Living Proof That Screening Saves
Living Proof That Screening Saves

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Breast cancer is the second most common form of cancer in women, affecting one in every eight women in the United States. At Charlotte Radiology, we believe the key to beating this statistic and detecting breast cancer early is yearly, quality mammograms (starting at age 40), monthly self breast exams and regular clinical examination.

The Mammography Debate

The USPSTF is an independent panel of physicians who review guidelines for clinical screenings. The Task Force updates their recommendations every five years, with their most recent draft update made this year and their previous update in 2009, when they recommended biennial screening mammography for only women ages 50-74. The Task Force's 2009 changes and 2015 review have created a lot of media, which has resulted in additional media and attention being given to several unfounded mammography studies that are not backed by solid research or new technologies.

Most of the recent mammography studies from Canada and other countries as well as the USPSTF's data are seriously flawed. Here is how:

  • Poor Data Sources – computer models vs. REAL research:
    • The Institute of Medicine (IOM) recommendations for screening guideline development are considered the "gold standard" among the medical community; many recent studies' methods do not meet those standards and are NOT considered "trustworthy guidelines" by respected doctors.
    • No direct research was used in many of the recent studies or by the USPSTF. Statistics and computer models that estimate screening mammography benefits by ages are NOT accepted scientific approaches. Trusted research should include randomized, double-blinded study methods that measure real outcomes. Gold standard research reflects a 30% decrease in mortality from breast cancer since 1990 due to screening women 40+ annually and improved treatments; the National Cancer Institute puts the drop in mortality at 35% since the mid-1980s.
  • Expert Opinions were NOT included
    • No breast imaging or breast cancer experts were included on the USPSTF panel or meetings.
  • New and improved technology was NOT considered.
    • Many recent studies and the USPSTF do NOT take into account improved mammography techniques and technology, thereby misrepresenting their statements regarding over-diagnosis and harms of mammography. Outdated data has biased the results and often does not take into account the benefits of life-years saved and improved, and sometimes less invasive, treatment options offered when cancers are detected earlier.
  • There is no way to dictate which non-invasive cancers (DCIS) will be fatal.
    • Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer found in the milk ducts of the breast tissue, however it only accounts for less than 1/3 of the cancers detected at Charlotte Radiology. Additionally, it is impossible to know which of these DCIS cancers will develop into the more dangerous invasive cancers.
  • Age matters more than family history!
    • Cancers in women under 50 are often more aggressive, making screening women under 50 even more important.
    • 75% of women diagnosed have no family history; we risk NOT detecting the majority of breast cancers in women under 50.
  • Unnecessary Deaths: Analysis of the Task Force's methodology (and some recent studies) shows that if their recommendations are followed, approximately 6,500 additional US women each year would die from breast cancer.
  • Loss of Coverage for Mammograms for Some Women: The USPSTF revised grading and recommendations put insurance coverage for annual mammograms, as well as all mammograms for women age 40-49, at risk, as the Affordable Care Act only requires private insurers to cover exams given a grade "B" or higher by the USPSTF (a "B" was only given to mammograms for women ages 50-74 every other year).

Charlotte Radiology is one of the nation's largest radiology practices, serving the greater Charlotte area for nearly 50 years. Locally, our data supports our recommendation for annual screening mammography for women ages 40+.

From July 1996-December 2013, we have conducted more than 1.1 million screening mammograms. Of the breast cancers detected using screening mammography, more than 20% were found in women ages 40-49. Additionally, 40% of life-years-lost to breast cancer are in women diagnosed in their 40s.

The bottom line is that early detection is the key to beating breast cancer. Additionally, annual screening results in lower recall rates than does biennial screening and finds cancer at its earliest stage - providing a more favorable prognosis.

Ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer, however DCIS or non-invasive cancers make up less than 1/3 of the cancers detected at Charlotte Radiology. In a review of our data from 2011-2014, invasive cancers accounted for 71.7% of the total cancers detected, and approximately 45% of those invasive cancers were found in screening mammography patients.

Digital Breast Tomosynthesis (also known as 3D Mammography) creates multiple images that allow the radiologists to look at different layers of the breast tissue, helping to distinguish normal breast tissue from abnormal breast tissue. Tomosynthesis is of greatest benefit to women with dense breast tissue. The USPSTF also reviewed tomosynthesis and concluded there is "not enough evidence to determine whether it will result in improved health or quality of life or fewer deaths among women." Data on mortality takes 20-30 years to gather; so it is too soon to formally assess mortality rates for 3D mammography. However, "accuracy data" is available. In fact, Charlotte Radiology's data of 3D mammography reflects a 35% decrease in our recall rate in women with dense breast tissue, which helps decrease the anxiety of false positives often cited as a harm by the USPSTF. Additionally, we are finding a higher cancer detection rate increasing our catches of invasive breast cancers.