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28-11-2012 | Article

Studies see risks in mammography guideline changes


RSNA meeting release

medwireNews: Two studies presented at the Radiological Society of North America (RSNA) annual meeting identify a higher likelihood of breast cancers going undetected since the controversial US Preventive Service Task Force (USPSTF) changes to screening guidelines in 2009.

One of the studies examined the potential impact of women undergoing screenings every other year instead of annually, and ceasing tests altogether at the age of 74 years - per the reviewed guidelines - and found that women in the Medicare age bracket (over 65 years) were less willing to undergo breast cancer screening than women in other age groups.

The other study found that approximately a fifth of screen-detectable breast cancers would go undiscovered owing to the USPSTF recommendation to start screening at 50 rather than 40 years.

"It seems unacceptable to potentially miss nearly 20 percent of the breast cancers we are identifying," said Elizabeth Arleo, from the New York-Presbyterian Hospital-Weill Cornell Medical College (NYPH-WCMC), and author of the latter study, in a press release. "This, in our view, would represent a substantial degree of under-diagnosis."

Arleo's study involved a retrospective analysis of screening mammograms conducted between 2007 and 2010 at NYPH-WCMC. Out of 43,351 screens, 33.5% of the patients were in their forties. This age bracket also made up 19% of the 205 breast cancers that were detected, with over 50% of them categorized as invasive.

The second study calculated the annual rate that female Medicare beneficiaries utilized screening mammography from 2005 to 2010 - 2010 being the first full year since the USPSTF guidelines were released. By looking at Medicare Part B Physician/Supplier Procedure Summary Master Files, David Levin, from Thomas Jefferson University Hospital, and co-authors found a gradual yet consistent 0.9% increase in screening from 2005 to 2009. From 2009 to 2010 there was a notable 4.3% drop in utilization from 322.9 to 309.1 per 1000 women.

"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." Levin explained. "But, clearly, the new USPSTF guidelines have had an effect."

Levin added that future utilization rates will have to be assessed to see if they correlate with any breast cancer mortality trends.

By Peter Sergo, medwireNews Reporter