Annual screening does not cut breast cancer deaths, suggests Canadian study

Highlights:
– Annual screening in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination
– .Canada decided to compare breast cancer incidence and mortality up to 25 years in over 89,000 women aged 40-59 who did or did not undergo mammography screening
– During the 25 year study period, 3,250 women in the mammography arm and 3,133 in the control arm were diagnosed with breast cancer and 500 and 505, respectively, died of breast cancer
– Furthermore, the study shows that 22% of screen detected breast cancers were over-diagnosed
* 25-year study from Canada published on bmj.com today. FEB 2014 Continue reading “Annual screening does not cut breast cancer deaths, suggests Canadian study”

Mammogram rate did not decline after controversial USPSTF recommendations

Contact: Tom Langford tlangford@partners.org 617-534-1605 Brigham and Women’s Hospital

In 2009, the United States Preventative Services Task Force recommended against annual mammograms for women between the ages of 40 and 49

Boston – More than three years after the United States Preventive Services Task Force (USPSTF) recommended against routine mammogram screening for women between the ages of 40 and 49, a study from Brigham and Women’s Hospital (BWH) finds that mammogram rates in the United States have not declined in that age group, or any other.  The study results are published in the April 19, 2013 online edition of the journal Cancer.

“If the USPSTF recommendations had been widely adopted, we would have expected to see a significant decline in mammography rates among women in their forties,” said the study’s lead author, Lydia Pace, MD, MPH, a global women’s health fellow in the Division of Women’s Health at BWH. “However, this study demonstrates that younger women are continuing to get mammograms.”

Researchers analyzed data from nearly 28,000 women who were asked about their mammography use during the 2005, 2008 and 2011 National Health Interview Survey.  They found that among all women, mammography rates rose at a slight but statistically non-significant rate between 2008 and 2011 from 51.9 percent to 53.6 percent.  Among women in the 40 to 49 age group, mammography rates also rose at a slight but statistically non-significant rate between 2008 and 2011 from 46.1 percent to 47.5 percent.

“Our research does not explain the reasons why mammography rates did not decline, but it is worth noting that several prominent professional and advocacy organizations continue to recommend mammography screening for women between the ages of 40 and 49,” said Dr. Pace. “Providers may disagree with the USPSTF recommendations or they may not have the time or the tools needed for discussions with patients about the relative benefits and harms of mammography. Patients may also disagree with the recommendations and may still be requesting annual mammograms or self-referring to mammography facilities.”

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This research was supported by the Global Women’s Health Fellowship at the Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital.

Harms from breast cancer screening outweigh benefits if death caused by treatment is included

Contact: Emma Dickinson edickinson@bmjgroup.com 44-020-738-36529 BMJ-British Medical Journal

Cancer expert remains to be convinced by breast screening review

Harms from breast cancer screening outweigh benefits if death caused by treatment is included

Michael Baum, Professor emeritus of surgery at University College London says that, while deaths from breast cancer may be avoided, any benefit will be more than outweighed by deaths due to the long term adverse effects of treatment.

He estimates that, for every 10, 000 women invited for screening, three to four breast cancer deaths are avoided at the cost of 2.72 to 9.25 deaths from the long term toxicity of radiotherapy.

These figures contrast with an independent report on breast cancer screening, led by Sir Michael Marmot and published in November last year. Marmot and his committee were charged with asking whether the screening programme should continue, and if so, what women should be told about the risks of overdiagnosis.

They concluded that screening should continue because it prevented 43 deaths from breast cancer for every 10,000 women invited for screening.

The downside was an estimated 19% rate of overdiagnosis: 129 of the 681 cancers detected in those 10,000 women would have done them no harm during their lifetime. However, those women would have undergone unnecessary treatment, including surgery, radiotherapy and chemotherapy.

But despite this higher than previous estimate of overdiagnosis, they concluded that the breast screening programme should continue.

The report also judged that screening reduces the risk of dying from breast cancer by 20%. But Professor Baum disputes these figures, saying the analysis takes no account of improvements in treatment since these trials were done, which will reduce the benefits of screening. Nor does it make use of more recent observational data.

With these data included, estimated rates of overdiagnosis as a result of screening increase to up to 50%, he argues.

This is important because it can change the decisions women make when invited for screening. In a study also published today, researchers at the University of Sydney explored attitudes to screening in a sample of 50 women. Many of the women were surprised when they were told about overdiagnosis and most said they would attend screening if overdiagnosis rates were 30% or lower, but a rate of 50% made most of them reconsider.

An accompanying editorial points out that the harms of screening will reduce as more effective diagnostic  processes develop to inform less harmful and more personalised treatments. In the meantime, it says women need up to date and transparent information about the benefits and harms of screening to help them make informed choices.

