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Release devotes more space to researcher’s bio than to study data on mammograms

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IMAGE: Charles H. Hennekens, M.D., is senior author and first Sir Richard Doll Professor and senior academic advisor to the dean in the Charles E. Schmidt College of Medicine at Florida… view more

Credit: Florida Atlantic University

Breast cancer is the second most common cancer in women after skin cancer and occurred in 230,000 women in the United States in 2015. Breast cancer afflicts 1 in 8 women in their lifetime and 1 in 25 die from this disease. Although a number of randomized trials demonstrate the clear benefits of mammography screening in women up to age 74 on reducing mortality, data are sparse in women over the age of 74, especially minorities. In 2010, 41 percent of breast cancer deaths occurred in the more than 19 million women who are between the ages of 65 to 84 years.

In a new study published in the American Journal of Medicine, Charles H. Hennekens, M.D., senior author and first Sir Richard Doll Professor and senior academic advisor to the dean in the Charles E. Schmidt College of Medicine at Florida Atlantic University, indicates that black and white women ages 75 to 84 years who had an annual mammogram had lower 10-year breast cancer mortality than corresponding women who had biennial or no/irregular mammograms.

Among elder women, the American Cancer Society and the United States Preventive Services Task Force recommend regular mammography for ages 65 to 74.

Although many guidelines rely on self-reports, Hennekens and his collaborators from Baylor College of Medicine and Meharry Medical College, used the Surveillance, Epidemiology, and End Results (SEER) program file linked to the Medicare administrative claims file, which allowed them to identify screening mammography use from 1995 to 2009 from 64,384 non-Hispanic women (4,886 black and 59,498 white). These linked files also permitted them to explore breast cancer mortality differences between elderly black or white women who self-selected for regular annual or biennial mammography screening. The researchers selected 69 as the lower age limit because Medicare coverage of the general population begins at age 65, and the exposure of interest was regular mammography screening in the four years immediately preceding breast cancer diagnosis.

Three mutually exclusive categories were defined: no or irregular mammography; biennial mammography; and annual mammography. They looked at data from non-Hispanic, white or black women; Hispanics were not included because Hispanic white women have substantially lower mortality than non-Hispanic whites, and the number of Hispanic blacks is small. The researchers also measured socioeconomic status looking at median household income, the percentage of individuals living below the poverty level, and whether or not they had a high school education.

Other significant findings from the study show that:

  • White women who had died tended to be older, to have a later stage diagnosis, to have received chemotherapy, and to have a higher socioeconomic status.
  • White women who died were less likely to have undergone surgery and receive radiation therapy.
  • Similar characteristics were seen in black women as in white women.
  • 69- to 84-year-old women receiving regular annual screening mammography during the four years immediately preceding breast cancer diagnosis had consistently lower five-year and 10-year risks of breast cancer mortality than women with no or irregular screening regardless of race.
  • 10-year risks were more than three times higher among white and more than two times higher among blacks aged 69 to 84 years with no or irregular screening compared with annual screening.

Hennekens notes that further research is needed, but that in the future, the use of regular claims-based surveillance for mammography as a source of data may offer some unique advantages over self-reports.

From 1995 to 2005, according to Science Watch, Hennekens was the third most widely cited medical researcher in the world and five of the top 20 were his former fellows and/or trainees. In 2012, Science Heroes ranked Hennekens No. 81 in the history of the world for having saved more than 1.1 million lives, which placed him two ahead of professor Jonas Salk ranked No. 83 for the development of the polio vaccine. In 2013, he received the “Fries Prize for Improving Health” and in 2014, he received the Alton Ochsner Award for his pioneering work on smoking and health. In 2015, he was ranked the No. 14 “Top Scientist in the World” based on his H-index of 173.

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About Florida Atlantic University:

Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, the University, with an annual economic impact of $6.3 billion, serves more than 30,000 undergraduate and graduate students at sites throughout its six-county service region in southeast Florida. FAU’s world-class teaching and research faculty serves students through 10 colleges: the Dorothy F. Schmidt College of Arts and Letters, the College of Business, the College for Design and Social Inquiry, the College of Education, the College of Engineering and Computer Science, the Graduate College, the Harriet L. Wilkes Honors College, the Charles E. Schmidt College of Medicine, the Christine E. Lynn College of Nursing and the Charles E. Schmidt College of Science. FAU is ranked as a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. The University is placing special focus on the rapid development of critical areas that form the basis of its strategic plan: Healthy aging, biotech, coastal and marine issues, neuroscience, regenerative medicine, informatics, lifespan and the environment. These areas provide opportunities for faculty and students to build upon FAU’s existing strengths in research and scholarship. For more information, visit http://www.fau.edu.

New FAU study suggests benefits of regular mammography extend to the elderly

Our Review Summary

Charles H. Hennekens looms large in this news release -- perhaps larger than the study itself.

Researcher Charles H. Hennekens, MD looms large in this news release — perhaps larger than the study itself.

