By Marci A. Landsmann
It's been two years since the US Preventive Services Task Force changed breast cancer screening recommendations, raising the age for screenings from age 40 to age 50 and opposing patient-directed breast self-exams. Considerable discussion has also surrounded whether breast cancer screenings contribute to more mastectomies--despite national screening programs that prompt women to get mammograms to reduce their risk of invasive surgery.
A new study in The British Medical Journal explores this controversy by analyzing mastectomy rates in breast cancer patients who underwent preventive screening versus those who did not, as a national screening campaign unrolled. The Norwegian study, led by Pal Suhrke, a doctorate-candidate at Oslo Hospital, analyzed the rates of breast cancer surgery in 35,408 women aged 40-79 with invasive breast cancer or ductal carcinoma in situ, treated surgically from 1993 to 2008.
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Mammogram screening was associated with a noticeable increase in rates for breast cancer surgery in women aged 50-69 (the age group invited to undergo screening) and also an increase in mastectomy rates compared to those who weren't invited to undergo screening. However, overall mastectomy rates also declined towards the end of the study duration, researchers note.
More mastectomies may not necessarily be a bad thing, according to one expert. "I would expect that women who were screened would have more cancers picked up, which would contribute to more surgery," says Dr. Carol Lee, chairperson of the American College of Radiology Breast Imaging Communications Committee.
The mastectomies could, therefore, saves lives down the road. The study does not explore mortality rates or whether the surgeries were not necessary says Lee, who reviewed the journal article and was not involved in carrying out the research.
Another US study, which included a cohort of 5,903 patients, noted that mammography detected earlier stage cancers, with 25.1 percent and 52.5 percent being found at stages 0 and I, respectively. Cancers detected by palpation were found later, with 29.2 percent and 50 percent found at stage I and II, respectively. Findings also indicated that palpation patients were more likely to undergo mastectomy than mammography patients. This data, presented at the American Society of Clinical Oncology Breast Cancer Symposium in San Francisco, included only patients already diagnosed with breast cancer.
