WASHINGTON, Sept. 29, 2015 /PRNewswire/ — The American College of Radiology (ACR), Society of Breast Imaging (SBI) and major medical organizations experienced in breast cancer care continue to recommend that women start getting annual mammograms at age 40. This approach saves many more lives than screening started at a later age or with less frequent exams. To mark National Breast Cancer Awareness Month, women are encouraged to ask their health care providers about scheduling an annual mammogram.
“All women age 40 and over can benefit from annual mammography. Risk-based screening is a poor approach. Seventy-five percent of women diagnosed with breast cancer have no family history or other factors that place them at high risk for the disease. I encourage women to speak with their providers about mammography benefits and limitations and create a schedule to get their annual mammograms,” said Debra Monticciolo, MD, FACR, chair of the American College of Radiology Breast Imaging Commission.
Breast cancer remains the second leading cause of deaths among women in the United States. In 2015, according to the National Cancer Institute, 231,840 women will be diagnosed with the disease and 40,290 will die from it. Deaths are highest among women who are not screened regularly and have their cancers found at later stage.
“Mammography screening is not perfect but has been shown to markedly reduce the number of women each year who die from breast cancer,” said Elizabeth Morris, MD, FACR, president of the Society of Breast Imaging. “The decision whether or not to get a mammogram remains with women. We want them to know that mammography can detect cancer early — when it’s most treatable and can be treated less invasively — which not only saves lives but helps preserve quality of life.”
The ACR and SBI believe women 40 and older should have access to mammograms and that Medicare and private insurers should be required to cover them for these exams.
Contact Shawn Farley at 703-648-8936 or PR@acr.org to arrange an interview with an ACR spokesperson.
Contact Joy Burwell at 202-263-2971 or firstname.lastname@example.org to arrange an interview with an SBI spokesperson.
About the American College of Radiology
The American College of Radiology (ACR), founded in 1924, is a professional medical society dedicated to serving patients and society by empowering radiology professionals to advance the practice, science, and professions of radiological care.
About the Society of Breast Imaging
The Society of Breast Imaging (SBI), established in 1985, is a professional medical organization dedicated to improving the practice of breast imaging and the quality of medical education in breast imaging. The SBI also provides a medium for the exchange of ideas among those involved in breast imaging. The SBI includes leading international breast imaging specialists nationwide among its membership.
SOURCE Society of Breast Imaging
In what is a short and fairly straightforward news release, we’re told by the American College of Radiology and American Society of Breast Imaging that all women age 40 and over should get an annual mammogram. Furthermore, readers are told that if they have any questions about the practice, they should consult their doctor.
But that’s about the extent of it. We’re never told how many lives could be saved by more regular screening, nor how those benefits stack up against growing concerns related to overdiagnosis and overtreatment. Nor is any evidence presented to back up the questionable assertion that “all women can benefit” from regular mammography.
Every year in the United States, breast cancer is diagnosed in about 224,000 women and kills about 41,000 women, per the CDC’s latest data. To detect and treat the disease as early as possible, clinicians perform more than 39 million mammograms a year, according to the FDA’s numbers. But mammography’s seemingly immutable benefit as an effective, life-saving tool has come under fire in recent years through the publication of large, longitudinal studies.
In 2014, for example, a British Medical Journal study of 89,000 Canadian women who were followed for 25 years found no benefit in the practice when it came to saving lives. It also found that 1 in 424 of those women received unnecessary cancer treatment. However, an American Cancer Society official told the New York Times in 2014 that the data showed a benefit for screenings in women in their 40s (i.e. a 15% reduction in breast cancer deaths).
Another study published by JAMA Oncology in 2015, which we examined in a recent blog post, focused on the most common diagnosis after mammography: ductal carcinoma in situ, or DCIS. (DCIS is a tissue anomaly contained within the ductwork of the breast, and is typically only visible in a high-resolution mammogram image.) The study looked at the medical records of 108,000 women diagnosed with DCIS and found that about 80% likely received unnecessary treatment; only black women and women diagnosed under the age of 35, an accompanying editorial concluded, should have received treatment.
For reasons that are still unclear, research continues to suggest that early screening is not as widely effective as was once believed — hence the push to clarify the benefits of mammography, as in this American College of Radiology news release that we review below.
The average cost of an annual mammogram is relatively easy to find, but this news release didn’t address it. The average out-of-pocket expense, per mammogram visit, is about $33. This is about 1/7th the cost of the full tab (approximately $266), according to a 2011 study in Journal of Women’s Health.
There aren’t any numbers on this, and it’s a crucial part of the sales pitch. The release says that screening regularly starting at age 40 “saves many more lives” than screening later or done less frequently. But how many more lives are we talking about? A quick look at at hyperlink in the release — which takes you to the ACR-produced advocacy website mammographysaveslives.org — and clicking “Are you confused?” takes you to a page that suggests mammography has reduced the U.S. breast cancer death rate by 30 percent. But that’s a relative risk reduction, and since the rate of breast cancer for women in their 40s is low, this figure may tend to inflate the size of the benefit for these women. We would have preferred to see a number describing the absolute reduction in breast cancer deaths. For example, according to a recent US Preventive Services Task Force evidence review, screening mammography prevents 4 deaths for every 10,000 women who are screened for at least 10 years compared with no screening.
Overdiagnosis and overtreatment aren’t discussed, but these are real and significant issues with mammography.
Without any quantification of how mammography can help a woman, and by sidestepping any mention of the two studies mentioned in the “Why This Matters” section (above), it’s difficult to argue this aspect of the release is Satisfactory. In fact, there is really no discussion of any of the evidence that supports screening mammography in this news release — it’s mainly composed of assertions that may or may not be supported by evidence. It’s impossible to tell since the evidence is never presented or discussed.
There are no gratuitous descriptions or inflammatory language in the release, and it encourages readers to discuss the issue with their doctors.
The Society of Breast Imaging and the American College of Radiology are clearly indicated.
A few options are mentioned, i.e. mammography screening only for high-risk groups, later-age screening, and less-than-annual mammograms. Other approaches that could have been discussed include regular physical exams of the breast by a clinician (without mammography) as well as breast self-exams.
Availability isn’t mentioned. But because getting a mammogram is relatively routine, we’ll mark this one “not applicable.”
Mammography has been around for decades, so what’s the news hook for the release? Apparently it’s the start of National Breast Cancer Awareness Month. Although that’s a pretty weak basis for putting out a news release, we’ll rule this Satisfactory as the release doesn’t pretend that there’s any actual news here..
A statement from Dr. Debra Monticciolov raised our eyebrows, especially given the surge in recent, high-quality evidence questioning the value of mammograms for some women: “All women age 40 and over can benefit from annual mammography.” In fact, it seems not every woman does benefit — for every woman whose life is saved, many more are overdiagnosed and overtreated. We think women should be encouraged to make an informed personal decision about screening mammography based on a clear understanding of the benefits and risks. This could include, in partnership with her doctor, a look at all known risk factors, including gender, age, race, family history, reproductive history, pregnancies, radiation exposure, previous abnormal breast biopsies, DES, HRT, alcohol use, obesity, physical activity, known genetic abnormalities, prior cancer classification, and other factors. Mammograms do not eliminate these risks.