Mammography

More Benefit Than Harm From Mammography: IARC Update

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Women between 50 and 69 years of age who participate in screening mammography have about a 40% reduction in the risk for death from breast cancer, an update from the International Agency for Research on Cancer (IARC) Working Group concludes.

The updated report was published online June 3 in the New England Journal of Medicine.

If all women in the same age group who are invited to participate in screening mammography are considered, the average reduction in the risk for mortality from breast cancer is 23%.

There is also a “substantial” reduction in the risk for death from breast cancer in women between 70 and 74 years of age who either attend or who are invited to attend a screening mammography program.

In contrast, evidence supporting the benefit of screening mammography in women younger than 50 years was limited, so the IARC Working Group did not find overt benefit from screening mammography in younger women.
These new conclusions extend those issued in 2002, when the IARC Working Group last considered the evidence. At that time, the IACR concluded that “the efficacy of screening by mammography as the sole means of screening in reducing mortality from breast cancer was sufficient for women 50 to 69 years of age, limited for women 40 to 49 years of age and inadequate for women younger than 40 or older than 69 years of age.”

“Recent improvements in treatment outcomes for late-stage breast cancer and concerns regarding overdiagnosis called for reconsideration,” the current Working Group writes.

Recent years have seen a huge public debate about the value of screening mammography, as reported by Medscape Medical News on numerous occasions, with an increasing focus on potential harms.

The IARC Analysis

The IARC brought together a working group of 29 international experts from 16 countries to assess the benefits and harms associated with breast cancer screening with mammography.
Results from 40 case-control and cohort studies from high-income countries were analyzed for the benefits vs the harms of screening mammography in different age groups.

“The most important harms associated with early detection of breast cancer through mammographic screening are false positive results, overdiagnosis and possibly radiation-induced cancer,” the authors observe.

Estimates of the cumulative risk for false positive results differ between organized programs, but the group estimates that it is approximately 20% for a woman who has undergone 10 mammographic screenings between age 50 and 70 years.

On the other hand, fewer than 5% of all false positive test results lead to an invasive procedure, the group points out.

Estimates of overdiagnosis of breast cancer from screening mammography based on several calculations range from between 1% to 10%, the group adds.

The estimated cumulative risk for death from breast cancer attributable to radiation from mammographic screening is from 1 to 10 per 100,000 women, depending on age and the frequency and duration of screening.

Echoing the finding of others, the Working Group concluded that data from available studies generally did not show a reduction in breast cancer–related mortality when breast self-examination was either taught or practiced competently and regularly.

“Screening for breast cancer aims to reduce mortality from this cancer as well as the morbidity associated with advanced stages of the disease through early detection in asymptomatic women,” the Working Group notes.

“And the key to achieving the greatest potential effects from this screening is providing early access to effective diagnostic and treatment services,” they conclude.

Mammogram finds US reporter’s cancer

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Good Morning America‘s Amy Robach has revealed she will have a double mastectomy this week, a month after undergoing a mammogram on the show.

The 40-year-old correspondent discovered she had breast cancer after reluctantly agreeing to have a screening filmed for the ABC show.

She said GMA anchor Robin Roberts had persuaded her that if the story saved one life, it would be worth it.

“It never occurred to me that life would be mine,” said Robach.

Producers chose Robach to cover the mammogram story because it is recommended that women at the age of 40 regularly check for breast cancer.

During Monday’s programme, and in a blog post following the show, Robach said doctors had not yet determined what stage the cancer had progressed to, or whether it had spread.

The original story, which was part of the GMA Goes Pink breast cancer awareness day, featured Robach emerging from her on-air mammogram, before telling colleagues that it hurt much less than she thought it would.

A few weeks later she was told she had cancer, after returning for what she thought would be some follow-up images.

Robach said that her husband, actor Andrew Shue, had returned from his work trip that night and her parents had also caught a flight to New York to join her.

“We started gearing up for a fight,” she said, as she revealed that she would have both breasts removed this Thursday, followed by reconstructive surgery.

Robach joined ABC in 2012 from NBC, where she was a Weekend Today host.

‘No excuses’

She frequently filled in as a presenter on ABC’s top-rated morning show GMA, while host Roberts was fighting a serious blood and bone marrow disease.

Robach said that with a full-time job and two children she had always found reasons to put off having a mammogram herself.

However a doctor told her that the test had saved her life.

“I can only hope my story will inspire every woman who hears it to get a mammogram, to take a self-exam,” said Robach.

“No excuses. It is the difference between life and death.”

BREAST CANCER AWARENESS AND MAMMOGRAM.

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October is breast cancer awareness month. Most of the breast cancer can be detecte mt BSE( breast self examination) and my mammography. So, don’t panic if you find a lunp in your breast. Consult an expert.

The facts are clear. Breast cancer is the most common cancer among African-American women. And black women’s breast cancer mortality rates are higher than their white female counterparts. After lung cancer, breast cancer is the highest killing cancer among black women.

Unfortunately, the solution to this problem is multifaceted. Black women’s high breast cancer mortality rates are linked to poor access to medical care, inadequate utilization of early detection precautions, differences in treatment, and differences in tumor characteristics compared to their white female counterparts.

In terms of early detection, while it’s essential that every woman learns how to perform an efficient breast self-exam, mammograms are also important. However, it’s also an option that many women fear.

