Download The Facts on Annual Screening Mammography

The Facts on Annual Screening Mammography
Charlotte Radiology’s Screening Mammography Recommendations:
In alliance with the American College of Radiology, Society for Breast Imaging and breast health experts, Charlotte Radiology
strongly recommends women begin ANNUAL screening mammograms at age 40; women with a family history of breast cancer
should consult their physician about when to start mammography and if additional imaging is needed.
Why all the fuss over mammograms, and who is the U.S. Preventive Services Task Force (USPSTF)?
The USPSTF is an independent panel of physicians who review guidelines for clinical screenings. The Task Force updates their
recommendations every five years, with their most recent draft update made this year and their previous update in 2009, when
they recommended biennial screening mammography for only women ages 50-74. The Task Force’s 2009 changes and 2015
review have created a lot of media, which has resulted in additional media and attention being given to several unfounded
mammography studies that are not backed by solid research or new technologies.
What exactly are the flaws in recent studies and the USPSTF data:
Most of the recent mammography studies from Canada and other countries as well as the USPSTF’s data are seriously flawed.
Poor Data Sources – computer models vs. REAL research:
• The Institute of Medicine (IOM) recommendations for screening guideline development are considered the “gold standard”
among the medical community; many recent studies’ methods do not meet those standards and are NOT considered
“trustworthy guidelines” by respected doctors.
• No direct research was used in many of the recent studies or by the USPSTF. Statistics and computer models that estimate
screening mammography benefits by ages are NOT accepted scientific approaches. Trusted research should include
randomized, double-blinded study methods that measure real outcomes. Gold standard research reflects a 30% decrease in
mortality from breast cancer since 1990 due to screening women 40+ annually and improved treatments; the National
Cancer Institute puts the drop in mortality at 35% since the mid-1980s.
Expert Opinions were NOT included
• No breast imaging or breast cancer experts were included on the USPSTF panel or meetings.
New and improved technology was NOT considered.
• Many recent studies and the USPSTF do NOT take into account improved mammography techniques and technology, thereby
misrepresenting their statements regarding over-diagnosis and harms of mammography. Outdated data has biased
the results and often does not take into account the benefits of life-years saved and improved, and sometimes less invasive,
treatment options offered when cancers are detected earlier.
There is no way to dictate which non-invasive cancers (DCIS) will be fatal.
• Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer found in the milk ducts of the breast
tissue, however it only accounts for less than 1/3 of the cancers detected at Charlotte Radiology. Additionally, it is impossible
to know which of these DCIS cancers will develop into the more dangerous invasive cancers.
Age matters more than family history!
• Cancers in women under 50 are often more aggressive, making screening women under 50 even more important.
• 75% of women diagnosed have no family history; we risk NOT detecting the majority of breast cancers in women under 50.
What are the possible impacts of these flawed recommendations?
Unnecessary Deaths:
Analysis of the Task Force’s methodology (and some recent studies) shows that if their recommendations are followed,
approximately 6,500 additional US women each year would die from breast cancer.
Loss of Coverage for Mammograms for Some Women:
The USPSTF revised grading and recommendations put insurance coverage for annual mammograms, as well as all
mammograms for women age 40-49, at risk, as the Affordable Care Act only requires private insurers to cover exams given a
grade “B” or higher by the USPSTF (a “B” was only given to mammograms for women ages 50-74 every other year).
Local Facts from the Breast Imaging Experts
Charlotte Radiology is one of the nation’s largest radiology practices, serving the greater Charlotte
area for nearly 50 years. Locally, our data supports our recommendation for annual screening
mammography for women ages 40+.
Why start at age 40?
From July 1996-December 2013, we have conducted more than 1.1 million screening mammograms. Of the breast cancers
detected using screening mammography, more than 20% were found in women ages 40-49. Additionally, 40% of life-years-lost to
Cancers Found At Screening
breast cancer are in women diagnosed in their 40s.
1400
Charlotte Radiology Data - July 1996 - December 2013
Age Group
Screens
Cancers
1271
1200
Cancer Rate
Per Thousand
Women
Percent of
Cancers
1000
800
<40
54, 833
97
1.8
2.16%
40-49
354,204
906
2.6
20.21%
50-59
325,948
1271
3.9
28.35%
60-69
214,328
1299
6.1
28.98%
70-79
107,764
765
7.1
17.06%
> 79
16,430
145
8.8
3.23%
1299
906
765
600
400
200
0
40-49
50-59
60-69
Age Of Patient
70-79
Why go every year?
The bottom line is that early detection is the key to beating breast cancer. Additionally, annual screening results in lower recall
rates than does biennial screening and finds cancer at its earliest stage - providing a more favorable prognosis.
How prevalent is DCIS cancer vs. Invasive cancer?
Ductal carcinoma in situ (DCIS) is the most common type of non-invasive
breast cancer, however DCIS or non-invasive cancers make up less than 1/3
of the cancers detected at Charlotte Radiology. In a review of our data from
2011-2014, invasive cancers accounted for 71.7% of the total cancers detected,
and approximately 45% of those invasive cancers were found in screening
mammography patients.
Percent of Invasive Cancers by Age
Found on Screening Mammography
80%
75%
70%
65%
60%
What about recommendations for
Tomosynthesis or 3D Mammography?
<39
40-49
50-59
60-69
70-79
>80
Digital Breast Tomosynthesis (also known as 3D Mammography) creates multiple images that allow the radiologists to look at
different layers of the breast tissue, helping to distinguish normal breast tissue from abnormal breast tissue. Tomosynthesis is of
greatest benefit to women with dense breast tissue.
The USPSTF also reviewed tomosynthesis and concluded there is “not enough evidence to determine whether it will result in
improved health or quality of life or fewer deaths among women.” Data on mortality takes 20-30 years to gather; so it is too soon
to formally assess mortality rates for 3D mammography.
However, “accuracy data” is available. In fact, Charlotte Radiology’s data of 3D mammography reflects a 35% decrease in our
recall rate in women with dense breast tissue, which helps decrease the anxiety of false positives often cited as a harm by
the USPSTF. Additionally, we are finding a higher cancer detection rate increasing our catches of invasive breast cancers.
> For more information, please contact Katie Robbins at 980-297-1460.