Breast cancer screening saves lives, says study??? that screening only narrowly decreased risks that a 50-year-old woman would die from breast cancer within 10 years — from 0.53 percent to 0.46 percent.

Engineering Evil Note: There seems to be conflicting studies being utilized to favor screening. I found this report stating that they used no current data for the meta analysis. The data they claimed to have used here was over 20 years old. I am withholding my humble opinion to see if there were current studies, and if they used the superior MRI  overt he  antiquated mammograms. There seems to be a few different press releases quoting different studies, in addition now to a few broken links to those reports.

i.e. http://todayhealth.today.com/_news/2012/10/29/14787480-breast-cancer-checks-save-lives-despite-over-diagnosis-reportsays?lite

Breast cancer screening saves lives, says study

PARIS (AFP)  Benefits of preemptive breast cancer screening outweigh the risks, a study said Tuesday, insisting the practice saves thousands of lives.The new research adds to the debate about the dangers of overdiagnosis, which sees some women undergo invasive treatment for cancers that would never have made them ill or even been diagnosed were it not for the scans.”Breast screening extends lives,” concluded a panel of researchers in The Lancet medical journal.

The team had analysed data from other trials conducted over many years in Britain, where women aged 50 to 70 are invited for a screening mammogram every three years.

The data, it said, pointed to a 20 percent reduction in mortality — or one death prevented for every 180 women screened.

This meant that the UK screening programmes “probably prevent about 1,300 breast cancer deaths every year,” said the report.

But there is a cost.

Nearly 20 percent of breast cancer diagnosed by screening would never have caused any problems, said the study.

The panel, set up to advise British policymakers, estimated that among every 10,000 women invited to screening from the age of 50 in the Britain, 681 cancers would be discovered, of which 129 would be overdiagnoses, and 43 deaths prevented.

The report showed that “the UK breast-screening programme extends lives and that, overall, the benefits outweigh the harms,” The Lancet wrote in an editorial.

“Women need to have full and complete access to this latest evidence in order to make an informed choice about breast cancer screening.”

The team conceded there were limitations to its work, including that all the data scrutinised was more than 20 years old.

Cancer experts have been at loggerheads for years about whether the benefits of screening outweigh the harm of overdiagnosis.

All cancer, once picked up in the screening process, is treated, often with surgery as well as radio- and chemotherapy, as it is impossible to tell which growths would have remained undetected for the remainder of a woman’s life.

In August, medical experts Steven Woloshin and Lisa Schwartz wrote in the British Medical Journal (BMJ) that screening only narrowly decreased risks that a 50-year-old woman would die from breast cancer within 10 years — from 0.53 percent to 0.46 percent.

Up to half of women screened annually over 10 years experienced at least one false alarm that required a biopsy, they said.

And in 2010, a report in the New England Journal of Medicine said mammograms have only a “modest” impact on reducing breast cancer deaths.

The latest panel had been created by the national cancer director for England, Mike Richards and Cancer Research UK chief executive officer Harpal Kumar.

Its work, said The Lancet, “should begin to lay the benefits versus harm controversy to rest”.

http://www.afp.com/en/news/topstories/breast-cancer-screening-saves-lives-says-study

137th Health Research Report 07 SEP 2008

 Full Report at www.healthresearchreport.me

Editors Top Five:

 

1. Study Finds How BPA Affects Gene Expression, Anxiety; Soy Mitigates Effects

2. Vitamin B3 may offer new tool in fight against ‘superbugs’

3. Johns Hopkins team finds ICU misdiagnoses may account for as many annual deaths as breast cancer

4. Prenatal exposure to pesticide additive linked with childhood cough

5. Childhood virus RSV shows promise against adult cancer

 

 

In this Issue:

