The evolving discussion on breast cancer screening

Breast cancer screening and treatment is still a work in progress. Debate continues over the optimal frequency of screening, which patient populations to target and how different supplemental screening modalities fit in. Whatever take you have on these issues, the top stories in women’s imaging over the last month should offer plenty to mull over.

A study published online April 21 in JAMA Internal Medicine aimed to measure the effect of false-positive mammograms, and found the anxiety they provoke is largely short-lived. Researchers from the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H. surveyed more than 1,000 women after they underwent screening to track their personal anxiety as well as the impact of a false-positive on health utility and attitudes toward future screening.

Results showed that women with a false-positive mammogram had significantly higher anxiety initially, but health utility scores were similar and there was no significant differences between women with and without a false-positive after one year. Importantly, those who experienced a false-positive were more likely to have future screening intentions, as were younger women and those in poorer health.

The authors noted that their results should help those who counsel women on the decision to undergo mammographic screening, and while anxiety from a false-positive has a relatively small, transient effect, further research should focus on how to further reduce this anxiety.

Earlier in the month, the notion that mammography screening programs should continue at all was challenged in an editorial published in the New England Journal of Medicine. Co-authors Nikola Biller-Andorno, MD, PhD, a medical ethicist of the University of Zurich, and Peter Jüni, MD, a clinical epidemiologist of the University of Bern, were members of an expert panel that assessed mammography under the Swiss Board in 2013. Restating recommendations from the board, Biller-Andorno and Jüni called for screening programs to be halted and for more balanced information about the benefits and harms of screening to be disseminated to women.

“It is easy to promote mammography screening if the majority of women believe that it prevents or reduces the risk of getting breast cancer and saves many lives through early detection of aggressive tumors,” they wrote. “We would be in favor of mammography screening if these beliefs were valid. Unfortunately, they are not, and we believe that women need to be told so.”

This controversial opinion is based on three major issues. First, the original trials supporting mammography are archaic and outdated. There is also a question, based on more recent studies including the follow up to the Canadian Breast Cancer Screening Study, of whether the benefits come at too high of a cost considering the risk of overdiagnosis. Lastly, Biller-Andorno and Jüni wrote that there is a disconnect between women’s perceptions of the benefits of mammography compared with reality.

Leaving the editorial pages, the final top story comes from the office of Arizona Governor Jan Brewer, who recently signed her state’s breast density notification bill. This makes Arizona the 15^th state to mandate that patients be informed if a mammogram indicates they have dense breast tissue.

Dense breast tissue can make it more difficult to detect cancers using mammography, and women with dense breasts should consult a physician about the possibility of additional screening. The spread of breast density notification bills could impact the utilization of imaging tools such as digital breast tomosynthesis. For more about this exciting technology, check out “Delving into Digital Breast Tomosynthesis” in the current issue of Health Imaging.

-Evan Godt
Editor – Health Imaging