Risk of annual mammograms

AppId is over the quota
AppId is over the quota
Women with annual mammograms are more likely to experience anxiety from false-positive results. The probability of having an unnecessary biopsy is higher with annual screeningFalse-positive results are a source of anxiety and common in many mammogramsAnnual mammograms not conclusively more effective than biennial screeningsFederal advisory group recommendeds most women get screened once every two years

(Health.com) -- Women who have a screening mammogram every other year are substantially less likely than those who opt for annual screening to experience false-positive results and biopsies that turn out to be unnecessary, according to a new study funded by the National Cancer Institute.

Using data from a nationwide network of breast-cancer registries, researchers analyzed more than 386,000 mammograms from about 170,000 women who began having the breast X-rays between 1994 and 2006.

Over 10 years of screening, the study estimates, 61% of women who have annual mammograms and 42% of women who have biennial mammograms will be called back at least once for a follow-up test that reveals they do not in fact have cancer.

The probability of having an unnecessary biopsy is similarly higher with annual screening. Depending on the age at which they begin screening, 7% to 9% of women who have annual mammograms and 5% to 6% of those who have biennial mammograms will have unnecessary biopsies over a 10-year period, according to the study, which appears this week in the Annals of Internal Medicine.

Health.com: 25 breast cancer myths busted

Annual mammograms were not conclusively more effective than biennial screening at identifying dangerous late-stage cancers, although a slightly higher percentage of women in the biennial group did develop these cancers.

The researchers caution, however, that the small number of women in the study who received a diagnosis of invasive breast cancer (4,492) prevents them from drawing firm conclusions about the effectiveness of one screening schedule over another. A larger study will be needed to clarify that point, they say.

The findings don't show that biennial screening is better than annual screening, or vice versa, but rather that false positives -- a source of anxiety for many women -- are common and "part of the process of screening mammography," says lead researcher Rebecca Hubbard, Ph.D., an assistant investigator at the Group Health Research Institute, the research arm of a nonprofit health plan in Seattle.

"I don't think there is any one right answer," Hubbard says. "I think it's a personal decision where every single woman has to think about what is her risk tolerance, how would she handle a false positive, and her own personal breast cancer risk."

Health.com: How to cut your breast cancer risk at any age

Doctors and researchers have been debating the pros and cons of annual mammograms for years, but the question has taken on added urgency since 2009, when a federal advisory group recommended that most women have mammograms every other year beginning at age 50, rather than every year beginning at age 40.

The group, known as the United States Preventive Services Task Force, suggested that screening decisions should be based on a woman's individual risk as well as her "values" regarding the potential benefits and harms of more frequent screening.

Laura Esserman, M.D., the director of the breast care center at the University of California, San Francisco, says the new study validates the task force's recommendation and "confirms that biennial screening is the best way to go." (Esserman was involved in neither the task force nor the study.)

The increased risk of advanced cancer associated with biennial as opposed to annual screening is "so tiny that [it's] not even relevant," Esserman says. Mammography is primarily useful for catching slow-growing cancers, she says, while fast-growing cancers -- which are more common among younger women, and tend to cause a palpable mass in the breast -- grow so quickly that even annual mammograms could miss them.

Health.com: Fighting the cancer a mammogram can't catch

But Daniel B. Kopans, M.D., a professor of radiology at Harvard Medical School, in Boston, says the implications of the study are not so clear-cut. Studies like this one that analyze large amounts of registry data have certain inherent limitations, even when mitigating factors such as age and family history of cancer are taken into account, he says.

Unlike studies in which women are randomly assigned to receive either annual or biennial screening, the method used by Hubbard and her colleagues can't rule out the possibility that the women who chose to get annual mammograms are different from their peers in unidentified ways that may have skewed the findings, Kopans says.

"The reason that oncologists have not been calling for a cessation to annual screening beginning at the age of 40 is because they know well that the best way for their therapies to cure breast cancer is to find it early," Kopans says. "It is, probably, not a good idea to set the clock back by lengthening the screening interval."

Health.com: How to help a loved one cope with breast cancer

The study has some important shortcomings. For instance, relatively few of the women completed a full decade of annual or biennial mammograms, so the researchers had to resort to statistical modeling to estimate the 10-year probability of false positives and unnecessary biopsies. And most of the mammograms included in the study were traditional film-screen mammograms, not the digital mammograms now in widespread use.