1. Vitamin B3 may offer new tool in fight against ‘superbugs’

2. How a virus might make you diabetic later in life

3. Adolescent pot use leaves lasting mental deficits

4. Nutrition tied to improved sperm DNA quality in older men

5. Energy drinks improve heart function

6. Breast milk promotes a different gut flora growth than infant formulas

7. Johns Hopkins team finds ICU misdiagnoses may account for as many annual deaths as breast cancer

8. WSU researcher documents links between nutrients, genes and cancer spread

9. Antibiotic residues in sausage meat may promote pathogen survival

10. Smoking after stroke increases death risk by 3-fold

11. The raccoon spreads dangerous diseases as it invades Europe

12. Chocolate: A sweet method for stroke prevention in men?

13. Bacterial cause found for skin condition rosacea

14. WSU researchers discover mechanism leading from trichomoniasis to prostate cancer

15. Lyme retreatment guidance may be flawed

16. Chemical exposure in the womb from household items may contribute to obesity

17. Affluent people less likely to reach out to others in times of chaos, study suggests

18. Coconut oil could combat tooth decay

19. Heavy drinking rewires brain, increasing susceptibility to anxiety problems

20. Even in normal range, high blood sugar linked to brain shrinkage

21. High doses of Vitamin D help tuberculosis patients recover more quickly

22. High levels of DDT in breast milk

23. Large Review Finds Some Evidence for “Chemo Brain” in Breast Cancer Survivors, Moffitt Cancer Center Says

24. Are restrictions to scientific research costing lives?

25. Toddlers increasingly swallowing liquid detergent capsules

26. Brainy beverage: Study reveals how green tea boosts brain cell production to aid memory

27. Children exposed to 2 phthalates have elevated risk of asthma-related airway inflammation

28. Prenatal exposure to pesticide additive linked with childhood cough

29. Nutritional supplement offers promise in treatment of unique form of autism

30. Diagnostic chest radiation before 30 may increase breast cancer risk

31. Report: Strategies to prevent noise-induced hearing loss, tinnitus in soldiers

32. Childhood virus RSV shows promise against adult cancer

33. Stress prompts some to retain as much salt as eating fries

34. Study Finds How BPA Affects Gene Expression, Anxiety; Soy Mitigates Effect

 

 

Health Technology Research Synopsis

137th Issue Date 07 SEP 2012

Compiled By Ralph Turchiano

www.healthresearchreport.me www.vit.bz

www.youtube.com/vhfilm http://www.facebook.com/vitaminandherbstore

www.engineeringevil.com


High rate of false-positives with annual mammogram

During a decade of receiving mammograms, more than half of cancer-free women will be among those summoned back for more testing because of false-positive results, and about one in 12 will be referred for a biopsy.

Simply shifting screening to every other year lowers a woman’s probability of having one of these false-positive episodes by about a third – from 61 percent to 42 percent – over the course of a decade.

A new study delving into false-positives in mammography looked at nearly 170,000 women between the ages of 40 and 59 from seven regions around the United States, and almost 4,500 women with invasive breast cancer. Because of the added decade of testing alone, it found, women who start mammograms at 40 instead of 50 are more likely to have false-positive results that lead to more testing.

“This study provides accurate estimates of the risk of a false-positive mammography and breast biopsy for women undergoing repeat mammography in community practice, and so provides important information about the potential harms of undergoing regular mammography,” said co-author Karla Kerlikowske, a professor of medicine at the UCSF School of Medicine.

The study will be published in Annals of Internal Medicine. The research was led by Group Health Research Institute of Seattle for the Breast Cancer Surveillance Consortium.

“Recalls” for a second mammogram for what turn out to be non-cancer results, known as false positives, may cause inconvenience and anxiety. Recommendations for fine-needle aspiration or surgical biopsy are less common, but can lead to unnecessary pain and scarring. The additional testing also contributes to rising medical costs.

Kerlikowske is the lead author of an additional report – to be published in the same issue of Annals – that for the first time in the United States examines the accuracy of film mammography against digital, which has increasingly replaced older film screening.

That study looked at nearly 330,000 women between the ages of 40 and 79. The data was pooled from the Breast Cancer Surveillance Consortium, a collaborative network of mammography registries in the United States.

The researchers found that overall cancer detection rates were similar for both methods. However, digital screening may be better for women between the ages of 40 and 49 who are more likely to have extremely dense breasts associated with lower cancer detection. The study also found new evidence that digital mammography is better at detecting estrogen receptor-negative tumors, particularly in women aged 40 to 49 years.

Breast cancer may not be detected, the researchers caution, if a radiologist fails to identify a visible breast lesion or if a tumor is obscured by normal breast tissue. Additionally, an imperceptible tumor may grow quickly and be discovered through a clinical exam prior to the next mammogram.

Digital mammography was developed in part to improve the detection of breast cancer in dense breasts by improving the ability to distinguish normal dense breast tissue from isodense invasive cancer.

The authors note that for every 10,000 women 40 to 49 who are given digital mammograms, two more cases of cancer will be identified for every 170 additional false-positive examinations.

Healthy women will undergo 12 screening mammograms in their lifetimes if they follow U.S. Preventive Services Task Force guidelines that recommend biennial screening starting at age 50 and continuing until age 74. This is controversial, with many practitioners recommending annual mammograms.

If women start biennial screening at 40, they will undergo 17 exams; those who start annual screenings at age 40 will undergo 34 exams.

For the false-positive study, the researchers found that after a decade of annual screening, a majority of women will receive at least one false-positive result, and 7 to 9 percent will receive a false-positive biopsy recommendation.

“We conducted this study to help women know what to expect when they get regular screening mammograms over the course of many years,” said study leader Rebecca Hubbard, PhD, an assistant investigator at Group Health Research Institute. “We hope that if women know what to expect with screening, they’ll feel less anxiety if – or when – they are called back for more testing. In the vast majority of cases, this does not mean they have cancer.”

