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| |  RSNA MEETING: Annual Mammography Safe And Cost-Effective CHICAGO, IL -- December 1, 1997 -- On the heels of a National Cancer Institute recommendation that women 40 and older have regular mammograms, two studies suggest annual mammography screening for breast cancer is not only safe but cost-effective. The studies were presented today at the 83rd Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA). "This is more evidence that women should be screened annually after age 40," said Stephen Feig, M.D., director of the Breast Imaging Center at Thomas Jefferson University, Philadelphia. Dr. Feig is also chairman of the American College of Radiology (ACR) Ad Hoc Committee on Mammography Screening Guidelines of the Task Force on Breast Cancer. Dr. Feig's study finds the benefit of annual mammograms far outweighs any risk of radiation-induced cancer. "No woman has ever been shown to develop breast cancer as a result of mammography, not even after multiple exams over many years and at much higher doses than those used today," said Dr. Feig, who analyzed a variety of studies on radiation risk and mammography benefits. "Women should not be concerned about potential radiation risk from mammography. If there is a risk, it's really negligible compared to the benefit." The risk is probably even lower because the statistics he used were based on radiation received by Japanese victims of the Hiroshima and Nagasaki bombs and by women who were treated with radiation therapy for benign breast conditions or who were subjected to multiple chest fluoroscopies during treatment of tuberculosis in the 1920s. Those women received up to 2,500 times the radiation dosage per exposure that a woman receives during a mammogram today. In contrast to the negligible theoretical risk of radiation-induced breast cancer, Dr. Feig estimated that annual mammography screening reduces death due to breast cancer by at least 35 percent in women age 40 to 49 compared to at least 24 percent when mammograms are done every other year. The death rate is reduced by 45 percent in women age 50 to 59 when mammograms are performed annually compared to 39 percent when done every other year. The more often a woman is screened, the more likely breast cancer will be caught early and treated more effectively, he said. In fact, studies such as the Gothenburg, Sweden, screening trial show that the benefit is undoubtedly much greater, said Dr. Feig. He calculated that if all women age 39 to 49 in this trial had been screened annually instead of every 1.5 years, breast cancer mortality reduction could have been as great as 75 percent. In a related study presented at the RSNA meeting, researchers found that while regular mammography screening may appear expensive up-front, it more than pays for itself in the long run. Breast cancer is far more likely to be caught in the early stage through regular mammography screening and is therefore treated less expensively and more effectively, according to researcher M. Elizabeth Glenn, M.D., radiologist, Brooke Army Medical Center, Fort Sam Houston, TX. The cost for medical workups and biopsies also is significantly less when breast cancer is caught early. Additionally, recurrence is less likely when breast cancer is discovered at an early stage. "In this country, one reason we have been slow to support screening mammography under age 50 is the up-front cost," Dr. Glenn said. "This shows that there is no doubt -- mammography screening definitely pays off. The up-front cost isn't close to what you will save in the long run." Dr. Glenn analyzed costs of breast care for 7,000 patients evaluated at Brooke Army Medical Center at Fort Sam Houston in San Antonio, and reviewed local Department of Defense Tumor Registry breast cancer cases over seven years. Although the cost figures were generated by the government, she said the analysis can be applied to the general population. She compared workup and treatment costs of women who weren't screened with those who were screened at varying frequency, some occasionally, others annually. "It is logical that if women were screened annually, the cost benefit would be even greater," Dr. Glenn said. "Regular screening starting at age 40 shifts at least 30 percent of people who would otherwise be diagnosed in the later stages of breast cancer to the very early stages, which are more easily cured and far less expensively treated," Dr. Glenn said.
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