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Backing Off From Annual Screening Mammography?

January 17, 2014

Backing Off From Annual Screening Mammography?

  1. Andrew M. Kaunitz MD

New analysis fails to identify clear net benefit of screening.

  1. Andrew M. Kaunitz MD

We have become increasingly aware of the potential harms of screening mammography, while cognizant that much of the reduction in breast cancer mortality reflects advances in treatment (NEJM JW Womens Health Nov 21 2012). To clearly communicate the relative benefits and risks associated with screening mammography, investigators used study data from Sweden, Canada, and the U.S. (representing upper- and lower-bound estimates) to quantify the likelihood of three outcomes in women aged 40, 50, and 60: reduction in breast cancer mortality, false-positive results, and overdiagnosis of in situ and invasive breast cancer.

The authors estimate that among 1000 women aged 50 who undergo annual screening for 1 decade, 0.3 to 3.2 fewer deaths from breast cancer will occur, 490 to 670 women will receive at least 1 false-positive finding, and 3 to 14 women will be overdiagnosed (usually leading to unnecessary treatment).

Comment

Simply knowing that mammographic screening involves risks and benefits is not enough; making informed choices about screening involves the ability to weigh these risks and benefits. These authors acknowledge that, while the estimated outcome ranges they have calculated might not help all women to make informed decisions, providing a single “best” estimate could be misleading. Some clinicians and women may perceive this quantitative analysis to be biased against screening. As noted by investigators who are creating a mammography decision aid for women aged ≥75, this perspective could be fostered by years of media emphasis on the benefits of mammograms. Lastly, we should keep in mind that the most recent randomized trial of screening mammography took place more than 50 years ago. It could well be time to rigorously reevaluate this practice.

  • Disclosures for Andrew M. Kaunitz MD at time of publication Consultant / Advisory board Agile; Bayer; Merck Equity Vertex Royalties UpToDate Grant / research support Agile; Bayer; Endoceutics; Medical Diagnostic Laboratories; Noven; Teva Editorial boards Contraception; MedScape; Menopause; OBG Management Leadership positions in professional societies North American Menopause Society (Board of Trustees)

Citation(s):

Reader Comments (3)

Hazem Hamdy Physician, Family Medicine/General Practice, Solo Practice

I am most confused. The province of Ontario pays a bounce for breasts screening. I order it because I am convinced it a useful tool, but it is the standard of practice and my personal opinion is supported by evidence in court.

Min-Han Tan Physician, Oncology

Just a minor comment: there is one randomized study of incident screening mammography in Singapore (1993) that has not reported its final results. (Cancer. 1998 Apr 15;82(8):1521-8.); this occurred in the last twenty years, so this statement that "the most recent randomized trial of screening mammography took place more than 50 years ago" should be reconsidered. The Singapore study has most recently reported poor calibration of the Gail model (Breast Cancer Research 2012, 14:R19 doi:10.1186/bcr3104)

ARIANE COMETA

It has been 50 years in the US since randomized mammography studies have been done.

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