It's not clear how the change in technology might affect the relevance of the findings. In another study in the same issue of the journal, Hubbard and her colleagues compared digital and film mammography. Both techniques were similarly effective, they found, although digital mammography was better at identifying tumors in extremely dense breast tissue and estrogen receptor negative tumors, both of which are more common among women in their 40s.

Hubbard stresses that the greater likelihood of false positives associated with more frequent mammograms shouldn't dissuade women from getting the tests altogether. "It's really important that women are getting screened, and that concern or anxiety about false positive results doesn't become a barrier for participating," she says.

Copyright Health Magazine 2010

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Annual cancer screening tests urged less and less

AppId is over the quota
AppId is over the quota
Annual cancer tests are becoming a thing of the past. New guidelines out Wednesday for cervical cancer screening have experts at odds over some things, but they are united in the view that the common practice of getting a Pap test every year is too often and probably doing more harm than good.

A Pap smear once every three years is the best way to detect cervical cancer, the U.S. Preventive Services Task Force says. Last week, it recommended against prostate cancer screening with PSA tests, which many men get every year.

Two years ago, it said mammograms to check for breast cancer are only needed every other year starting at age 50, although the American Cancer Society still advises annual tests starting at age 40. Earlier this week, a large study found more false alarms for women getting mammograms every year instead of every other year.

"The more tests that you do, the more likely you are to be faced with a false-positive test" that leads to unnecessary biopsies and possible harm, said Dr. Michael LeFevre, one of the task force leaders and a professor of family and community medicine at the University of Missouri. "We see an emerging consensus that annual Pap tests are not required for us to see the benefits that we have seen" from screening, he said.

Those benefits are substantial. Cervical cancer has declined dramatically in the United States, from nearly 15 cases for every 100,000 women in 1975 to nearly 7 per 100,000 in 2008. About 12,200 new cases and 4,210 deaths from the disease occurred last year, most of them in women who have never been screened or not in the past five years.

New proposed guidelines from the cancer society and other groups say using Pap smears together with tests for HPV, the virus that causes cervical cancer, every three to five years is the preferred way to screen women ages 30 to 65. But the government task force concluded the evidence is insufficient "to assess the balance of benefits and harms" of that.

Instead, more lives probably could be saved by reaching women who are not being adequately screened now, the task force says.

And despite what many people suspect, cost has nothing to do with the task force's stance, its leaders said.

"We don't look at cost at all. We really are most concerned about harms," said Dr. Evelyn Whitlock of Kaiser Permanente Northwest's Center for Health Research in Portland, Ore., who led an evidence review for the task force.

Here are some questions and answers about the cervical cancer guidelines.

Q. At what ages should screening start and end?

A. The task force recommends against screening women under 21 or older than 65. Very few cervical cancer cases occur in women under 21, so the old advice to start screening three years after the age of first intercourse has been changed. HPV tests are only approved for women after age 30 because transient infections that don't pose a cancer risk are more common at younger ages.

"We should not be screening teenagers. It's not helping, it's not finding any more cancers and it's creating way too many harms for them," said Debbie Saslow, the cancer society's director of breast and gynecologic cancer.

Q. Should anyone else not be screened?

A. Women who have had their cervix and uterus removed should not be tested, but check with your doctor — not all hysterectomies are complete; some leave the cervix.

Q. What does screening cost?

A. Paps cost $15 to $60; HPV tests run $50 to $100.

Q. Will insurance pay for HPV tests since the government panel doesn't endorse them?

A. Probably. They are included in preventive services that other federal advisers say should be covered under the Affordable Care Act, and the government has continued to pay for mammograms for women who want them even if it is sooner or more often than the task force recommends.

Q. What if I've had the HPV vaccine?

A. Doctors don't know how the vaccine will affect HPV test results or how long the vaccine lasts, so women should still be screened for cervical cancer if they are within the recommended screening ages.