The researchers say that screening every other year would likely lessen the probability of false-positive results “but could also delay cancer diagnosis.”  However, for those diagnosed with cancer, the authors found women screened every two years were not significantly more likely to be diagnosed with late-stage cancer compared to those screened at one-year intervals.

The study stresses the importance of radiologists being able to review a patient’s previous mammograms because it “may halve the odds of a false-positive recall.”

US cancer body oversells mammograms: experts

AFP 2 Aug 2012

Medical experts on Friday accused a major US breast cancer foundation known for its high-profile “pink ribbon” campaign of overselling pre-emptive mammography and understating the risks.

The Susan G. Komen for the Cure foundation uses misleading statistics in its pro-screening campaigns, two doctors from The Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire wrote in the BMJ medical journal.

“Unfortunately, there is a big mismatch between the strength of evidence in support of screening and the strength of Komen’s advocacy for it,” professors Steven Woloshin and Lisa Schwartz wrote.

They take issue with a Komen poster comparing the 98-percent five-year survival rate for breast cancer when caught early, with a of 23-percent rate for later diagnosis.

Comparing the two figures did not tell you anything about the benefits of screening, they argued, and in reality a mammogram only narrowly decreases the chances that a 50-year-old woman will die from breast cancer within 10 years from 0.53 percent to 0.46 percent.

Breast cancer treatments are more effective today, and some question whether screening mammography has any benefit whatsoever, wrote the pair.

They accused Komen of overlooking the potential harms, with up to half of women screened annually over 10 years experiencing at least one false alarm that requires a biopsy.

Screening also results in overdiagnosis — detecting cancers that would never have killed or even caused symptoms in a person’s lifetime, and unnecessary treatment.

“The Komen advertisement campaign failed to provide the facts,” said the piece. “Worse, it undermined decision making by misusing statistics to generate false hope about the benefit of mammography screening.”

In 2010, a report in the New England Journal of Medicine said mammograms have only a “modest” impact on reducing breast cancer deaths.

Komen, in a response to the BMJ comment, insisted that early detection enables early treatment, which gives the best shot at survival.

“Everyone agrees that mammography isn’t perfect, but it’s the best widely available detection tool that we have today,” said Chandini Portteus, the foundation’s vice president of research, evaluation and scientific programmes.

“We’ve said for years that science has to do better, which is why Komen is putting millions of dollars into research to detect breast cancer before symptoms start, through biomarkers, for example.”

In February, Komen was embroiled in a controversy over its decision to stop funding for an abortion clinic group in the United States.

New study supports claim that breast screening may be causing more harm than good

Requested Repost from Dec 2011

Research: Possible net harms of breast cancer screening: Updated modelling of Forrest report

A new study published on bmj.com today supports the claim that the introduction of breast cancer screening in the UK may have caused more harm than good.

Harms included false positives (abnormal results that turn out to be normal) and overtreatment (treatment of harmless cancers that would never have caused symptoms or death during a patient’s lifetime). This may be because the cancer grows so slowly that the patient dies of other causes before it produces symptoms, or the cancer remains dormant or regresses.

It shows that the harms of screening largely offset the benefits up to 10 years, after which the benefits accumulate, but by much less than predicted when screening was first started.

The Forrest report in 1986, which led to the introduction of breast cancer screening in the UK, estimated the number of screened and unscreened women surviving each year over a 15-year period.  Costs and benefits were measured in quality adjusted life years or QALYs (a combined measure of quantity and quality of life) but it omitted harms.

It suggested that screening would reduce the death rate from breast cancer by almost one third with few harms and at low cost.

Since the Forrest report, the harms of breast cancer screening have been acknowledged. So, researchers at the University of Southampton set out to update the report’s survival estimates by combining the benefits and harms of screening in one single measure.

The results are based on 100,000 women aged 50 and over surviving by year up to 20 years after entry to the screening programme.

Inclusion of false positives and unnecessary surgery reduced the benefits of screening by about half. The best estimates generated negative net QALYs for up to eight years after screening and minimal gains after 10 years.

After 20 years, net QALYs accumulate, but by much less than predicted by the Forrest report.

The authors say more research is needed on the extent of unnecessary treatment and its impact on quality of life. They also call for improved ways of identifying those most likely to benefit from surgery and for measuring the levels and duration of the harms from surgery. From a public perspective, the meaning and implications of overdiagnosis and overtreatment need to be much better explained and communicated to any woman considering screening, they add.

However, the continuing uncertainty surrounding the extent of overtreatment is apparent in a study of French women published on bmj.com last month, which put overdiagnosis of invasive breast cancer due to screening at around 1%.

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