#RSNA16
Age no reason to stop breast cancer screening: RSNA study
November 29, 2016
by Thomas Dworetzky, Contributing Reporter
There is no hard-and-fast age to stop breast cancer screening, a new largest-ever study has found.
The new findings bolster guidelines that call for screenings based on “individual patients and their health status,” without an arbitrary age limit.
"All prior randomized, controlled trials excluded women older than 75, limiting available data to small observational studies," study co-author Dr. Cindy S. Lee, assistant professor in residence at the University of California, San Francisco, announced at RSNA on Monday.
"There has been a lot of controversy, debate and conversation regarding the different breast cancer screening guidelines, even among major national organizations, over the past few years."
This study could alter the 2009 United States Preventive Services Task Force (USPSTF) guidelines that advised that there was insufficient evidence to weigh risk-benefit of screening mammographies in over-age-75 women.
The study reviewed nearly 5.6 million screening mammograms in the National Mammography Database for the 2008-2014 7-year period.
Analysis shows a mean cancer detection rate of 3.74 per 1,000 patients, recall rate of 10 percent, PPV2 of 20 percent and PPV3 of 29 percent. These metrics showed “a gradual upward trend for cancer detection rate, PPV2 and PPV3, but a downward trend in recall rate” by age.
"The continuing increase of cancer detection rate and positive predictive values in women between the ages of 75 and 90 does not provide evidence for age-based mammography cessation," Lee said, noting that, “we know that the risk of breast cancer increases with age."
Co-authors on the study are Debapriya Sengupta, M.B.B.S., M.P.H., Judy Burleson, Mythreyi Bhargaven-Chatfield, Ph.D., Edward A. Sickles, M.D., Elizabeth S. Burnside, M.D., M.P.H., and Margarita L. Zuley, M.D.
Breast cancer is the second-most frequent cancer for U.S. women after skin cancer. The American Cancer Society estimates that in 2016 alone there will be about 246,660 new cases of invasive breast cancer, 61,000 new cases of carcinoma in situ, and approximately 40,450 women will die from the disease.
Breast cancer screening has faced a number of controversies recently. Payment from insurance companies has figured into the debate as well.
In fact, in October, a study of a 2014 New Jersey law that requires insurance companies to pay for supplemental ultrasound and/or MR screening if a woman has dense breasts diagnosed, revealed that it has resulted in better patient care and outcomes.
"The number of supplemental screening ultrasound and MR examinations increased after [The New Jersey Breast Density Law (NJBDL)] implementation," Dr. Linda Sanders, medical director of the Breast Center at RWJBarnabas Health ACC in Livingston, N.J., and lead author of the study, told HCB News at the time.
Another side of the screening controversy was noted in an October study that questioned the value of widespread use of mammography for cancer screening – and which was in turn challenged by a number of cancer and radiology experts.
The study, reported in the New England Journal of Medicine, concluded that “women were more likely to have breast cancer that was over-diagnosed than to have earlier detection of a tumor that was destined to become large."
The study examined U.S. government cancer statistics in the SEER database, covering women's health from 1975 to 2012, to measure the effectiveness of screening since it became widely adopted in the 1980s.
The study's authors, led by Dartmouth Institute of Health Policy and Clinical Practice's Dr. H. Gilbert Welch, concluded that “the reduction in breast cancer mortality after the implementation of screening mammography was predominantly the result of improved systemic therapy.”
The Welch data “do not support the authors’ conclusion that improved therapy is more key to breast cancer survival than mammography screening. Nor does the data support that mammography use leads to rampant over-diagnosis,” according to a release issued by the American College of Radiology (ACR), adding that “the baseline assumption on which the conclusions are based is contradicted by the primary author’s previous papers and well-established research.”
"These conclusions are bold, attention-grabbing, and should be taken with a grain of salt — actually, an entire spoonful," the American Cancer Society's chief cancer control officer, Dr. Richard Wender stated.
The new findings bolster guidelines that call for screenings based on “individual patients and their health status,” without an arbitrary age limit.
"All prior randomized, controlled trials excluded women older than 75, limiting available data to small observational studies," study co-author Dr. Cindy S. Lee, assistant professor in residence at the University of California, San Francisco, announced at RSNA on Monday.
"There has been a lot of controversy, debate and conversation regarding the different breast cancer screening guidelines, even among major national organizations, over the past few years."
This study could alter the 2009 United States Preventive Services Task Force (USPSTF) guidelines that advised that there was insufficient evidence to weigh risk-benefit of screening mammographies in over-age-75 women.
The study reviewed nearly 5.6 million screening mammograms in the National Mammography Database for the 2008-2014 7-year period.
Analysis shows a mean cancer detection rate of 3.74 per 1,000 patients, recall rate of 10 percent, PPV2 of 20 percent and PPV3 of 29 percent. These metrics showed “a gradual upward trend for cancer detection rate, PPV2 and PPV3, but a downward trend in recall rate” by age.
"The continuing increase of cancer detection rate and positive predictive values in women between the ages of 75 and 90 does not provide evidence for age-based mammography cessation," Lee said, noting that, “we know that the risk of breast cancer increases with age."
Co-authors on the study are Debapriya Sengupta, M.B.B.S., M.P.H., Judy Burleson, Mythreyi Bhargaven-Chatfield, Ph.D., Edward A. Sickles, M.D., Elizabeth S. Burnside, M.D., M.P.H., and Margarita L. Zuley, M.D.
Breast cancer is the second-most frequent cancer for U.S. women after skin cancer. The American Cancer Society estimates that in 2016 alone there will be about 246,660 new cases of invasive breast cancer, 61,000 new cases of carcinoma in situ, and approximately 40,450 women will die from the disease.
Breast cancer screening has faced a number of controversies recently. Payment from insurance companies has figured into the debate as well.
In fact, in October, a study of a 2014 New Jersey law that requires insurance companies to pay for supplemental ultrasound and/or MR screening if a woman has dense breasts diagnosed, revealed that it has resulted in better patient care and outcomes.
"The number of supplemental screening ultrasound and MR examinations increased after [The New Jersey Breast Density Law (NJBDL)] implementation," Dr. Linda Sanders, medical director of the Breast Center at RWJBarnabas Health ACC in Livingston, N.J., and lead author of the study, told HCB News at the time.
Another side of the screening controversy was noted in an October study that questioned the value of widespread use of mammography for cancer screening – and which was in turn challenged by a number of cancer and radiology experts.
The study, reported in the New England Journal of Medicine, concluded that “women were more likely to have breast cancer that was over-diagnosed than to have earlier detection of a tumor that was destined to become large."
The study examined U.S. government cancer statistics in the SEER database, covering women's health from 1975 to 2012, to measure the effectiveness of screening since it became widely adopted in the 1980s.
The study's authors, led by Dartmouth Institute of Health Policy and Clinical Practice's Dr. H. Gilbert Welch, concluded that “the reduction in breast cancer mortality after the implementation of screening mammography was predominantly the result of improved systemic therapy.”
The Welch data “do not support the authors’ conclusion that improved therapy is more key to breast cancer survival than mammography screening. Nor does the data support that mammography use leads to rampant over-diagnosis,” according to a release issued by the American College of Radiology (ACR), adding that “the baseline assumption on which the conclusions are based is contradicted by the primary author’s previous papers and well-established research.”
"These conclusions are bold, attention-grabbing, and should be taken with a grain of salt — actually, an entire spoonful," the American Cancer Society's chief cancer control officer, Dr. Richard Wender stated.