If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  Controversial US Government Mammography Guidelines Rapped by RSNA Expert Panel: Presented at RSNA By Charlene Laino CHICAGO -- December 4, 2009 -- A panel of radiological experts said they were perplexed and upset by new guidelines that recommended against routine annual screening mammography to detect breast cancer. “The net effect of the new guidelines is that screening would begin too late and its effects would be too little. We would save money, but lose lives,” said Stephen Feig, MD, University of California at Irvine, Irvine, California, in a special news briefing convened here on December 2, at the Radiological Society of North America (RSNA) 95th Annual Meeting. Panel members expressed their dissatisfaction with the newly revised guidelines from the US Preventive Services Task Force (USPSTF) that recommend against routine mammography screening for average-risk women in their 40s. USPSTF also recommends women aged 50 to 74 years have mammograms every 2 years instead of every year. The breast-screening panel said the guidelines would represent a major setback, wiping out decades of progress. “Deaths from breast cancer have dropped by 30% since 1990 when mammography screening beginning at age 40 became more widespread,” said Daniel B. Kopans, MD, Harvard Medical School, Boston, Massachusetts. Dr. Kopans said the task force relied on studies with methodology flaws that underestimated the benefits of mammography. The breast-screening panel said it supports American Cancer Society (ACS) guidelines, which continue to recommend annual routine mammography screening for all healthy women aged 40 years and over. “Current American Cancer Society guidelines have been shown to save lives,” Dr. Kopans said. “The Task Force, by its own admission, said women will lose their lives. That doesn’t seem to be much of a choice.” W. Phil Evans, MD, University of Texas Southwestern Medical Center, Dallas, Texas, and President of the Society of Breast Imaging, said that the American Cancer Society, the American College of Obstetricians and Gynecologists, the Mayo Clinic, the American Society of Breast Disease, and the American College of Radiology are all opposed to the USPSTF guidelines. Only 2 organizations -- the National Breast Cancer Coalition and the Dr. Susan Love Research Fund -- are in favour of them. Dr. Feig, who is also President-Elect of the American Society of Breast Imaging, cited several US and international studies that showed the benefits of annual screening beginning at age 40 years. Among them was a Swedish study showing annual mammograms reduce breast cancer mortality by 44% among women who are screened. Radiologists said that concerns about the harms of false positives led the USPSTF not to recommend screening for younger women. “You’re going to have some false positives, if you detect cancer early,” when it is most curable, Dr. Feig said. Dr. Feig also discounted concerns about radiation exposure. “The risk is negligible, compared with the benefits of screening,” he said. A key concern, the panel agreed, is that the USPSTF’s recommendations will be used in any possible public health plan being considered in US Congress. That, in turn, would lead insurance companies to stop covering annual breast cancer screening beginning at age 40 years, it said. In fact, mammograms are cost effective, Dr. Feig said. He showed data showing that with mammography, a quality year of life saved costs $17,000. In contrast, a quality year of life saved with dialysis costs $55,000. Asked if he thought radiologists were biased, Dr. Kopans said, “I would argue if there is no conflict of interest, you’re not an expert. We have true intentions and are saying to look at the data.” Dr. Kopans said he thinks the government panel had “good intentions.” Dr. Evans agreed; however, he pointed out that there were no radiologists or breast cancer screening experts on the panel. Dr. Kopans said he tried to e-mail the USPSTF data from several studies showing mammograms save lives but that as far as he knows, his e-mail was ignored. At a US House of Representatives Energy and Commerce Subcommittee on Health hearing in Washington, DC, that was concurrent with the RSNA panel, Diana Petitti, MD, MPH, vice chair of the USPSTF, said that while no radiologists were on the task force, they were “consulted and reviewed the recommendations and provided input.” Dr. Petitti told the subcommittee that their message could have been better communicated and that it wasn’t saying women younger than 50 years shouldn’t have mammograms, just that for them, the risks of mammography may outweigh the benefits. Told about the hearing, Dr. Kopans said that the average primary-care doctor only sees about 2 breast cancer patients a year. “They don’t know much about breast screening. Women have to be smarter than their doctors and save themselves,” he said.
|
