ACR challenges BMJ mammo study

Sectra MicroDose L30 full-field digital mammography incorporates photon counting technology.

Discredited and obsolete data used in the updated Forrest model, published Dec. 8 in the British Medical Journal, underestimated lives saved by mammography screening by half. The authors’ comparison of anxiety from false positives to breast cancer deaths is also questionable, according to a Dec. 9 statement issued by the American College of Radiology (ACR).

“The estimated 15 percent reduction in breast cancer deaths used in this study is the same used in 2009 by the U.S. Preventative Services Task Force (USPSTF). That estimate has been discredited by a series of large randomized control trials and other data that prove the benefit is at least twice that,” said Barbara Monsees, MD, chair of the ACR Breast Imaging Commission.

“While anxiety over test results is real, most women simply need another mammogram or ultrasound exam to answer questions about their mammogram. A small number will undergo a benign breast biopsy based on an abnormal screening and subsequent evaluation. However, most women would balk at comparing the anxiety of this with that of dying from breast cancer.”

Recently, the Swedish Two-County Study, a landmark trial that involved 130,000 women followed over 29 years, reconfirmed that regular mammography screening reduced the breast cancer death rate by 30 percent. This followed the largest breast cancer screening trial ever performed, involving a million women over 16 years, which proved mammography screening reduced breast cancer deaths in women ages 40 to 49 by 29 percent.

In addition, Otto et al, published in the Dec. 6 Cancer Epidemiology, Biomarkers & Prevention, showed that mammography screening cuts the risk of dying from breast cancer nearly in half.

According to National Cancer Institute data, since mammography screening became widespread in the early 1990s, the U.S. breast cancer death rate, unchanged for the previous 50 years, has dropped well over 30 percent.

Yet, Raftery and Chorozoglou estimated that mammography screening results in only a 15 percent reduction in breast cancer deaths—the same figure used in the discredited USPSTF recommendations. The U.S. government disavowed those recommendations and barred insurance companies from using them in coverage decisions.

A recent analysis, published in the American Journal of Roentgenology, showed that if USPSTF breast cancer screening guidelines were followed, approximately 6,500 additional women each year in the U.S. would die from breast cancer.