News | November 21, 2012

ACR/SBI: Bleyer and Welch Breast Cancer Screening Article in NEJM 'Flawed and Misleading'

November 21, 2012 — The article by Bleyer and Welch[1] in the New England Journal of Medicine, which suggests that screening mammography finds many cancers that would not advance to kill patients, is based on false assumptions, according to the American College of Radiology (ACR) and the Society of Breast Imaging (SBI). The thesis depends on their suggestion that the incidence of breast cancer is much higher than would have been expected had screening not been initiated.

The authors suggest that the baseline incidence of breast cancer would have increased by 0.5 percent each year, when in fact the data show that it would likely have increased by twice that amount. The incidence of invasive breast cancer has actually increased by 1 percent per year for decades.[2] In 1940, it was 60/100,000. By 1980, prior to any screening, it had risen to 100/100,000. If there had been no screening, and the rate had continued to increase as it had for 40 years, the incidence in 2008 would have been more than 130/100,000. In fact, due to prevalence screening, where new women who have never been screened enter the screened population each year, and lead time (cancers found earlier due to screening), the incidence of breast cancer without any "overdiagnosis" would have been expected to be even higher than 130/100,000. In reality, it was lower even than that, at 127/100,000.

Therefore, not only is there no evidence of the authors' claimed "overdiagnosis," but it is likely that treatment of ductal carcinoma in situ (DCIS) over the past decades has reduced the incidence of invasive cancers. This is in addition to the observed 30 percent reduction in deaths each year due largely to screening. While the authors observe that screening is associated with a reduction in advanced stage cancers, ACR and SBI claim that they fail to recognize the fact that a reduction in advanced stage disease is not required to have a reduction in deaths from screening.

References:
[1] Bleyer A, Welch HG. Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence. N Engl J Med 367;21:1998-2005.

[2] Garfinkel L, Boring CC, Heath CW Jr. Changing Trends: An Overview of Breast Cancer Incidence and Mortality. Cancer. 1994 Jul 1;74(1 Suppl):222-7).

Related Content

MRI Reveals Striking Brain Differences in People with Genetic Autism

Example images for a control participant , a deletion carrier, and a duplication carrier. In the sagittal image of the deletion carrier, the thick corpus callosum, dens and craniocervical abnormality, and cerebellar ectopia are shown. For the duplication carrier, the sagittal image shows the thin corpus callosum and the axial image shows the increased ventricle size and decreased white matter volume. Image courtesy of the Radiological Society of North America (RSNA).

News | Neuro Imaging | August 09, 2017
August 9, 2017 — In the first major study of its kind, researchers using magnetic...
Clinical Data Supports Use of Xoft System for Endometrial Cancer
News | Brachytherapy Systems | August 03, 2017
Researchers presented clinical data supporting use of the Xoft Axxent Electronic Brachytherapy (eBx) System for the...
brain with chronic traumatic injury
News | Magnetic Resonance Imaging (MRI) | August 02, 2017
Fighters are exposed to repeated mild traumatic brain injury (mTBI), which has been associated with neurodegenerative...
The ASPIRE Cristalle FFDM system with DBT combines Fujifilm’s state-of-the-art hexagonal close pattern (HCP) detector design, advanced image processing and image acquisition workflow
News | Women's Health | August 01, 2017
Fujifilm Medical Systems U.S.A., Inc. announced that The Mammography Center of Monterey, an ACR-accredited breast...
NIH-funded scientists have discovered that Parkinson’s disease increases the amount of “free” water in a particular brain area

NIH-funded scientists have discovered that Parkinson’s disease increases the amount of “free” water in a particular brain area. Image courtesy of David Vaillancourt, Ph.D., University of Florida.

News | Neuro Imaging | July 31, 2017
Scientists at the University of Florida have discovered a new method of observing the brain changes caused by Parkinson...
more healthcare providers and patients are choosing options such as Gamma Knife stereotactic radiosurgery
News | Radiation Therapy | July 31, 2017
Each year, up to 650,000 people who were previously diagnosed with various forms of cancer will develop brain...
Sponsored Content | Videos | Breast Imaging | July 28, 2017
Nancy Cappello, Ph.D., executive director and founder of Are You Dense Inc. and Are You Dense Advocacy, explains how
"Residual Echo" of Ancient Humans May Hold Clues to Mental Disorders

MRI data shows (left) areas of the skull preferentially affected by the amount of Neanderthal-derived DNA and (right) areas of the brain’s visual system in which Neanderthal gene variants influenced cortex folding (red) and gray matter volume (yellow). Image courtesy of Michael Gregory, M.D., NIMH Section on Integrative Neuroimaging

News | Neuro Imaging | July 26, 2017
Researchers from the National Institute of Mental Health (NIMH) have produced the first direct evidence that parts of...
New York Hospital Finds Significant Cost Savings With Toshiba’s Aquilion One CT
News | Computed Tomography (CT) | July 25, 2017
In five years, Kaleida Health’s Stroke Care Center (SCC) at the Gates Vascular Institute in Buffalo, N.Y., has realized...
Overlay Init