JAMA Review on Mammography Points to the Need for Better Ways to Advise Women and Detect Breast Cancer

This new JAMA article reviews the literature. At a glance, it may add to the growing perception among journalists, primary care physicians and others – including ordinary women – that mammography’s effectiveness has been, again, disproved.

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More on Mammography, Breast Cancer, Misleading Arguments, Emotion and Women’s Health

While therapy has improved quite a bit since 1985, the greatest benefit derives from most women avoiding the need for life-long treatment by having small tumors found and removed before they’ve spread.

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Don’t Blur the Message on Cancer Screening

I hope this week’s headlines and editorials don’t add to the blurriness of the public’s perception of cancer screening – that people might begin to think it’s a bad thing all around. The details matter….screening if it’s done right can save lives and dollars. That’s because for most tumor types, treating advanced, metastatic disease is costlier than treatment of early-stage, curable tumors.

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A Closer Look at the Details on Mammography, in Between the Lines

A seemingly slight adjustment in a statistic, for teaching purposes, can significantly change a test’s calculated value….

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NEJM Publishes New Review on Breast Cancer Screening

With little fanfare, the NEJM published a feature on breast cancer screening in its Sept 15 issue. The article, like other “vignettes” in the Journal, opens with a clinical scenario. This time, it’s a 42 year old woman who is considering first-time mammography. The author, Dr. Ellen Warner, an oncologist at the University of Toronto, takes […]

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Mammography Update!

This week I’ve come across a few articles and varied blog posts on screening mammography. The impetus for rehashing the topic is a new set of guidelines issued by the American College of Obstetricians and Gynecologists. That group of women’s health providers now advises that most women get annual mammograms starting at age 40. Why […]

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Breast Cancer Rate in the U.S. is No Longer Declining

A worrisome report on breast cancer trends in the U.S. appeared on-line today, ahead of print in an AACR journal, Cancer Epidemiology, Biomarkers & Prevention. The analysis, based on the NCI’s SEER data from 2000 – 2007, shows that the incidence of breast cancer in the U.S. is no longer declining. (A drop after 2002 […]

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Radiologists’ Experience Matters in Mammography Outcomes

There’s a new study out on mammography with important implications for breast cancer screening. The main result is that when radiologists review more mammograms per year, the rate of false positives declines. The stated purpose of the research,* published in the journal Radiology, was to see how radiologists’ interpretive volume – essentially the number of […]

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New Numbers Should Factor Into the Mammography Equation

On Friday the New York Times reported that surgeons are performing far too many open breast biopsies to evaluate abnormal mammogram results. A new American Journal of Surgery article analyzed data for 172,342 outpatient breast biopsies in the state of Florida. The main finding is that between 2003 and 2008, surgeons performed open biopsies in an operating room – as opposed to less invasive, safer biopsies with needles – in 30 percent of women with abnormal breast images.

I was truly surprised by this should-be outdated statistic, which further tips the mammography math equation in favor or screening.

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It’s Not About the Money

If physicians’ potential profit motives cloud the mammography debate, as the authors contend, that doesn’t mean that mammography is ineffective. Rather it signifies that doctors and scientists should analyze data and make clinical decisions in the absence of financial or other conflicts of interest.

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Getting the Math on Mammograms

But consider – if the expert panel’s numbers are off just a bit, by as little as one or two more lives saved per 1904 women screened, the insurers could make a profit!

By my calculation, if one additional woman at a cost of, say, $1 million, is saved among the screening group, the provider might break even. And if three women in the group are saved by the procedure, the decision gets easier…

Now, imagine the technology has advanced, ever so slightly, that another four or five women are saved among the screening lot.

How could anyone, even with a profit motive, elect not to screen those 2000 women?

Posted in Breast Cancer, cancer screening, cancer treatment, Diagnosis, health care costs, Medical Ethics, Medical News, Policy, Women's HealthTagged , , , , , , 1 Comment on Getting the Math on Mammograms
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