• American Cancer Society abandons ‘one size fits all’ advice on mammograms

    mammograms

    By Karen Kaplan – Contact Report
    Los Angeles Times – October 20, 2015

    After a thorough review of the benefits and limitations of mammograms, the nation’s top cancer-fighting organization is advising women that they can wait until they are 45 years old to start using the tests to screen for breast cancer.

    New guidelines from the American Cancer Society also assure women that they can have fewer mammograms over the course of their lives.

    The guidelines, published in Wednesday’s edition of the Journal of the American Medical Assn., are designed for women who are in good health and have no reason to suspect their risk of developing breast cancer is above average. The findings represent a departure from the group’s previous recommendation that all women with an average risk of breast cancer get annual mammograms starting at age 40.

    The American Cancer Society has updated its guidelines for average risk women.

    Although the American Cancer Society still endorses that course for women who prefer it, the group acknowledged that some women favor a less-aggressive approach to breast cancer screening. If so, it said, they can delay their first mammogram until they are 45 and wait two years between screenings starting at age 55 without fear that doing so will put their health in jeopardy.

    Either way, regular mammograms should continue as long as women have a life expectancy of at least 10 years and are good candidates for breast cancer treatment, the guidelines say. [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…]

  • Mandatory Reporting Of Breast Density In Screening Mammograms. Why The Controversy

    Elaine Schattner
    www.forbes.com

    imagesRecently, the Governor of Michigan signed into law a requirement that radiologists inform women if their mammogram reveals dense breasts. The law will take effect on June 1, 2015. With this act, Michigan became the 21st state to enact legislation on mandatory reporting of breast density found in breast cancer screening.

    The surprisingly controversial law, having to do with a woman’s right to know if her mammogram result is unclear, may go national: Last July, Senators Dianne Feinstein (D-Calif.) and Kelly Ayotte (R-N.H.) introduced the Breast Density and Mammography Reporting Act. Similar legislation repeatedly has been put before Congress by Rep. Rosa DeLauro (D-CT) and co-sponsors. [Read More…]

  • Local Clinic to Offer Day of Thermography Breast Screening For Women

  • Minnesota and Rhode Island enact breast density laws

    May 27, 2014

    dense-breastsby Loren Bonner , DOTmed News Online Editor

    This week, Gov. Lincoln Chafee signed Rhode Island’s breast density inform bill into law, and late last week, Gov. Mark Dayton did the same for Minnesota women.

    Breast density laws require physicians to inform women if they have dense breasts along with the possible risks that can be present.

    Minnesota becomes the sixteenth state with mandatory breast density notification for women, and Rhode Island became the seventeenth.

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

  • Mammography controversy needs greater participation to inform decisions

    Wednesday 7 May 2014 – 2am PST

    Doctors at the World Congress on the Menopause in Cancun, Mexico, have called for any decision to participate in mammography to be a based on an informed choice and consideration of all factors, rather than just be an automatic process.

    A major session at the World Congress on the Menopause has debated the benefits and risks associated with regular mammography. The potential benefit of mammography is earlier detection of breast cancer, but increasing evidence has shown that mammography also uncovers some cancers which would not go onto cause any problem, and many doctors believe that this over diagnosis can cause real harm through unnecessary treatment. The debate in the scientific press has led to confusion in the minds of many women, who hope for a definitive answer on whether or not they should undergo regular mammography.

    Now two prominent doctors from opposing sides of the debate have agreed that women need to be more involved in making decisions on whether or not mammography is right for them.

    Dr Eugenio Paci presented work from the EUROSCREEN working group, showing that over diagnosis is at the lower end of the estimates, indicating that mammography saves lives. This work indicates that screening 1000 women saves up to 7 lives, with only 4 over diagnosis. Professor Robin Bell presented an analysis showing that up to 40% of invasive breast cancer cases identified in women invited for mammography may be over diagnosed, and says that the total number of deaths in screened patients does not drop when measured against non-screened patients, indicating that screening has few benefits. [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.

  • FAIL: Another Mammography Study Finds They Don’t Save Lives