• Mammogram screening and overdiagnosis: tumor size an issue?

    Hologic Imaging MachineDOTmed.com – Health Care Business Daily News
    Written by: Thomas Dworetzky , Contributing Reporter

    A just-published study of breast cancer data has raised the issue of overdiagnosis from mammography screening – and puts tumor size squarely in the middle of the debate.

    That’s because many “small breast cancers have an excellent prognosis because they are inherently slow-growing,” according to Yale Cancer Center experts in a June 8th New England Journal of Medicine report, which weighed in on the benefits of breast cancer early detection.

    Frequently these smaller tumors come from slow-growing cancers that may not become an issue during a patient’s lifetime, they noted. [Read More…]

  • U.S. breast cancer cases to increase 50 percent by 2030: NCI report

    April 22, 2015

    by Lisa Chamoff , DOTmed contributing reporter

    Signs-of-Breast-CancerThe number of breast cancer cases in the U.S. will be 50 percent higher in 2030 than it was in 2011, with an estimated 441,000 cases in 15 years, according to new research by the National Cancer Institute (NCI).

    The research, presented this week at the American Association for Cancer Research annual meeting, shows a marked increase in estrogen receptor (ER)-positive tumors in women older than 70. Part of the increase is due to the fact that women are living longer, and also due to screening technology that enables doctors to diagnose smaller, in situ tumors and invasive tumors, which are mostly detected via mammography.

    The forecast comes the same week that the U.S. Preventive Services Task Force updated, but did not change, its breast cancer screening recommendations, which state that women age 50 to 74 should only be screened once every two years, while women in their 40s should discuss screening with their doctors. [Read More…]

  • USPSTF new breast screening recommendations ‘would result in thousands of breast cancer deaths’: ACR

    April 21, 2015

    by Lauren Dubinsky , Staff Writer

    Breast Cancer Word Cloud ConceptThe U.S Preventive Services Task Force (USPSTF) released the draft update for its breast cancer screening recommendations on Monday — but not much has changed from the 2009 recommendations. The recommendations state that women between ages 50 and 74 should only undergo routine biennial screening and women in their 40s should discuss with their physician whether they need screening.

    On the their website, the Task Force gives screening women ages 40 to 49 a “C” recommendation and wrote, “Women who place a higher value on the potential benefit than the potential harms may choose to begin screening between the ages of 40 and 49 years.” The Task Force gave screening women ages 50 to 74 a “B” recommendation. [Read More…]

  • Breast Biopsies Leave Room for Doubt, Study Finds

    By DENISE GRADY
    MARCH 17, 2015
    Original Link – New York Times

    Breast biopsies are good at telling the difference between healthy tissue and cancer, but less reliable for identifying more subtle abnormalities, a new study finds.

    Because of the uncertainty, women whose results fall into the gray zone between normal and malignant — with diagnoses like “atypia” or “ductal carcinoma in situ” — should seek second opinions on their biopsies, researchers say. Misinterpretation can lead women to have surgery and other treatments they do not need, or to miss out on treatments they do need.
    [Read More…]

  • Breast cancer: are men the forgotten victims?

    In recognition of Breast Cancer Awareness Month this October, cancer charities and organizations around the globe will be “thinking pink.” On October 24th, Breast Cancer Campaign will have their “Wear it Pink” event, in which people all over the US will wear pink clothing to raise awareness of the disease that will be diagnosed in more than 230,000 women this year. But in this flurry of feminine pink, it can be easy to forget that men can get breast cancer, too.

    indexIn fact, it is estimated that 2,360 new cases of breast cancer will be diagnosed in men in the US this year, and around 430 men will die from the disease.

    Admittedly, breast cancer in men is rare. A man’s lifetime risk of the disease is 1 in 1,000, while a woman’s is 1 in 8. But according to a 2012 study that assessed more than 13,000 male breast cancers from the US National Cancer Data Base, men with breast cancer are less likely to survive the disease than women.

    The researchers found that at diagnosis, men were likely to have much larger breast tumors, and the cancer was more likely to have already spread to other areas of the body.

    “This may be attributed to the fact that awareness of breast cancer is so much greater among women than men,” commented study leader Dr. Jon Greif. “Guidelines call for regular screening, both clinical and mammographic, in women, leading to earlier detection.” [Read More…]

  • Breast density: over 700,000 UK women living with ‘hidden’ breast cancer risk

    1 October 2014

    Risk Determination and Prevention of Breast Cancer[1], published in the journal Breast Cancer Research, identifies the critical gaps that must be addressed if we are to reverse the increase in breast cancer expected over the next 10 years – and reach a tipping point where more breast cancers will be prevented in the general population, not only in women at high risk. High breast density is highlighted as a significant risk factor for breast cancer that could play a key role in redefining the risk of breast cancer faced by each individual woman.

