The Screening Mammogram Debate Continues

Here is another point of view which I thought was worth reading and considering. Like most things in life change is a given and is constant. As health care providers begin to understand more through research and practise about the behavior of certain diseases, eventually the management of certain diseases changes as well.

A review of 50 years of breast cancer screening data, published in the April issue of JAMA has come to the conclusion that a woman’s decision to have screening mammography “should be individualized based on patients’ risk profiles and preferences,”

The Article is in JAMA. 2014;311(13):1327-1335. doi:10.1001/jama.2014.1398.

A Systematic Assessment of Benefits and Risks to Guide Breast Cancer Screening Decisions
Lydia E. Pace, MD, MPH1; Nancy L. Keating, MD, MPH2,3

From Medscape:

by Nick Mulcahy

Clinicians face a tremendous task when trying to communicate the risks and benefits of mammography screening to individual patients, they suggest.

They do offer some advice for clinicians who sit and talk with women considering screening: “Messages based on fear or guilt may impede full understanding.”

Fifty Years of Data

In their review of 50 years of data, Drs. Pace and Keating conclude that mammography screening is associated with a 19% overall reduction of breast cancer mortality (approximately 15% for women in their 40s and 32% for women in their 60s).

But, for a 40- or 50-year-old woman undergoing 10 years of annual mammograms, the cumulative risk of a false-positive result is about 61%.

Additionally, about 19% of the cancers diagnosed during that 10-year period of mammograms would not have become clinically apparent without screening (and thus represent overdiagnosis). However, Drs. Pace and Keating note that “there is uncertainty about this [overdiagnosis] estimate.”

Strong Response From Imaging Societies

The analysis from Drs. Pace and Keating met with fierce opposition from 2 medical societies: the American College of Radiology (ACR) and the Society of Breast Imaging (SBI).

In a joint press release, the 2 groups raise the specter of missed cancers and subsequent deaths.

“Breast cancer screening based primarily on risk — as discussed in the JAMA article — would miss the overwhelming majority of breast cancers present in women and result in thousands of unnecessary deaths each year,” the statement reads.

Part of the problem with the study is that it relied too much on old data, the groups assert.

“The JAMA article authors also placed too much emphasis on the obsolete and low lifesaving benefit of mammography claimed in outdated or discredited studies,” they state.

The rest of this article written by Nick Mulcahy can be found in the April 02, 2014 issue of Medscape.
Click on the blue link above.

As always, consult with your health care provider before making any important decisions about your health.

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