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Mammography screening rate drops among younger women

by Brendon Nafziger , DOTmed News Associate Editor
The mammography screening rate for women under 50 has fallen since the U.S. Preventive Services Task Force released its controversial 2009 guidelines cautioning against routine screening in younger women, according to a presentation at the American Roentgen Ray Society's annual meeting in Chicago this week.

A separate study also found that younger women who were screened had smaller and less aggressive cancers, suggesting that the USPSFT guidelines could worsen breast cancer survival, according to researchers.

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However, the studies have not appeared in a peer-reviewed journal yet.

In November 2009, the influential USPSTF issued new recommendations for breast cancer screening, advising against routine mammograms for normal-risk women aged 40-49. It also called on women 50 and over to get screened once very two years, instead of annually.

Those recommendations drew criticism from the American Cancer Society, the American College of Radiology and some women's groups. But they seem to have had an impact on screening rates.

In a presentation at the ARRS meeting, Dr. Lara Hardesty, the chief of breast imaging at University of Colorado Hospital in Denver, said screening rates among younger women at her hospital have fallen 15 percent while remaining almost unchanged for older women.

At her hospital, 1,327 women 40-49 were screened before the guidelines, but only 1,122 after they were released, according to a WebMD summary of her presentation. For women 50 and above, the number was nearly unchanged: 4,479 women underwent screenings before the recommendations came out, and 4,498 after.

Hardesty also surveyed about 50 health care providers at her hospital, and found the number of providers recommending that younger women get routine screenings declined by more than half. Before the USPSTF released its guidelines, 56 percent recommended yearly screening for women 40-49. After the guidelines, that number fell to 20 percent. However, after the guidelines came out, 54 percent recommended one-on-one counseling about the risks and benefits of screening, as recommended by the USPSTF.

Finding cancer early

Another study also shared at the ARRS meeting, by Dr. Donna Plecha, chief of mammography at University Hospitals at Case Medical Center in Cleveland, found that cancers in young women caught by mammography were smaller and therefore likely easier to treat.

In her study, she reviewed records of 359 biopsies of women in their 40s who had screening mammograms at her hospital between 2008 and 2009. Of these women, about 15 percent had cancer -- cancers in an earlier and presumably more treatable stage, she said, according to a CNN report.

However, Dr. Virginia Moyer, the current chair of the USPSTF, said the study assumes catching some of the cancers earlier will actually save more lives, which might not be the case.

"The data that we have suggests that one in a thousand will benefit from mammograms in the 40-49 age," she told CNN. "There are whole lots of assumptions that are not supported by the data they presented."

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(2)

Steve Arey

Drop in mamms in all women

May 05, 2011 09:11

Maybe this loss in income will finally cause the manufacturers to develop an effective screening test that "does no harm".
It is not sensible to me that you would subject a normal healthy, asymptomatic woman with no family history to ionizing radiation of any kind unless it is an emergency.
Why aren't we screening for lung cancer? What about prostate cancer?
Use of medical radiation has increased 7 times more than 1980's. Why? because reimbursement is good. Because the people who have been making up the regulations are the same people who make their living from it. Has breast cancer incidence gone down? I don't think it has 7 times or even at all. Go dig up what the history of breast cancer is and you will see for yourself.

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(9)

Carole Lamarque

drop in mammos in younger women

May 05, 2011 09:47

terribly disappointed by that fact, but was to be
expected with the new Health care reform bill, which increased the age the younger generation
could be covered by their parents/legal guardians
health coverage. The fact of the matter reamins
that a base-line mammogram should be established
already by age 30, not so late as 40 - 49; then
when no suspicious image, again at 40 -49, and any
recommended intervals thereafter from the MD-mammo
in tandem with the MD-onco. and MD-primary care,
based on medical history of the individual woman.
In the long run, viewing/using guide-lines as one
size fits all for treatment is detrimental to the
patient, and more expensive. Prevention has/is
always better, less costly than "cure" in any area, in medicine particularly, and when it comes
to breast-care, it is unecessary risk-taking in
this day and age to forgo rigorous acquisition of
medical daata and stick strickly to guide-lines =
expediency, to me anyway.

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(7)

Jeff Buske

Aiport X-ray scanner Dose

May 10, 2011 09:21

Backscatter x-ray airport scanners deliver a significant dose of collimated soft x-rays (50KVp) to skin and underlying tissues generating more double DNA breaks greatly increasing your chances for cancer. The “official” published whole body dose greatly underestimates skin and soft tissue exposure (breast/testicles,thyroid) by 20x because soft x-ray radiation penetrates a few cm, where whole body dose assumes radiation is averaged over body volume. Whole body dose is based on 1940's hard radiation damage to internal organs REM units not applicable to less penetrating soft x-rays.

The same soft 50KVp x-rays used in mammography. A strong correlation between breast cancer and introduction of mammography exists.

For example about 5% of women carry the BRCA (DNA repair gene) making them hyper sensitive to ionizing radiation greatly increasing breast and ovarian cancer risk. Expecting mothers and young children should avoid non-medically necessary radiation.

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