Q. How can I comment on the guidelines?

A. The web sites below tell how. Comments are accepted for a month before guidance is adopted.

___

Online:

Task force advice: http://www.uspreventiveservicestaskforce.org/

Cancer society advice: www.asccp.org/practice-management/molecular-screening-symposium

and http://tinyurl.com/44gnadx

and http://tinyurl.com/257mnge

Cervical cancer science review: http://tinyurl.com/6lc2rzg

CDC on HPV tests: http://www.cdc.gov/hpv/Screening.html

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

Associated Press

Technology

News

Read More

Risk of annual mammograms

AppId is over the quota
AppId is over the quota
Women with annual mammograms are more likely to experience anxiety from false-positive results. The probability of having an unnecessary biopsy is higher with annual screeningFalse-positive results are a source of anxiety and common in many mammogramsAnnual mammograms not conclusively more effective than biennial screeningsFederal advisory group recommendeds most women get screened once every two years

(Health.com) -- Women who have a screening mammogram every other year are substantially less likely than those who opt for annual screening to experience false-positive results and biopsies that turn out to be unnecessary, according to a new study funded by the National Cancer Institute.

Using data from a nationwide network of breast-cancer registries, researchers analyzed more than 386,000 mammograms from about 170,000 women who began having the breast X-rays between 1994 and 2006.

Over 10 years of screening, the study estimates, 61% of women who have annual mammograms and 42% of women who have biennial mammograms will be called back at least once for a follow-up test that reveals they do not in fact have cancer.

The probability of having an unnecessary biopsy is similarly higher with annual screening. Depending on the age at which they begin screening, 7% to 9% of women who have annual mammograms and 5% to 6% of those who have biennial mammograms will have unnecessary biopsies over a 10-year period, according to the study, which appears this week in the Annals of Internal Medicine.

Health.com: 25 breast cancer myths busted

Annual mammograms were not conclusively more effective than biennial screening at identifying dangerous late-stage cancers, although a slightly higher percentage of women in the biennial group did develop these cancers.

The researchers caution, however, that the small number of women in the study who received a diagnosis of invasive breast cancer (4,492) prevents them from drawing firm conclusions about the effectiveness of one screening schedule over another. A larger study will be needed to clarify that point, they say.

The findings don't show that biennial screening is better than annual screening, or vice versa, but rather that false positives -- a source of anxiety for many women -- are common and "part of the process of screening mammography," says lead researcher Rebecca Hubbard, Ph.D., an assistant investigator at the Group Health Research Institute, the research arm of a nonprofit health plan in Seattle.

"I don't think there is any one right answer," Hubbard says. "I think it's a personal decision where every single woman has to think about what is her risk tolerance, how would she handle a false positive, and her own personal breast cancer risk."

Health.com: How to cut your breast cancer risk at any age

Doctors and researchers have been debating the pros and cons of annual mammograms for years, but the question has taken on added urgency since 2009, when a federal advisory group recommended that most women have mammograms every other year beginning at age 50, rather than every year beginning at age 40.

The group, known as the United States Preventive Services Task Force, suggested that screening decisions should be based on a woman's individual risk as well as her "values" regarding the potential benefits and harms of more frequent screening.

Laura Esserman, M.D., the director of the breast care center at the University of California, San Francisco, says the new study validates the task force's recommendation and "confirms that biennial screening is the best way to go." (Esserman was involved in neither the task force nor the study.)

The increased risk of advanced cancer associated with biennial as opposed to annual screening is "so tiny that [it's] not even relevant," Esserman says. Mammography is primarily useful for catching slow-growing cancers, she says, while fast-growing cancers -- which are more common among younger women, and tend to cause a palpable mass in the breast -- grow so quickly that even annual mammograms could miss them.

Health.com: Fighting the cancer a mammogram can't catch

But Daniel B. Kopans, M.D., a professor of radiology at Harvard Medical School, in Boston, says the implications of the study are not so clear-cut. Studies like this one that analyze large amounts of registry data have certain inherent limitations, even when mitigating factors such as age and family history of cancer are taken into account, he says.

Unlike studies in which women are randomly assigned to receive either annual or biennial screening, the method used by Hubbard and her colleagues can't rule out the possibility that the women who chose to get annual mammograms are different from their peers in unidentified ways that may have skewed the findings, Kopans says.

"The reason that oncologists have not been calling for a cessation to annual screening beginning at the age of 40 is because they know well that the best way for their therapies to cure breast cancer is to find it early," Kopans says. "It is, probably, not a good idea to set the clock back by lengthening the screening interval."

Health.com: How to help a loved one cope with breast cancer

The study has some important shortcomings. For instance, relatively few of the women completed a full decade of annual or biennial mammograms, so the researchers had to resort to statistical modeling to estimate the 10-year probability of false positives and unnecessary biopsies. And most of the mammograms included in the study were traditional film-screen mammograms, not the digital mammograms now in widespread use.

