It is amazing to me when I am speaking to women that they are surprised and unaware that 80 % of breast cancers that are diagnosed every year are in women that do NOT have a family history of breast cancer. I think the main reason is that family history is stressed so much in the media. Our statistics at KCBC support this fact as well.
So at what age should the average risk women start screening for breast cancer? There has been so much confusion with the recommendations of the U.S. Preventative Task Force under Obama Care stating that instead of starting at age 40, start at 50 and stop screening at 74. I was even surprised when the American Cancer Society changed their guidelines to recommend starting at 45 doing yearly until 54 and then every other year. Unfortunately, I am seeing physicians not recommending screening for their older patients. We diagnose women in their nineties with breast cancer.
Here is a summary of a study published by the American Journal of Roentgenology In May 2017.
Starting breast cancer screening at 50 means that up to 20% of breast cancers could be missed – offering more proof that women between the ages of 40 and 49 should be screened regularly.
Screening mammography guidelines published by the U.S. Preventive Services Task Force (USPSTF) recommend that women begin biennial screening at age 50, While the American Cancer Society (ACS) recommends annual screening starting at age 45 through age 55, with biennial screening thereafter. Both organizations do state that the decision of when to start screening is up to women and their healthcare providers to discuss.
But these guidelines are dangerous, according to a team led by Dr. Jenifer Pitman of Weill Cornell Medical College in New Your City. Pitman and colleagues conducted a study to determine how many cancers might be missed if women between the ages of 40 and 49 were not screened.
“Women in their 40s would probably be interested in knowing what might happen if they were to choose to follow one recommendation over another,” the authors wrote. We found “that during the study period (2014-2016) women in their 40s overall had 18.8% of screen-detected breast cancers – more than 60% of which were invasive… Increasing the risk of a later stage at diagnosis and thus a poorer prognosis.”
I can support whole heartedly and encourage all women from the age of 40 to have a yearly mammogram. This table is food for thought when reviewing the average risk women in the U.S. that is diagnosed with breast cancer.
Incidence of Breast Cancer
A Woman with Average Risk
(No Family History of Breast Cancer)
1 out of 64 – Forty Year Olds
1 out of 50 – Fifty Year Olds
1 out of 25 – Sixty Year Olds
1 out of 12 – Seventy Year Olds
1 out of 8 – Eighty Year Olds
Average Doubling Time of a Breast Cancer:
80 % of women diagnosed every year have NO
Family History of Breast Cancer.
The proper time interval for screening of All
Women over 40:
The Knoxville Comprehensive Breast Center (KCBC) is the first in Tennessee – and is among just a handful of breast centers in the country – to offer an exciting new way to treat breast cancer by freezing the tumor.
This minimally invasive technique, called FROST (Freezing Instead of Resection of Small Tumors), can be done on an outpatient basis at KCBC using local anesthesia.
“There’s nothing better than seeing my patients walk out of the office happy to go home after the procedure because they know that their early stage breast cancer has been taken care of without surgery or a change in the shape of their breast,” said Kamilia Kozlowski, M.D., a clinical breast radiologist and founder of KCBC.
Freezing, also called cryoablation, has been used successfully for decades to treat several types of cancer, most commonly liver, lung and prostate. The process uses liquid nitrogen to freeze tumors and damage the adjacent blood vessels that fuel their growth. “We know that it works in other cancers,” Dr. Kozlowski says. “That is why we are participating in this clinical trial, to prove that it works in breast cancer.”
The technology uses a probe that channels liquid nitrogen to flow within a precise area of the needle so that it creates a freeze zone. This creates what Kozlowski calls an “iceball” around the tumor that freezes and kills it.
This is a minimally invasive procedure done under local anesthesia and ultrasound guidance in the office. The procedure can usually be done in under an hour. Patients can resume normal activity right away.
Kozlowski says FROST offers a safe, effective option for women with early-stage breast cancer (typically with a tumor size of 1.5 cm. or smaller), especially when they are not good candidates for standard treatments (for example, if they have other medical conditions that would make surgery risky). It is also less likely to disfigure the breast because no breast tissue is removed and the aftereffects are “minimal.” Patients receive imaging every six months after the treatment as follow-up.
Currently, the standard of care for early-stage breast cancer is surgery (lumpectomy or mastectomy) followed by radiation and/or chemotherapy. A major drawback of surgery is cosmetic and functional impairment of the breast.
An important added bonus of the FROST treatment is that it may stimulate an immune response in the body that will keep it on the lookout for any stray cancer cells, even after the tumor is destroyed.
“The thinking is that once we freeze the tumor cells and the dead cells enter the blood to be eliminated, the body will perceive them as abnormal and begin creating antibodies to them,” adds Lusi Tumyan, M.D., a diagnostic radiologist and assistant clinical professor in the Department of Diagnostic Radiology at City of Hope who is also participating in this clinical trial. “So not only do you get this freezing effect, you also get this immunological effect. It’s exciting and we should be looking at that effect also.”
