News | Mammography | June 08, 2017

Are Mammograms Overdiagnosing Small Tumors?

According to Yale Cancer Center experts, many small breast cancers have promising prognosis

mammogram

Photo courtesy of Barco

An analysis of breast cancer data revealed that many small breast cancers have an excellent prognosis because they are inherently slow growing, according to Yale Cancer Center experts. Often, these cancers will not grow large enough to become significant within a patient's lifetime and subsequently early detection could lead to overdiagnosis, said the reseachers. In contrast, large tumors that cause most breast cancer deaths often grow so quickly that they become intrusive before they can be detected by screening mammography, they note.

The study, published June 8 in the New England Journal of Medicine, questions the value of breast cancer early detection.

"Our analysis explains both how mammography causes overdiagnosis and also why it is not more effective in improving outcomes for our patients. More importantly, it questions some of our fundamental beliefs about the value of early detection," said Donald R. Lannin, M.D., professor of surgery at Yale School of Medicine and lead author on the paper.

The research team analyzed invasive breast cancers diagnosed between 2001 and 2013 in the Surveillance, Epidemiology, and End Results (SEER) database and divided them into three prognostic groups based on biologic factors: grade, estrogen receptor (ER) status, and progesterone-receptor (PR) status. The three biologic categories were defined as favorable, intermediate, and unfavorable.

The team, which also included Shiyi Wang, M.D., assistant professor of epidemiology at Yale School of Public Health, then used the expected rate of overdiagnosis of 22% to model the types of breast cancers and patient age ranges that likely account for the majority of overdiagnosis. The results showed that most overdiagnosis occurred in older patients with biologically favorable, slow-growing tumors.

"Until now, we thought that the lead time, or time until a cancer becomes problematic for a patient, for most breast cancers was about three or four years. This paper shows that lead times vary widely depending on the tumor type. A large portion of aggressive cancers have a lead time of two years or less, whereas another large portion of breast cancers grow so slowly that the lead time is 15 to 20 years," Lannin explained.

"It is important that we educate physicians, patients, and the public on the indolent, slow-growing nature of some breast cancers. This knowledge will allow us to individualize treatment options, provide 'personalized medicine,' and avoid the major harms of overdiagnosis, which can result in overtreatment and the anxiety and fear that a cancer diagnosis causes," Lannin said.

For more information: www.nejm.org

Related Content

Siemens Healthineers Introduces Mammomat Revelation Mammography System for Improved Biopsy Workflow
Technology | Mammography | December 11, 2017
Siemens Healthineers unveiled the new Mammomat Revelation premium mammography platform at the 2017 Radiological Society...
Breast Cancer Screening Performance Impacted by Mean Mammographic Compression Pressure
News | Mammography | December 08, 2017
Dutch researchers demonstrated a strong relationship between compression pressure in mammography and breast cancer...
Sponsored Content | Videos | Mammography | December 06, 2017
Martin Yaffe, Ph.D., FAAPM, senior scientist, physical sciences/imaging research, Sunnybrook Health Sciences Centre,
Ikonopedia and Konica Minolta Showcase Integrated Breast Imaging Workflow and Reporting at RSNA
News | Breast Imaging | December 05, 2017
Ikonopedia and Konica Minolta Healthcare Americas Inc. showcased integrated breast imaging workflow and reporting at...
Sponsored Content | Videos | Breast Imaging | December 05, 2017
Stamatia Destounis, M.D., FACR, associate professor, University of Rochester School of Medicine, attending radiologis
Numerous Studies Highlight Importance of Quantitative Breast Imaging Analysis at RSNA 2017
News | Breast Density | November 30, 2017
The importance of quantitative analysis in breast imaging was the focus of numerous abstracts accepted for presentation...
Hologic Receives FDA 510(k) Clearance of Quantra 2.2 Breast Density Assessment Software
Technology | Breast Density | November 28, 2017
Hologic Inc. announced it has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for its...
Eizo RadiForce RX560 Monitor Receives FDA 510(k) for Tomosynthesis and Digital Mammography
Technology | November 20, 2017
Eizo Corp. announced it has received U.S. Food and Drug Administration (FDA) 510(k) clearance for breast tomosynthesis...
Biop Medical Launches Cervical Cancer Diagnosis Technology at MEDICA 2017

Biop Medical cervical cancer detection system

Technology | Women's Health | November 13, 2017
November 13, 2017 — Biop Medical announced it will present its point-of-care...
Overlay Init