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Age no reason to stop breast cancer screening: RSNA study

by Thomas Dworetzky, Contributing Reporter | November 29, 2016
RSNA Women's Health X-Ray
There is no hard-and-fast age to stop breast cancer screening, a new largest-ever study has found.

The new findings bolster guidelines that call for screenings based on “individual patients and their health status,” without an arbitrary age limit.

"All prior randomized, controlled trials excluded women older than 75, limiting available data to small observational studies," study co-author Dr. Cindy S. Lee, assistant professor in residence at the University of California, San Francisco, announced at RSNA on Monday.

"There has been a lot of controversy, debate and conversation regarding the different breast cancer screening guidelines, even among major national organizations, over the past few years."

This study could alter the 2009 United States Preventive Services Task Force (USPSTF) guidelines that advised that there was insufficient evidence to weigh risk-benefit of screening mammographies in over-age-75 women.

The study reviewed nearly 5.6 million screening mammograms in the National Mammography Database for the 2008-2014 7-year period.

Analysis shows a mean cancer detection rate of 3.74 per 1,000 patients, recall rate of 10 percent, PPV2 of 20 percent and PPV3 of 29 percent. These metrics showed “a gradual upward trend for cancer detection rate, PPV2 and PPV3, but a downward trend in recall rate” by age.

"The continuing increase of cancer detection rate and positive predictive values in women between the ages of 75 and 90 does not provide evidence for age-based mammography cessation," Lee said, noting that, “we know that the risk of breast cancer increases with age."

Co-authors on the study are Debapriya Sengupta, M.B.B.S., M.P.H., Judy Burleson, Mythreyi Bhargaven-Chatfield, Ph.D., Edward A. Sickles, M.D., Elizabeth S. Burnside, M.D., M.P.H., and Margarita L. Zuley, M.D.

Breast cancer is the second-most frequent cancer for U.S. women after skin cancer. The American Cancer Society estimates that in 2016 alone there will be about 246,660 new cases of invasive breast cancer, 61,000 new cases of carcinoma in situ, and approximately 40,450 women will die from the disease.

Breast cancer screening has faced a number of controversies recently. Payment from insurance companies has figured into the debate as well.

In fact, in October, a study of a 2014 New Jersey law that requires insurance companies to pay for supplemental ultrasound and/or MR screening if a woman has dense breasts diagnosed, revealed that it has resulted in better patient care and outcomes.

"The number of supplemental screening ultrasound and MR examinations increased after [The New Jersey Breast Density Law (NJBDL)] implementation," Dr. Linda Sanders, medical director of the Breast Center at RWJBarnabas Health ACC in Livingston, N.J., and lead author of the study, told HCB News at the time.

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