    WH_stages_of_breast_cancer-300x193The number of people diagnosed with breast cancer in the UK is on the rise and this trend is projected to continue until at least 2030. The increase is partly due to an aging population, insufficient levels of physical activity, increases in obesity and alcohol consumption, women having fewer children and having them later in life, all of which are risk factors for the disease.

    The 4 key risk and prevention gaps identified in Risk Determination and Prevention of Breast Cancer are:
    Risk estimation: Accurate ways to estimate risk in the general population and in women at high risk. Adding information about breast density and newly identified genes is likely to improve existing models. [Read More…]

  • From the ED: Breast Cancer Mammograms: Overrated – and Over-diagnosing Women

    Posted on June 23, 2014
    by Caitlin C.
    Posted at:  Breast Cancer Action

    Editor’s Note: You may have seen Karuna’s article back in April of this year when it was published in The Guardian. The piece generated a lot of discussion – over 1,000 people shared it on their Facebook page and over 150 people commented on the article itself. Many of you who have been through several iterations of these debates are used to the controversy that arises from publicly challenging routine mammography screening. What’s new this time around is the growing agreement that the benefits of routine mammography screening have long been overstated, and the harms long underestimated. Ten years ago, our challenge to the conventional position that “early detection saves lives” and “early detection is your best protection” was highly unpopular. Our independent position was a hard truth for many to hear even though it was grounded in evidence because it went against the grain of pretty much every mainstream breast cancer organization—many of which were and still are heavily invested (both in terms of funders and core values) in the “early detection saves lives” philosophy. We’ve reached a tipping point recently and now increasingly we hear more discussion about this issue and less unquestioned acceptance of the earlier screening messages.Karuna-Jaggar-headshot-2014-150x150

    By Karuna Jaggar, Executive Director

    How will we ever hope to make desperately needed progress in the breast cancer epidemic when the mainstream breast cancer movement continues to push an outdated and scientifically debunked agenda? The evidence has been mounting that the time has come to radically re-think the tenets of the breast cancer awareness movement because it is clear that the fundamental philosophy behind “early detection” is flawed. [Read More…]

  • Gov. Jan Brewer signs Breast Density Law

    April 22, 2014

    by Loren Bonner , DOTmed News Online Editor

    breastdensitylawArizona became the fifteenth state to require physicians to inform women if they have dense breasts along with the possible risks that can be present.

    After legislation was introduced at the request of a diagnostic radiologist in Arizona, and went through the procedural votes in both chambers, Governor Jan Brewer signed SB 1225 into law late last week.
    According to JoAnn Pushkin, founder of D.E.N.S.E. NY, 50 percent of U.S. women now live in states where density notification is required.

    Connecticut was the first state to pass breast density inform legislation in 2009, followed by Texas, Virginia, California, New York, and most recently Hawaii, Maryland, Alabama, Tennessee, Nevada, Oregon, North Carolina and Pennsylvania, New Jersey and now Arizona. [Read More…]

  • Abolishing Mammography Screening Programs? A View from the Swiss Medical Board

    Nikola Biller-Andorno, M.D., Ph.D., and Peter Jüni, M.D.

    April 16, 2014DOI: 10.1056/NEJMp1401875

    In January 2013, the Swiss Medical Board, an independent health technology assessment initiative under the auspices of the Conference of Health Ministers of the Swiss Cantons, the Swiss Medical Association, and the Swiss Academy of Medical Sciences, was mandated to prepare a review of mammography screening. The two of us, a medical ethicist and a clinical epidemiologist, were members of the expert panel that appraised the evidence and its implications. The other members were a clinical pharmacologist, an oncologic surgeon, a nurse scientist, a lawyer, and a health economist. As we embarked on the project, we were aware of the controversies that have surrounded mammography screening for the past 10 to 15 years. When we reviewed the available evidence and contemplated its implications in detail, however, we became increasingly concerned.