An initial five-year, multicenter study of cryoablation to treat early-stage breast cancer sponsored by the National Cancer Institute found it to be 92 percent effective for complete ablation of invasive breast tumors smaller than 2 centimeters and 100 percent effective for complete ablation of invasive ductal breast cancer tumors smaller than 1 centimeter.
Results from this study led to the current FROST trial, for which Dr. Kozlowski is actively recruiting patients. The FROST Clinical Study is currently enrolling women age 50 and older with core needle biopsy proven clinical stage I, T1, (≤1.5 cm.) clinically node negative (N0), unifocal, hormone receptor positive and HER2/neu-negative invasive ductal carcinoma. For more information, please go to www.clinicaltrials.gov.
“This is the future. It offers a noninvasive treatment of breast cancer. Patients can come into our office and they go home the same day. It’s so rewarding to offer this advanced technology to our patients with early stage breast cancer, when appropriate,” said Dr. Kozlowski.
Since its inception in 1983, the Knoxville Comprehensive Breast Center was the first independent breast center of its kind in Tennessee. At KCBC Dr. Kamilia Kozlowski has developed Clinical Breast Radiology, a specialty which differs from traditional radiology in that clinical breast radiologists manage both the diagnostic and clinical aspects of care. Patients are not burdened with visits to multiple specialists, as clinical breast radiologists can diagnose and direct treatment in one setting.
KCBC is a multidisciplinary practice that delivers streamlined, cost-effective care in a comfortable setting. Specialists include clinical breast radiologists, a dedicated breast surgeon, medical oncologists, radiation oncologists, a breast pathologist, plastic and reconstructive surgeon and lymphedema specialist. Find out more by visiting http://www.knoxvillebreastcenter.com.
October 20th, 2017 – Knoxville Comprehensive Breast Center (KCBC) is putting a brand new mobile mammography unit on the road this October during Breast Cancer Awareness Month. The New Mobile is a 37-foot long coach equipped with the latest state of the art digital mammography equipment. The coach was designed especially for women by Dr. Kamilia Kozlowski, founder, and CEO of KCBC.
KCBC was one of the first Mobile Mammography Programs in the Southeast and has been providing mammograms to women since 1987. The Mobile reaches areas all across Tennessee, from Memphis to Kingsport and includes several areas in Eastern Kentucky. This year KCBC estimates the mobile will provide mammograms to over 3000 women.
Nancy Ortiz is the Operations Manager at KCBC and has been working with the mobile program since 1988. She says, “I love the new coach, it is designed with the patient’s convenience and comfort in mind, and gives women throughout the region easier access to mammography.”
There are many reasons that can make scheduling a mammogram difficult, distance to a facility, economics, and work schedules are some examples. That is why KCBC continues to provide access to top quality mammography through the mobile program. The mobile provides services at health fairs, job fairs, workplaces, health centers and more.
KCBC’s Mission Statement is “To Save Lives from the Disease of Breast Cancer” In Dr. Kozlowski’s words, “We are saving lives one mammogram at a time.”
Breast cancer is common in the United States and other developed countries, with one in eight women being diagnosed during their lifetime.
Most women who are diagnosed with breast cancer have no substantial risk factors. I cannot tell you how many patients I have had who tell me, “This can’t be breast cancer. I exercise every day. I eat really healthy and I have no family history of cancer. This can’t happen to me. I do everything right.” And yet they ARE diagnosed anyway.
Our BEST defense is a good offense. Since breast cancer is so very common, our best strategy is to minimize the impact, if and when we are diagnosed with this common disease. Anyone who treats breast cancer can tell you that the earlier the diagnosis, the more likely and easier it is to cure.
Keep in mind that 80% of breast cancers that are diagnosed are in women who have NO family history of breast cancer.
All women in their 40’s should undergo mammograms EVERY year. One out of every 64 forty year old woman, i.e., the average risk woman (a woman with no family history of breast cancer) is diagnosed with breast cancer. Women who are diagnosed with breast cancer in their 40’s make up almost a third of breast cancer deaths because cancers tend to be more aggressive in young women.
Having a mammogram every year results in the fewest breast cancer deaths at all ages. Some women may consider choosing to have a mammogram every other year after age 55. Yet the average doubling time of a breast cancer is one year. So the best interval for screening is one year. If you have dense breast tissue or any family history of breast cancer, you should still have a mammogram EVERY year because your risk is higher than average of having breast cancer.
If you have dense breast tissue, which appears white on the mammogram, you are more likely than the average woman to be diagnosed with breast cancer. In addition, that white tissue can make it harder to see cancers on mammography. Breast ultrasound screening is the best imaging exam to complement the mammogram to find cancers with a dense mammographic pattern. This has been proven in a number of studies.
Optimize your ability to beat this disease by getting a mammogram every year beginning at age 40. Although some women will choose to have less frequent mammograms as they get older, this is not a good idea. Our chances of getting breast cancer increase with age: 1 out 12 seventy-year old women get breast cancer and 1 out of 8 women in their eighties are diagnosed with breast cancer. If older women do not have any overwhelming health problems and are mobile, they should continue with annual mammography. If there is a family history of breast cancer, prior biopsies with abnormal cells or dense tissue, women should continue to get a mammogram EVERY year and ultrasound to help find breast cancers earlier. Help us help you!
