by
Sean Ruck, Contributing Editor | May 27, 2011
From the May 2011 issue of HealthCare Business News magazine
“Early detection provides a number of benefits,” Attai explains. “An early stage 1 breast cancer versus a stage 3 means the difference between getting chemo and not getting chemo. It means the difference between a lumpectomy and a mastectomy.”
The balancing act
But there are a number of gray areas in the screening debate.
For one, there are the false-positives Attai previously noted. The USPSTF expressed concern about false-positives and the anxiety they might produce for women getting an unneeded screening call backs. LaFevre backs that concern. “If a woman screens regularly, there’s about a 50 percent false-positive rate for women in their 40s. I actually tell women that when they’re screening as a reassurance.”
Dr. Sara Fredrickson, chair of the breast imaging technologies certification and accreditation committee for the ASBS, says the extra screenings mean more things will be identified in a mammogram requiring further evaluation. “That generates extra tests,” she says. And she says some of those potential red flags ultimately turn out to be benign, with doctors treating findings that might never become health risks.
Still, Fredrickson says her recommendations to her patients mirror the American Society of Breast Surgeons, the American Cancer Society and the American College of Radiology recommendations. In her experience, most women are against following the USPSTF guidelines. “I don’t think there’s been as much impact from those revisions as people thought,” she says.
Dr. Robert Eng, chief of radiology at San Francisco’s Chinese Hospital, echoes that sentiment. Eng hasn’t seen any impact in terms of volume due to the 2009 guidelines. “We’re unique in that our patient population is 95 percent ethnic Chinese and the age skews higher,” he says. “Our average age is about 72 for outpatient and inpatient is in the low 80s.”
Although the revised guidelines bumped the maximum recommended age up by half a decade over the 1996 recommendations, if women based their decisions about screening by them, the majority of Eng’s patients would no longer have the procedure. The 2002 revisions didn’t set a maximum age.
Clarification and emphasis
For Dr. Carol H. Lee, chair of the ACR breast imaging commission, believes there shouldn’t be a debate. “Breast cancer mortality has dropped substantially since the introduction of regular screening,” she says. “We have a public health measure that proven in practice to work, why roll it back at all?”
Lee says ACR stands by the earlier [2002] screening guidelines saying no additional compelling evidence has come to light — including what the USPSTF based its recommendations on — for ACR to alter its decision.