This news release issued on behalf of a prestigious researcher — one said to have “saved more than 1.1 million lives” according to Science Heroes — claims the evidence is in that regular mammograms after age 74 save lives. But does the evidence presented really show that?

We expected to see many different studies and opinions released when the USPTF announced its final recommendations on screening with mammograms, and we were not disappointed.

This release raises some important points but it also seems to be touting the professional reputation of the study’s senior author (ranked ahead of Jonas Salk in terms of lifesaving prowess!) when it should have devoted more space to cost and limitations, and making a stronger case for the benefits and evidence.

 

Why This Matters

After skin cancer, breast cancer is the most common cancer in women across all races and ethnicities. Some health experts are challenging the stubborn view that more frequent and technically advanced screening is necessary to confront breast cancer, and have become very vocal in educating the public about the harms of over-diagnosis and erroneous diagnosis (false positives).

This release matters now because the study it informs us about indirectly challenges the findings (some might say non-findings) of the newly released US Preventative Services Task Force final recommendations for mammography screening in women. (In a Q&A on the new recs, the USPsTF says about mammograms for senior women: “For women age 75 and older, the evidence of the overall benefit of mammography screening is unclear, and the Task Force is unable to make a recommendation for or against screening.”) This study by Florida Atlantic University looked at Medicare claims data and came out with a recommendation that elderly women should continue to get regular mammograms. We can assume this release, based on a study published in July 2015, came out this week to coincide with and contribute to the discussion about the USPSTF final recommendations.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

Does not mention any costs — either direct or societal. And because patients over 74 are typically covered by Medicare, the financial costs to society would be substantial.  In addition to covering the cost of screening mammography, Medicare also covers the use of computer-aided diagnosis (CAD) which multiple studies have found to increase the number of false positives.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The release says the study revealed that “black and white women ages 75 to 84 years who had an annual mammogram had lower 10-year breast cancer mortality than corresponding women who had biennial or no/irregular mammograms.”

The implication is, of course, that having a mammogram during those years and receiving treatment for it (surgery, chemotherapy, radiation) lowers the risk of dying from breast cancer.

However, the release doesn’t tell us how many women went on to receive a cancer diagnosis, how many received any treatment and if so, what kind. The study is observational and doesn’t prove that annual mammograms in elderly women extends life.

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

The release doesn’t mention any harms that might come from more frequent or aggressive screening of older women. As experts at the University of California-San Francisco and Harvard explained following their 2014 review of studies conducted from 1990 to 2014 on risk factors for women 65 and older and the value of mammography for women 75 and older, “Doctors should focus on life expectancy when deciding whether to order mammograms for their oldest female patients, since the harms of screening likely outweigh the benefits unless women are expected to live at least another decade.”

Does the news release seem to grasp the quality of the evidence?

Not Satisfactory

While the release recommends elderly women should continue to receive regular mammograms, it doesn’t point out that this evidence is based on observation, which cannot prove cause and effect. The study itself published in the American Journal of Medicine states that “although the present data are promising, the results are not conclusive.”

Does the news release commit disease-mongering?

Not Satisfactory

The liberal use of statistics such as “1 in 8 women” will be affected and “1 in 25” without qualification earns this release a Not Satisfactory. The release opens with a long list of stats but doesn’t explain for an already worried public that some breast cancers are not deadly. There’s a long-running debate among medical experts that one of the most frequently diagnosed breast cancers — carcinoma in situ (CIS) — shouldn’t necessarily be termed “cancer” because it’s more of precancerous abnormality rather than a definite cancer precursor.

In addition, the first paragraph of the release ends by pointing out that 41% of breast cancer deaths in 2010 occurred in women between ages 65 to 84 but fails to add the important information that many, if not most of those women who died were diagnosed years, if not decades, before ages 65-84.  The release leaves the reader with the impression that 41% of breast cancer deaths in 2010 occurred in women diagnosed between ages 65-84.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

There is no mention of funders or potential conflicts of interest in the release.

Does the news release compare the new approach with existing alternatives?

Not Satisfactory

The main alternatives to extending mammograms to this age group are: 1) no mammogram after age 74 or 2) patients/physicians deciding together to have mammograms based on the patient’s history and risk factors. The release should have urged women older than 74 to talk with their healthcare provider about continuing or ending screening. Instead, the first paragraph seems likely to frighten older readers into thinking they definitely need to continue mammograms.

Does the news release establish the availability of the treatment/test/product/procedure?

Satisfactory

It’s common knowledge that mammograms are widely available. However, most current guidelines cap recommended annual or biannual mammograms at age 74. These recommendations have a direct effect on Medicare and private insurance coverage.

Does the news release establish the true novelty of the approach?

Satisfactory

Unlike other studies that are based on surveillance data and “self reports,” as noted in the release, this study looked at Medicare administrative claims filed from 1995 to 2009 to gather data on incidence and mortality rates.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Satisfactory

Aside from the fear-inducing litany of statistics found in the first paragraph (addressed under the Disease Mongering criteria), the rest of the release is free of unjustifiable language.

Total Score: 3 of 10 Satisfactory

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