Cancer Forums and News by PhD's


News | Forums Register

Go Back   Cancer Forums and News by PhD's > Cancer Forums and News

Cancer News

Breast
Colon
Kidney
Leukemia
Liver
Lung
Melanoma
Mesothelioma
Myeloma
Neck
Pancreatic
Prostate


Cancer Review

Breast
Colon
Kidney
Leukemia
Liver
Lung
Melanoma
Mesothelioma
Myeloma
Pancreatic
Prostate


 
Age 50 as mammography screening threshold proven unfounded
By Dross at 2010-09-30 21:19
Age 50 as mammography screening threshold proven unfounded

The landmark breast cancer screening study of women 40-49, published online in Cancer, has proven that annual mammography screening of women in their 40s reduces the breast cancer death rate in these women by nearly 30 percent. The results of this largest study ever conducted on women in this age group confirm that the use of the age of 50 as a threshold for breast cancer screening is scientifically unfounded. Women should begin getting annual mammograms at age 40.

"This study, which looked at the performance of screening mammography as it is actually used, rather than relying on mathematical modeling, shows without a doubt that mammography decreases deaths from breast cancer in women aged 40-49 by nearly one third. There is no excuse not to recommend that average risk women begin annual screening mammography at age 40," said Carol H. Lee, MD, Chair of the American College of Radiology Breast Imaging Commission.

In Nov. of 2009, the United States Preventive Services Task Force (USPSTF) ignored published data showing a similar death rate reduction to this landmark trial, and withdrew support for screening women 40-49. This real world study is far more robust, based on real world numbers, and proves that the benefit is nearly twice that of the USPSTF estimate of 15 percent.

"This study shows that annual mammograms for women 40 and over result in a tremendously significant reduction in the breast cancer death rate for women 40-49. The age of 50 is an artificial threshold that has no basis in scientific fact. The debate is now over. Women should no longer be confused about the importance of annual breast cancer screening. Mammography saves lives. If you are a woman age 40 or over, one of them could be yours," said Phil Evans, MD, President of the Society of Breast Imaging (SBI).

The Swedish trial followed more than 600,000 women for 16 years. The number of breast cancer deaths among the women in the study who did not receive mammograms was twice as high as those who underwent screening. Breast cancer is the most common cancer in women worldwide. It kills around 465,000 people globally each year. Mammography can catch cancer early, when it is most treatable. While not a perfect test, at present, there is no other screening tool to replace it.

"It is now time to stop confusing women with conflicting information. Mammography is a lifesaver for women in their 40s. What providers need to do now is uniformly confirm for women that they need to start getting annual mammograms beginning at age 40 and work to build on the ability of mammography to detect cancer early, when it is most treatable. Mammography saves a significant number of lives in all women 40 and over. Let's all move forward from there," said Gail Lebovic, MD, breast surgeon and President of the American Society of Breast Disease (ASBD).



12 comments | 2682 reads

by gdpawel on Sat, 2010-10-02 20:01
Dr. Peter C. Gotzsche of the Nordic Cochrane Center in Copenhagen, a nonprofit group that reviews health care research, has said in response to this study out of Sweden is that the investigators counted the number of women who received a diagnosis of breast cancer and also died of it. They did not compare the broader breast cancer death rates in the counties.

He said it is an important distinction because screening finds many cancers that do not need to be treated or found early. With more harmless cancers being found in the screened group, it will look like the chance of surviving breast cancer is greater in that group. “The analysis is flawed,” he said.

And Donald Berry, a statistician at MD Anderson Cancer Center, responded that the overdiagnosis problem was a serious one. "We are finding cancers that would never be found if we didn't look," he was quoted for the media. "Small wonder people think screening is great - some of the cancers it finds were not lethal in the first place."

It seems like the new Swedish study (not a randomized trial) would be far from convincing and probably wouldn't meet the USPSTF test for high-grade evidence. The authors made no adjustment for any risk factors.

The absolute risk revealed was quite small, about two-tenths of one percent. There were a total of 1,824 breast cancer deaths in the entire cohort, or roughly one of every 550 women. According to the authors of the study, 1,250 women in their 40's would have to be routinely given mammograms to prevent one breast cancer death.

As a result, a much larger proportion of those women would get false cancer signals, leading to unnecessary biopsies and other treatments. It was even suggested by the American Society of Clinical Oncology (ASCO) that women under 50 discuss with their doctors their own situation and the risks and benefits before going forward with routine mammograms.

by gdpawel on Mon, 2010-10-04 03:56
In a book written by Dr. H. Gilbert - Should I Be Tested for Cancer? - professor at the Dartmouth Medical School and co-director of the V.A. Outcomes Group in the Department of Veterans Affairs in White River Junction, Vt., admits that many doctors understand that early detection is a double-edged sword.

In fact, most learn about these problems in medical school. But once they are out of school all the forces are lined up to encourage them to test: whether it is making screening a measure of health-care quality (where the doctor who screens 100 percent is best), fear of legal liability from failure to diagnose (ever heard of a doctor sued for diagnosing cancer unnecessarily?) or financial pressure (it's quicker to order a test than to talk about why it might not be in your best interest).

For some common cancers, it is not clear that early detection and treatment actually prolong patients' lives. Early detection may just mean patients spend a longer time knowing they have cancer, and yet die at the same time they would have died anyway if the tumor had been diagnosed later. A decision to forgo cancer screening can be a reasonable option (Arch Intern Med. 2008;168(21):2300, 2302-2303, 2311-2316).

read full thread
 
Search

sponsored links




Donate


Newsletter



Subscribe to our newsletter to receive info on our site or upcoming clinical trials
Email

Confirm your email address

HTML format
State

Please select the newsletters you want to sign up to:

  • Cancerfocus
    Receive updates from Cancerfocus.
  • Breast
  • Colon
  • Kidney
  • Leukemia
  • Liver
  • Lung
  • Melanoma
  • Mesothelioma
  • Myeloma
  • Neck
  • Pancreatic
  • Prostate





All times are GMT -5. The time now is 04:06 AM.