Special report: The end of traditional mammography?

Special report: The end of traditional mammography?

by Carol Ko, Staff Writer | July 19, 2013
International Day of Radiology 2012
From the July 2013 issue of HealthCare Business News magazine


In November 2012, the New England Journal of Medicine came out with a large-scale study that seemed to lend further credence to these recommendations. It examined and analyzed health statistics on breast cancer diagnoses over the last 30 years to examine the impact of mammogram screenings. As expected, detection of early stage cancers increased with the introduction of mammogram screenings. However, the diagnosis rate for advanced cancer screenings remained almost unchanged.

This raises troubling questions around the efficacy of mammography: if mammograms find more early stage cancers, this should lead to a decrease in advanced-stage cancer diagnoses. The study claimed that mammography ultimately made only a small difference in the rate of death from breast cancer while leading to high rates of false positives among patients.

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Of course, these studies’ conclusions are vigorously contested by many medical experts. In a rebuttal published on Auntminnie.com, Dr. Daniel Kopans criticized the study’s lack of direct patient data, citing multiple studies using randomized, controlled trials that showed much lower false positive rates. He also argued that the study’s baseline of what breast cancer screening rates would have looked like without mammography screening used unreliable data collected from 1976 to 1979, ignoring 40 years of data collected by the Connecticut Tumor Registry that showed a different rate of increase in breast cancer.

Dr. Emily Conant, chief of breast imaging at University of Pennsylvania, also agrees that the Preventative Task Force’s numbers and modeling made the data misleading. “There’s a lot of different data that refute what the Preventative Task Force says — we see a 20 to 30 percent mortality reduction,” she says.

Dr. Rachel Brem, director of breast imaging and interventional center and professor of radiology at George Washington University, sees the data as a call to make mammography better, not reduce screenings. “We’re going backward. Nobody promises anybody a cure — we promise we try to do the best we can, but people die of breast cancer, but the fact that it’s imperfect just speaks to the need for additional research,” she says.

Are you positive?
One of the main points in the infamous Preventative Task Force findings zeroed in on the anxiety and psychological harm that false positive results had on patients. Other highly publicized studies, including a Danish study released in March 2013, have also shown that false positives take a psychological toll on patients for up to three years afterward.

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