Feature | December 10, 2012

New Studies Show Effects of Mammography Guideline Changes

The two mammography images on the left are from a woman in her forties with no family history of breast cancer who underwent a mammogram in 2010 and missed a year of screening. In the interval, her mammogram images from 2012 (two shown on the right) show she developed suspicious right upper out calcifications [ ] and a suspicious mass { }, both of which underwent biopsy, yielding invasive carcinoma.

Mammography image of a woman in her forties with no family history of breast cancer who underwent a mammogram in 2010.

Mammography image (from 2012) of a woman in her forties with no family history of breast cancer who missed a year of screening and in the interval developed suspicious right upper out calcifications [ ] and a suspicious mass { }, both of which underwent biopsy, yielding invasive carcinoma.

December 10, 2012 — Researchers assessing the impact of revised guidelines for screening mammography issued by the U.S. Preventive Services Task Force (USPSTF) found evidence that the new recommendations may lead to missed cancers and a decline in screening, according to two clinical studies presented at the annual meeting of the Radiological Society of North America (RSNA).

Routine screening mammography has traditionally been recommended by both the USPSTF and the American Cancer Society for all women over the age of 40. In 2009, the USPSTF issued controversial new guidelines recommending routine screening with mammography every two years for women 50 to 74 years old. In the studies being presented at RSNA 2012, researchers analyzed the impact of the new guidelines on women between the ages of 40 and 49 and the Medicare population.

"Recommendations on screening mammography are extremely important public policy and we wanted to contribute to that dialogue," said Elizabeth Arleo, M.D., assistant professor of radiology at New York – Presbyterian Hospital — Weill Cornell Medical College in New York City. "We get questions all day long from patients and referring physicians on the appropriateness of screening mammography. The inconsistent information is very confusing for everyone."

For her study, Arleo and a team of researchers analyzed data on screening mammography at New York – Presbyterian Hospital — Weill Cornell Medical College between 2007 and 2010. Over the four years, 43,351 screening exams were performed, which led to the detection of 205 breast cancers.

"Nearly 20 percent of cancers detected with screening mammography were found among women in their 40s, Arleo said. "It seems unacceptable to potentially miss nearly 20 percent of the breast cancers we are identifying. This, in our view, would represent a substantial degree of under-diagnosis."

Of the women screened in the study, 14,528, or 33.5 percent, were between the ages of 40 and 49. Of the 205 breast cancers detected, 39 (19 percent) were found in the 40-49 age group. Of those cancers, more than 50 percent (21 of 39) were invasive. Only three of the women between the ages of 40 and 49 diagnosed with cancer had a first-degree relative with pre-menopausal cancer.

"Our data favor the American Cancer Society recommendations of annual mammograms starting at age 40," Arleo said.

In the second study, a team of researchers analyzed data from The Medicare Part B Physician/Supplier Procedure Summary Master Files for 2005-2010. They calculated the following annual utilization rates for screening mammography per 1,000 female Medicare beneficiaries: 2005, 311.6; 2006, 312.4; 2007, 316.2; 2008, 320.1; 2009, 322.9; and 2010, 309.1.

From 2005 to 2009, the compound annual growth rate for screening mammography utilization was 0.9 percent, compared to a 4.3 percent decline in the utilization rate from 2009 to 2010.

"There was considerable controversy over the task force guidelines, but it was unclear how much they would influence women's choices about screening," said David C. Levin, M.D., professor and chairman emeritus of the Department of Radiology at Thomas Jefferson University Hospital in Philadelphia. "We're not able to tell from the data whether this significant drop in utilization was a result of women deciding to wait another year to have their mammogram, or women over the age of 74 not having the exam. But, clearly, the new USPSTF guidelines have had an effect."

Levin said the drop in the mammography utilization rate is especially concerning, given that the 2009 rate of 322.9 per 1,000 women wasn't particularly high.

"We'll never see 1,000 out of 1,000 women getting a screening mammogram, but you'd like to see that number closer to 1,000, and certainly higher than 322," he said. "We need to continue to follow these numbers and to watch the breast cancer mortality statistics."

Coauthors of Arleo's research are Melissa B. Reichman, M.D., Ruth Rosenblatt, M.D., Kemi T. Babagbemi, M.D., and Brittany Zadek Dashevsky, M.D., Ph.D.

Coauthors of Dr. Levin's research are Andrea J. Frangos, M.P.H., Vijay M. Rao, M.D., Laurence Parker, Ph.D., and Richard Sharpe, M.D., M.B.A.

For more information: www.rsna.org/press12

Related Content

Image courtesy of Philips Healthcare

News | Clinical Trials | July 19, 2018
The use of computed tomography (CT) scans has increased dramatically over the last two decades. CT scans greatly...
Fujifilm to Host Pediatric Imaging Best Practices Symposium at AHRA 2018
News | Pediatric Imaging | July 18, 2018
Fujifilm Medical Systems U.S.A. Inc. announced that it will offer educational opportunities and exhibit its latest...
CT Decision Instrument Reliably Guides Pediatric Blunt Trauma imaging Decisions

This is a four-site prospective observational cohort. Image courtesy of Kirsty Challen, B.Sc., MBCHB, MRES, Ph.D., Lancashire Teaching Hospitals, United Kingdom.

News | Clinical Decision Support | July 18, 2018
A new study finds The Pediatric NEXUS Head Computed Tomography (CT) Decision Instrument (DI) reliably identifies blunt...
Study Points to Need for Performance Standards for EHR Usability and Safety
News | Electronic Medical Records (EMR) | July 18, 2018
A novel new study provides compelling evidence that the design, development and implementation of electronic health...
Artificial Intelligence Provides Faster, Clearer MRI Scans

A new artificial-intelligence-based approach to image reconstruction, called AUTOMAP, yields higher quality images from less data, reducing radiation doses for CT and PET and shortening scan times for MRI. Shown here are MR images reconstructed from the same data with conventional approaches, at left, and AUTOMAP, at right. Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital

News | Artificial Intelligence | July 17, 2018
A research team with funding from the National Institute for Biomedical Imaging and Bioengineering (NIBIB) has...
Study Shows Biomarker Panel Boosts Lung Cancer Risk Assessment for Smokers
News | Lung Cancer | July 16, 2018
A four-protein biomarker blood test improves lung cancer risk assessment over existing guidelines that rely solely upon...
Breast Cancer Follow-up Imaging Varies Widely
News | Breast Imaging | July 13, 2018
July 13, 2018 — Follow-up imaging for women...
Lack of Insurance Coverage Delaying Proton Therapy Clinical Trials
News | Proton Therapy | July 12, 2018
Randomized clinical trials are the gold standard of cancer research and can shed light on whether innovative, new...
Invision Diagnostics Installs VolparaEnterprise Software to Enhance Mammography Image Quality
News | Mammography | July 11, 2018
Invision Diagnostics, a provider of mobile mammography services across North and South Carolina, announced that it is...
Breast Cancer Studies Ignore Race, Socioeconomic Factors
News | Women's Health | July 11, 2018
A new commentary appearing in the July issue of Cancer Causes & Control points to evidence that social factors help...
Overlay Init