Let’s calm your worries. Here are nine things you should know about mammograms.

1. The Definition. A mammogram is a picture of the inside of the breast. There are two types of mammograms available to patients: a screening mammogram and a diagnostic mammogram.

2. How a Screening Mammogram Works. Screening mammograms usually involve two sets of images of each breast. The images can detect tumors not felt during your self-exam, and also finds microcalcifications (tiny deposits of calcium) that could indicate the presence of breast cancer. Screening mammograms are done with routine checkups, meaning you don’t need to discover an abnormality first before receiving one.

3. How a Diagnostic Mammogram Works.Diagnostic mammograms take longer than screening mammograms because more images are taken to obtain views of the breast from different angles. Usually, the patient is no longer seeking precautionary measures, but looking to know more about a lump, sign, or symptom that already has been found. Signs of breast cancer may include pain, skin thickening, nipple discharge, and a change in breast size or shape. However, these signs also can be non-cancerous, and diagnostic mammograms can help doctors make accurate diagnoses.

4. The Good Side of Screening Mammograms. Early detection of breast cancer means that treatment can start earlier, and possibly before the disease has spread. Studies have proven that screening mammography can help reduce the numbers of deaths from breast cancer among women ages 40 to 74, and especially those over age 50. However, studies have not proven that there is a benefit from regular screening mammography in women under age forty.

 

5. The Bad Side of Screening Mammograms. Fast-growing or aggressive cancers may have already spread to other parts of the body, regardless of whether or not a screening mammogram has been taken. There’s also the possibility of false-negative results — when mammograms appear normal even though breast cancer is present. Screening mammograms miss up to 20 percent of breast cancers present at the time of screening, mainly due to dense and fatty breasts. Younger women are more likely to have denser breasts.

False-positive results also have occurred when radiologists conclude that the mammogram is abnormal but no cancer is actually present. Again, this is more common in younger women. All abnormal mammograms should be followed up with additional testing: diagnostic mammograms, ultrasound, and/or biopsy. There’s also the risk of radiation exposure, as with all radiology. And repeated x-rays and radiology exams have the potential to cause cancer. The radiation exposure of resulting from mammograms is very low, thus the benefits tend to outweigh the risk.

6. The Best Age to Begin Screening Mammograms. Women age 40 and older should receive screening mammograms every 1 to 2 years. But women who have a personal or family history of breast cancer should talk with their health care providers and decide whether or not to have mammograms before the age of 40 and if so, how often.

 

7. How Much Do Mammograms Cost? Unfortunately, the cost of screening mammograms varies by state, facility, and insurance coverage. Thankfully, most states have laws that require health insurance companies to reimburse all or part of the cost of screening mammograms. If you’re insured, contact your insurance company and mammography facility for information about cost and coverage. Women over the age of 40 with Medicare can get a free screening mammogram each year, and Medicare will pay for one baseline mammogram for female beneficiaries between the ages of 35 and 39. Uninsured women can get free or low-cost mammograms through calling the National Cancer Institute’s Cancer Information Service (CIS) at 1-800-232-4636.

8. Where Can You Get a High-Quality Mammogram? Women can get high-quality mammograms at breast clinics, hospital radiology departments, private radiology offices, and doctors’ offices. Find a facility using the Center for Disease Control and Prevention (CDC) website.

9. Know Your Legal Protections. The Mammography Quality Standards Act (MQSA) is a Federal law designed to ensure that mammography is safe and reliable. In the United States, the Food and Drug Administration (FDA) or an FDA-approved Certifiying State must certify all mammography facilities. The facility must have mammography equipment that is tested periodically, employ trained personnel to administer tests and interpret data, and have a quality assurance program. They also must have a system for following up on abnormal mammographic findings and obtaining biopsy results. Ask your doctor or staff at the local mammography facility about FDA certification before making an appointment. All facilities are required to display their FDA certificate. Women should look for the certificate and check for its expiration date.

 

 

 

First Ultrasound Imaging System Approved for Dense Breast Tissue .

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The FDA approved the first ultrasound system for imaging dense breast tissue on Tuesday. The somo-v Automated Breast Ultrasound System (ABUS) is intended for use in women with dense tissue who’ve had a negative mammogram and no symptoms of breast cancer.

In a clinical study of some 200 women with dense breast tissue, cancer was detected significantly more often when board-certified radiologists reviewed mammograms along with somo-v ABUS images than when they reviewed mammograms alone.

Source: FDA

Irradiation Heightens Risk for Breast Cancer in Women with BRCA Mutations .

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Diagnostic radiation studies, especially if done before age 30, increase the risk that women who carry BRCA mutations will develop breast cancer, according to a BMJ study.

Researchers asked some 2000 carriers of BRCA1 or BRCA2 mutations to recall their history of radiation exposure. Based on standard tables, the cumulative radiation dose to the breast was calculated. Compared with no exposure before age 30, the hazard ratios for breast cancer increased with quartiles of increasing cumulative exposure, reaching 3.8 in the highest quartile.

The authors estimate that among 100 BRCA carriers at age 40, roughly 9 will have developed breast cancer. The number would increase by 5 if all had had a mammogram before age 30.

They conclude that their results support using non-ionizing radiation imaging techniques, such as MRI, as the main surveillance tool in young BRCA carriers.

Source: BMJ