By Anna Chen
and Thomas A. Summers
We read with great interest the AP news story published in the Buffalo News on Nov. 22 regarding the limited benefits of screening mammography.
As board certified and fellowship trained radiologists practicing women’s imaging in the only Certified Breast Center of Imaging Excellence in Western New York, we took serious exception with the conclusion of the study which states, “Mammograms lead to overtreatment, do little to curb late-stage breast cancers.”
The article was based upon a scientific paper recently published in the New England Journal of Medicine, which concludes with their “best-guess estimate” that 70,000 women were over diagnosed with breast cancer in 2008. At best, the article suggesting that mammography finds cancers that would not advance enough to kill a woman is established on an inaccurate theory. The author concludes that breast cancer rates would increase at a rate of 0.5 percent each year, which they term this assumption as an “extreme” estimate.
However, qualified statistics confirm increases of twice that amount each year. Many academic reviewers of this article have found significant fault with the methodology of the study. Specifically, the reviewers at the American College of Radiology and Society of Breast Imaging have referred to the study as “deeply flawed and misleading”.
The fact remains that the current most important tool in the fight against breast cancer is early detection. Gov. Andrew M. Cuomo has signed legislation that goes into effect in 2013 which increases patient awareness about the limitations of mammography through patient information relative to their individual breast density. Scientific evidence shows that while mammography in a fatty breast provides very reliable results in the detection of breast cancer, its sensitivity is significantly decreased in dense breasts. Dense breast tissue impairs the detection of architectural distortions in particular; the most significant signs of invasive ductal carcinoma. Given this limitation, additional supplemental screening methods may provide increased sensitivity to further aid early cancer detection in selected patients.
Our concern is that while progress is being made in the fight against cancer, articles such as this – based upon flawed assumptions – can create confusion in the public mind and dissuade patients from valuable screening programs. The American Cancer Society, the American Radiologic Society, and the American College of OB/GYN review all available literature and make public recommendations relative to the use of mammography, which remains that mammography be performed on an annual basis beginning at the age of 40.
Anna Chen, D.O. is director of women’s imaging at Windsong Radiology Group. Thomas A. Summers, M.D., is president of the group.