1. Breast Cancer Screening 1

2. 2 Methods

3. 3 Mammography

4. 4 Digital Breast Tomosynthesis

5. 5

6. 6 Guidelines

7. 7 Preventive Services Task Force (USPSTF) Guidelines Screening for women aged 40-49 is not supported Biennial (versus annual) screening supported for women aged 50-74. Kopans, 2010. Radiol Clin N Am. 48: 843-57. Age 40 was chosen in part because the breast tissue of women younger than 40 is more susceptible to radiation damage. Age 50 was chosen as a surrogate for menopause.

8. 8 Bleyer and Welch, 2012. NEJM. 367;21: 1998-2005. Deaths from breast cancer in women over age 40 have decreased 28% over the last 30 years. “This reduction I mortality is probably due to some combination of the effects of screening mammography and better treatment” (treatment accounting for as little as 35% of the reduction to as much as 72%; the higher number is closer to reality.)

9. 9 Bleyer and Welch, 2012. NEJM. 367;21: 1998-2005. “Only 8 of 122 were destined to progress to advanced disease.”

10. 10 Bleyer and Welch, 2012. NEJM. 367;21: 1998-2005. “Despite substantial increases in the number of cases of early-stage breast cancer detected, screening mammography has only marginally reduced the rate at which women present with advanced cancer. Although it is not certain which women have been affected, the imbalance suggests that there is substantial over diagnosis, accounting for nearly a third of all newly diagnosed breast cancers, and that screening is having, at best, only a small affect on the rate of death from breast cancer.”

11. 11 What are the “harms” in over-diagnosing? Are we over-diagnosing?

12. 12 Although randomized clinical trials are difficult to do, several studies support the notion that the decline in death rate from breast cancer since 1990 is predominantly a result of mammography (not treatment). There is no data that screening of high-risk patients has any positive impact on lives saved. “The task force admitted that their approach would result in unnecessary deaths that could be prevented by screening, but the guidelines would reduce the false-positive studies, which they decided was more important than saving lives.” USPSTF recommendations were determined using computer modeling that focused on the “number of women needed to be screened to save one life.” (a surrogate for cost?) 40-49: 1900 50-59: 1300 60-74: 300 Kopans, 2010. Radiol Clin N Am. 48: 843-57.

13. 13 Kopans, 2010. Radiol Clin N Am. 48: 843-57.