It's not clear how the change in technology might affect the relevance of the findings. In another study in the same issue of the journal, Hubbard and her colleagues compared digital and film mammography. Both techniques were similarly effective, they found, although digital mammography was better at identifying tumors in extremely dense breast tissue and estrogen receptor negative tumors, both of which are more common among women in their 40s.

Hubbard stresses that the greater likelihood of false positives associated with more frequent mammograms shouldn't dissuade women from getting the tests altogether. "It's really important that women are getting screened, and that concern or anxiety about false positive results doesn't become a barrier for participating," she says.

Copyright Health Magazine 2010

Education Information

Technology

Read More

Annual cancer screening tests urged less and less

AppId is over the quota
AppId is over the quota
Annual cancer tests are becoming a thing of the past. New guidelines out Wednesday for cervical cancer screening have experts at odds over some things, but they are united in the view that the common practice of getting a Pap test every year is too often and probably doing more harm than good.

A Pap smear once every three years is the best way to detect cervical cancer, the U.S. Preventive Services Task Force says. Last week, it recommended against prostate cancer screening with PSA tests, which many men get every year.

Two years ago, it said mammograms to check for breast cancer are only needed every other year starting at age 50, although the American Cancer Society still advises annual tests starting at age 40. Earlier this week, a large study found more false alarms for women getting mammograms every year instead of every other year.

"The more tests that you do, the more likely you are to be faced with a false-positive test" that leads to unnecessary biopsies and possible harm, said Dr. Michael LeFevre, one of the task force leaders and a professor of family and community medicine at the University of Missouri. "We see an emerging consensus that annual Pap tests are not required for us to see the benefits that we have seen" from screening, he said.

Those benefits are substantial. Cervical cancer has declined dramatically in the United States, from nearly 15 cases for every 100,000 women in 1975 to nearly 7 per 100,000 in 2008. About 12,200 new cases and 4,210 deaths from the disease occurred last year, most of them in women who have never been screened or not in the past five years.

New proposed guidelines from the cancer society and other groups say using Pap smears together with tests for HPV, the virus that causes cervical cancer, every three to five years is the preferred way to screen women ages 30 to 65. But the government task force concluded the evidence is insufficient "to assess the balance of benefits and harms" of that.

Instead, more lives probably could be saved by reaching women who are not being adequately screened now, the task force says.

And despite what many people suspect, cost has nothing to do with the task force's stance, its leaders said.

"We don't look at cost at all. We really are most concerned about harms," said Dr. Evelyn Whitlock of Kaiser Permanente Northwest's Center for Health Research in Portland, Ore., who led an evidence review for the task force.

Here are some questions and answers about the cervical cancer guidelines.

Q. At what ages should screening start and end?

A. The task force recommends against screening women under 21 or older than 65. Very few cervical cancer cases occur in women under 21, so the old advice to start screening three years after the age of first intercourse has been changed. HPV tests are only approved for women after age 30 because transient infections that don't pose a cancer risk are more common at younger ages.

"We should not be screening teenagers. It's not helping, it's not finding any more cancers and it's creating way too many harms for them," said Debbie Saslow, the cancer society's director of breast and gynecologic cancer.

Q. Should anyone else not be screened?

A. Women who have had their cervix and uterus removed should not be tested, but check with your doctor — not all hysterectomies are complete; some leave the cervix.

Q. What does screening cost?

A. Paps cost $15 to $60; HPV tests run $50 to $100.

Q. Will insurance pay for HPV tests since the government panel doesn't endorse them?

A. Probably. They are included in preventive services that other federal advisers say should be covered under the Affordable Care Act, and the government has continued to pay for mammograms for women who want them even if it is sooner or more often than the task force recommends.

Q. What if I've had the HPV vaccine?

A. Doctors don't know how the vaccine will affect HPV test results or how long the vaccine lasts, so women should still be screened for cervical cancer if they are within the recommended screening ages.

Q. How can I comment on the guidelines?

A. The web sites below tell how. Comments are accepted for a month before guidance is adopted.

___

Online:

Task force advice: http://www.uspreventiveservicestaskforce.org/

Cancer society advice: www.asccp.org/practice-management/molecular-screening-symposium

and http://tinyurl.com/44gnadx

and http://tinyurl.com/257mnge

Cervical cancer science review: http://tinyurl.com/6lc2rzg

CDC on HPV tests: http://www.cdc.gov/hpv/Screening.html

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

Associated Press

Technology

News

Read More