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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New York City Reports Long Delays for Mammograms

A recent audit of nine NYC’s Health and Hospitals Corporation found City Comptroller Liu described as dangerous delays in women’s health care. It takes too long for women to get screening and diagnostic mammograms. The 2009 audit found women at Elmhurst Hospital had the longest waits – 50 working days (that would be 10 weeks, […]

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New Study, Presented at a Meeting of Breast Surgeons, Supports that Mammograms Save Lives of Women in Their 40s

The American Society of Breast Surgeons held its 2011 annual meeting in D.C. from April 27 – May 1. Among the papers presented was Abstract #1754: “Mammography in 40 Year Old Women: The Potential Impact of the U.S. Preventative Services Task Force (USPSTF) Mammography Guidelines.” You can find the press release, followed by the abstract, […]

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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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Why I Went for My Screening Mammogram

I was afraid to get a mammogram because I didn’t want to learn I had cancer….I feared having a “false positive,” and undergoing multiple tests to evaluate abnormal images that would turn out to be nothing…I didn’t have time for all that…

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Swedish Mammography Report Finds Benefit In Screening Younger Women

The Swedish study with its positive findings should be scrutinized, yes, but no more or less than the other papers on the same subject that have been highlighted, selectively, in the media. How journalists cover mammography studies, and that they do so with an open mind, matters a lot.

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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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What’s Missing in the Recent Mammography Value Study

I’d say the oppo­site is true: It’s pre­cisely because there are effec­tive treat­ments for early-stage dis­ease that it’s worth find­ing breast can­cer early. Oth­er­wise, what would be the point?

Metasta­tic breast can­cer is quite costly to treat and, even with some avail­able tar­geted ther­a­pies, remains

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Stepping Back, and Thinking Forward to October

A question central to today’s discussion – which does at least acknowledge the decline in breast cancer mortality – is the extent to which mammography is responsible for this trend, as opposed to other factors such as increased awareness about cancer, better cancer treatments and other variables.

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Another Erroneous Report on Breast Cancer Screening by Mammography

What the authors tried to do was analyze trends in breast cancer mortality in relation to mammography’s availability in distinct regions of Denmark over several decades. Using Poisson regression, a form of statistical analysis, they looked for a correlation and found none. They concluded that they couldn’t detect a benefit of screening mammograms among Danish women who might benefit (see below).

Here’s what I think are the two most serious flaws in this observational study:

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Looking Ahead on Breast Cancer Screening

The risks and costs of breast cancer screening are exaggerated and misrepresented in the recent news…. My conclusion is that rather than ditching a life-saving procedure that’s imperfect, we should make sure that all doctors and radiology facilities are up to snuff.

We need to distinguish between errors in the measurement (cancer or not) and errors in decisions that we – patients and doctors – make after upon detecting a premalignant or early-stage malignancy in a woman’s breast.

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A Bit More on False Positives, Dec 2009, Part 1

Why bother, you might ask – wouldn’t it be easier to drop the subject?

“Make it go away,” sang Sheryl Crow on her radiation sessions.

I’ll answer as might a physician and board-certified oncologist who happens to be a BC survivor in her 40s: we need establish how often false positives lead, in current practice, to additional procedures and inappropriate treatment…These numbers matter. They’re essential to the claim that the risks of breast cancer screening outweigh the benefits.

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Legitimate Concerns and Unfortunate Timing on Radiation from C.T. Scanning

The risks of radiation from CT scanning will almost certainly add to the current confusion and concerns about the risks of breast cancer screening.

Mammography differs from CT scanning in several important ways:

1. Mammograms involve much less radiation exposure than CT scans.
2. Mammography is well-regulated by the Food and Drug Administration (FDA) and other agencies. The Mammography Quality Standards Act (MQSA) requires…
3. Women who undergo screening mammograms can control when and where they get this procedure. Screening mammograms are elective by nature..

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On Juno and Screening Test Stats

“Well, well” says the convenience store clerk. “Back for another test?”

“I think the first one was defective. The plus sign looks more like a division symbol, so I remain unconvinced,” states Juno the pregnant teenager.

“Third test today, mama-bear,” notes the clerk.

…”There it is. The little pink plus sign is so unholy,” Juno responds.

She’s pregnant, clearly, and she knows she is.

(see clip from Juno the movie*)

Think of how a statistician might consider Juno’s predicament…

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Another Take on Mammography

Three key issues have escaped the headlines: 1. The expert panel carried out a careful analysis using data that are, necessarily, old; 2. The recommendations don’t apply to digital mammography; 3. Mammograms are not all the same.

We need to set the bar higher for mammography…

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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?

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To Screen is Human

Smack in the midst of October-is-breast-cancer-awareness-month, the Journal of the American Medical Association published a provocative article with a low-key title: “Rethinking Screening for Breast Cancer and Prostate Cancer.” The authors examined trends in screening, diagnosis and deaths from cancer over two decades, applied theoretical models to the data and found a seemingly disappointing result.

It turns out that standard cancer screening is imperfect.

The subject matters, especially to me. I’m a medical oncologist and a breast cancer survivor, spared seven years ago from a small, infiltrating ductal carcinoma by one radiologist, an expert physician who noted an abnormality on my first screening mammogram…

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