ACR Voices Objections to Breast Cancer Screening Guidelines

Following breast cancer screening guidelines suggested in a study published in the July 5, 2011 issue of Annals of Internal Medicine may negate “the significant, and proven life-saving benefit of mammography in women ages 40 and over and result in thousands of unnecessary breast cancer deaths each year”, according to the American College of Radiology. In the study, authors John T. Schousboe, MD, PhD; Karla Kerlikowske, MD, MS; Andrew Loh, BA; and Steven R. Cummings, MD suggested that for all age groups of women over 40, it is neither cost-effective to perform annual breast cancer screenings nor to screen at all women ages 40 to 49 who are at average risk of breast cancer. Instead, for every age group, the study authors advocate screening at various intervals (or not at all) based on individual risk factors, such as breast density and family history. Screening only high-risk women, the ACR contends, will “miss a large percentage of breast cancers present in American women, resulting in unnecessary deaths. It would also result in more cancers found at a more advanced stage, requiring far more extensive surgeries and aggressive treatment than would otherwise have been necessary. Women with a genetic predisposition to breast cancer account for only about 10 percent of breast cancers diagnosed each year. Other risk factors such as a family history of breast cancer account for only an additional 15%.” Furthermore, the ACR points out, none of the randomized, controlled trials (RCT) to date categorized effectiveness of mammography by groups at elevated risk of breast cancer due to dense breasts, family history, or previous breast biopsies. Since none of the trials stratified by risk, there are no data that directly measure the benefit of screening based on risk. Since the RCT’s all involved the general population, their results are only applicable to the general population. Furthermore, breast parenchymal density measurements need more validation and standardization before they can be considered helpful for determining screening regimens, if ever. The American Cancer Society, American College of Radiology, Society of Breast Imaging and National Comprehensive Cancer Network suggest that high risk women may benefit from supplemental screening (using magnetic resonance imaging in addition to mammography). None of these organizations, however, suggest that mammography screening should be tailored by individual risk factors for women over 40. To read the study abstract, click here: http://annals.org/content/155/1/10.abstract