development is the emergence of AI-enabled opportunistic screening. An artificial intelligence (AI) algorithm using deep learning can enable clinicians to estimate the coronary artery calcium scoring score on routine non-contrast chest CT, potentially allowing opportunistic early preventive interventions.

This is revolutionary because In one study, CAC was present on NCCT in 58% of patients, but only described in the radiology report of 44% of these cases. AI can now automatically detect and quantify this calcium, potentially identifying thousands of at-risk patients who would otherwise go undiagnosed.

Abdominal Aortic Aneurysm Screening: The screening pipeline correctly classified 47 AAA out of 48 and 24 control patients out of 25 with 97% accuracy, 98% sensitivity, and 96% specificity using AI-based detection on routine CT scans.

Future Directions: Personalized Screening

The future of preventive radiology lies in personalized risk assessment. AI-enabled automated cardiac chambers volumetry and calcified plaque characterization to CAC scans (AI-CAC) can now predict not just coronary disease but also heart failure, atrial fibrillation, and stroke risk from a single scan.

Implementation Challenges: Despite proven benefits, implementation remains challenging. screening will be most effective if it induces ‘down-staging’, i.e. shifting advanced-stage cancers, for which treatments are less efficient or non-existent, to earlier stages for which effective therapies exist. However, as treatments improve, the benefit-harm balance of screening evolves.

The Bottom Line

Preventive radiology screening saves lives through early detection, but success requires more than just technology. It demands:

• Addressing health disparities in screening access and follow-up
• Leveraging AI for opportunistic screening on routine imaging
• Personalizing screening recommendations based on individual risk
• Ensuring adequate follow-up for positive screening results
• Continuous evaluation of screening effectiveness as treatments evolve

In the future, additional preventive screening tests will become available, and radiologists will play an important role in helping those at risk achieve the earliest possible detection. The integration of AI promises to transform every routine scan into a potential life-saving screening opportunity, making preventive radiology more accessible and impactful than ever before.

References

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