    First, we noticed that the ongoing debate was based on a series of reanalyses of the same, predominantly outdated trials. The first trial started more than 50 years ago in New York City and the last trial in 1991 in the United Kingdom. None of these trials were initiated in the era of modern breast-cancer treatment, which has dramatically improved the prognosis of women with breast cancer. Could the modest benefit of mammography screening in terms of breast-cancer mortality that was shown in trials initiated between 1963 and 1991 still be detected in a trial conducted today? [Read More…]

  • More Doubts About Mammograms’ Value Are Raised in Large Study

    By Melinda Beck
    Updated April 1, 2014
    Article from The Wall Street Journal

    Nearly 20% of breast cancers diagnosed by mammogram would never cause problems if left alone, according to a new report. Melinda Beck and the study’s lead author Dr. Nancy Keating join the News Hub. Photo: AP.
     

    A large study published Tuesday adds to the growing body of research concluding that screening mammograms save relatively few lives from breast cancer while discovering many cancers that wouldn’t have caused problems if left alone.

    “The more we screen for cancer, the more we find it. But we could have saved some of these women the angst of being told they have cancer,” said Nancy Keating, a researcher at Harvard Medical School and senior author of the study, which examined decades of screening data.

    Other recent studies also have found that mammograms often lead to unnecessary treatment, including a British Medical Journal study in February that followed 90,000 Canadian women over 25 years. But to date, that message hasn’t resulted in fewer mammograms or changes in treatment—largely because scientists still can’t tell which breast cancers can be safely left alone.

    “The challenge is, we can’t tell which are the aggressive cancers,” said Dr. Keating.

    Growing doubts about the benefits of mammograms prompted the U.S. Preventive Services Task Force to change its recommendations in 2009. Since then, it has urged women to get mammograms every other year starting at age 50, rather than annually at 40. The American Cancer Society and other cancer advocacy groups continue to recommend annual screenings starting at 40.

    Many health-care policies encourage more screening. Several states now require doctors to tell women if they have dense breasts, which can make mammograms less accurate, and to discuss more high-tech options. A growing number of doctors are rated—and compensated—on the percentage of their patients who are up to date on screenings. And the Affordable Care Act requires insurers to make mammograms free to women without copays or deductibles.

    About 225,000 cases of breast cancer are diagnosed in the U.S. each year, and about 40,000 people die of it, according to the American Cancer Society.

    The latest study, published in the Journal of the American Medical Association, took an especially long view of the data, examining randomized trials and observational studies on mammograms back to the 1960s to calculate the benefits and harms for women at various ages. Researchers concluded that annual mammograms reduced the overall death rate from breast cancer by about 19%. But they also discovered that about 19% of the breast cancers found when women undergo 10 years of annual mammograms are “over-diagnosed”—that is, they never would have caused problems if left alone.

    Younger women had the least benefit, researchers found. They estimate that for every 10,000 women in their 40s who undergo annual mammograms for 10 years, 190 will be diagnosed with breast cancer. But only five of those women would avoid dying of breast cancer as a result of the screening. Of the remainder, about 25 would die despite being treated, and 36 would be treated unnecessarily because the cancer wouldn’t have become life-threatening.

    For women in their 50s, 10 breast-cancerdeaths would be averted for every 10,000 women screened annually for 10 years. For women in their 60s, 42 breast-cancer deaths would be averted. But as many as 137 women in their 50s, and 194 in their 60s would be diagnosed and treated unnecessarily.

    The conclusion that some cancers are overtreated is controversial, and critics note that it is based on statistical estimates alone. Scientists can’t ethically watch to see whether some breast cancers progress and some don’t. Even precancerous changes, known as ductal carcinoma in situ, can become invasive cancers, so those are almost always treated aggressively.

    Treatment typically involves a combination of surgery, radiation, chemotherapy and hormone therapy, with side effects that can last for years.

    Still, many breast-cancer survivors say they are simply grateful that their cancer was treatable. And some experts stress that even if screening spurs some unnecessary treatments, it saves lives. “Over a decade or so, we prevent between 10,000 and 11,000 deaths,” said Richard Wender, chief cancer control officer at the American Cancer Society. “The overwhelming odds for any one women to benefit are quite low, but overall, from a population perspective, it’s one of our best tools in the war on cancer.”

    Scientists are working on ways to distinguish between breast cancers that are slow-growing and those that are fast-moving and lethal, and to better predict which women are at high risk for aggressive cancers so that screening and treatment can be more targeted.

    In the meantime, many cancer experts urge women and their doctors to weigh their individual risks and preferences.

    “There isn’t a one-size-fits-all on mammograms,” said Dr. Keating, who said she discusses all the pros and cons with her primary-care patients at Brigham and Women’s Hospital.

    “I have a lot of patients who say, ‘I’m comfortable waiting,’ ” she said.