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Reinforcing the benefits of screening mammography guidelines

Posted on: 04/07/2014

The April issue of the Journal of the American Medical Association, JAMA, published a literature review conducted by Dr. Lydia Pace and Dr. Nancy Keating from Brigham and Women’s Hospital. The authors concluded that “mammography screening appears to be associated with reduced breast cancer mortality, but for some patients, the harms may outweigh the benefits.” They state that decisions about screening mammography should be individualized based on the patient’s risk profile and preferences in consultation with their physicians, and not based on current recommendations for annual screening to start at age 40. RIA believes, as does the American College of Radiology in their statement linked and pasted below, that the conclusions of the authors are flawed and potentially harmful. The authors placed too much weight on older studies that have since been discredited, and too little emphasis on more recent and accepted studies. The conclusions also did not account for the marked improvement in the imaging technology that has occurred with digital mammography and tomosynthesis (3D mammography.)

RIA continues to support the mammography screening recommendations of the American College of Radiology, the American College of Obstetrics and Gynecology, and The American Cancer Society for annual mammography beginning at age 40. The newest mammography and breast imaging technology is being implemented and is continuing to improve the effectiveness of mammography - still the best method available for early detection of breast cancer.

The American College of Radiology has responded to the JAMA article cautioning that its conclusion is potentially deadly for many women. See the ACR’s response attached below and at http://www.acr.org/About-Us/Media-Center/Press-Releases/2014-Press-Releases/20140402-JAMA-Article-Breast-Cancer-Screening-Recommendations-Potentially-Deadly-for-Many-Women


JAMA Article Breast Cancer Screening Recommendations Potentially Deadly for Many Women

ACR, SBI Continue to Recommend Annual Mammograms Beginning at Age 40
April 02, 2014

Washington, DC (April 1, 2014) – The American College of Radiology (ACR) and Society of Breast Imaging (SBI) agree with statements made by Pace and Keating, in their recent article published in the Journal of the American Medical Association (JAMA), that women should discuss mammography with their doctor and breast cancer diagnosis and treatment may one day be more individualized. However, at present, 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 United States Preventive Services Task Force (USPSTF) made similar suggestions to those of this JAMA article. However, an analysis (Hendrick and Helvie), published in the American Journal of Roentgenology, using the task force’s own methodology, showed that if USPSTF breast cancer screening guidelines were followed, approximately 6,500 additional women each year in the U.S. would die from breast cancer. It is also likely that thousands more would endure more extensive and expensive treatments than if their cancers were found early by a mammogram.

To arrive at their recommendations, the JAMA article authors also placed too much emphasis on the obsolete and low lifesaving benefit of mammography claimed in outdated or discredited studies. For instance, the Canadian National Breast Screening Study (CNBSS) has been widely discredited and should not be considered alone or in a meta-analysis such as this JAMA article. The World Health Organization long ago excluded the CNBSS from its analyses of screening mammography’s impact of breast cancer mortality. In a recent interview with CNN, the American Cancer Society echoed methodological concerns about the study. Breast cancer groups, such as BreastCancer.org, have criticized this study and warned against following the author’s recommendations. A recent article published in The Oncologist shows that many other studies cited in the Pace and Keating article, and elsewhere, regarding overdiagnosis and potential harms of mammography are not as well-founded as has been reported and that their conclusions cannot simply be taken as fact.

More recent randomized control trials, particularly the largest (Hellquist et al) and longest running (Tabar et al) breast cancer screening studies in history respectively, have reconfirmed that regular mammography screening cut breast cancer deaths by roughly a third (roughly double that claimed in Pace and Keating) in all women ages 40 and over — including women ages 40–49. A study (Otto et al) published in Cancer Epidemiology, Biomarkers & Prevention shows mammography screening cuts the risk of dying from breast cancer nearly in half. A recent study published in Cancer showed that more than 70 percent of the women who died from breast cancer in their 40s at major Harvard teaching hospitals were among the 20 percent of women who were not being screened. Perhaps most importantly, according to National Cancer Institute data, since mammography screening became widespread in the mid-1980s, the U.S. breast cancer death rate, unchanged for the previous 50 years, has dropped well over 30 percent. These trial results and government reports may be most applicable to the current state of breast cancer screening.

Every major American medical organization with expertise in breast cancer care, including the American Congress of Obstetricians and Gynecologists , American Cancer Society, American College of Radiology, National Accreditation Program for Breast Centers and Society of Breast Imaging recommend that women start getting annual mammograms at age 40. The ACR and SBI continue to stand by these recommendations.

Mammography can detect cancer early when it’s most treatable and can be treated less invasively — which not only save lives, but helps preserve quality of life. For more information regarding the proven effectiveness of regular mammography screening at reducing breast cancer deaths, please visit www.MammographySavesLives.org.

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