In last month’s newsletter, I discussed KCBC’S position on “3D Mammography” there are advantages of breast ultrasound screening over “3D Mammography” despite the current craze over this 3D technique. First, to review “3D Mammography” it is not 3D imaging as it purports in its name. It cannot radiographically image the breast in all 3 dimensions. It still is 2D Mammography but takes multiples slices radiographically in 2 dimensions.
Secondly, the European trial, “ASTOUND Study” demonstrated that standard 2D Mammography which we are all familiar with and breast ultrasound screening found more breast cancers than “3D Mammography” alone.
A study was published in August in Radiology, one of the leading, well-respected monthly radiology journals, by Dr. Soo-Yeon Kim and colleagues from South Korea. The study commenced in January 2004 and was completed in March of 2011. The study included 501 women with breast cancer identified with breast screening ultrasound. Only 15.8% * of these women had high-risk factors for breast cancer. Their results showed that women with dense breasts whose mammograms were negative were also found to have their breast cancers detected on breast ultrasound screening, and had a five-year survival rate of 100% and a recurrence-free survival rate of 98%. They concluded that these results cement breast ultrasound’s important place in the arsenal of breast cancer screening tools. This is because the breast cancers were found when they were small and as a result a significant number of the breast cancers had not spread to local lymph nodes (90.8%) in the axilla. This is key to preventing spread of disease. These results have also been shown in American based studies as well. Keep in mind that women do not succumb to a breast cancer in the breast. This happens when the breast cancer spreads beyond the breast to vital organs. Therefore, it is important to find the breast cancer when it is small.
Additionally, 89% had a less aggressive breast conservation procedure due to the small size of the breast cancer.
It is important to screen women with mammographically dense breasts with breast ultrasound. There is no radiation exposure with breast ultrasound. These two imaging tools find significantly more numbers of breast cancer than “3D mammography” alone. “3D Mammography” has not proven itself to find small node negative breast cancers as of this date.
*15.8% the women in this study had high-risk factors for the developing breast cancer. This means that 84.2% of women were at low risk for developing breast cancer. Just as a reminder, breast cancer screening yearly for all women beginning at 40 is important because it is such a prevalent disease and is the number 1 cause of cancer in women in the U.S.
KCBC’S POSITION ON “3D” MAMMOGRAPHY (TOMOSYNTHESIS)
There is a lot of buzz today in the mammography field about “3D” mammography being more sensitive in detecting breast cancers in dense breasts than the traditional “2D” mammography. At KCBC we receive a lot of questions about this newer technique and why KCBC does not perform “3D” mammography.
First, describing “3D” mammography as such is a misnomer. For it to be truly a 3D technique such as with MRI and CT scanning, the structure being imaged has to be seen in multiple slices from front to back (coronal), side to side (sagittal), and from top to bottom (cranial caudal) views.
“3D” mammography can only image multiple slices from side to side (sagittal) and top to bottom (cranial caudal).
Since 1983 when KCBC opened its doors and saw its first patients, this practice has performed 2D mammography along with breast ultrasound screening for women with dense breasts long before ultrasound was recognized as a valuable adjunct imaging modality to mammography. It was only truly recognized in early 2000.
It is so important to evaluate the dense mammographic pattern with ultrasound in addition to mammography. Ultrasound evaluates the breast tissues differently –sound absorption of tissues which creates images that demonstrate anatomy of the breast. The entire breast is imaged from the skin down to the chest wall. There is no overlapping of tissue which still occurs with “3D” mammography. With breast ultrasound, we can also evaluate the vascularity of questionable findings as well as the stiffness of the questioned findings, which results in additional value of breast ultrasound in the diagnosis of breast abnormalities.
A controlled clinical trial in a large series of patients was presented at the European Breast Cancer Conference in 2016 that compared the sensitivity of “3D” mammography versus 2D mammography and breast ultrasound. The results of the study showed that 2D mammography and breast ultrasound found more cancers than “3D” mammography.
The other statement one hears with “3D” mammography is that there are less callbacks for indeterminate findings. In fact, the callbacks were similar in both techniques utilized. So, one must ask the question, how many cancers is “3D mammography” missing?
At KCBC, we have seen women for second opinions where the “3D” mammography missed cancers involving half of the breast as well as small cancers that were seen in with 2D mammography and breast ultrasound.
Keep in mind, the KCBC Clinical Breast Radiologists are like the European breast radiologists who are recognized as mastologists in Europe. Mastologists are dedicated clinical breast imagers, which is a recognized subspecialty of radiology in Europe. Unfortunately, this subspecialty is not recognized in the U.S. Women and many physicians do not know this important fact. Most radiologists in the U.S. that read mammograms are not dedicated breast radiologists. In fact, most radiologists read multiple imaging modalities for multiple parts of the body and rotate with the other radiologists in their practice to read mammogram images. At KCBC, we specialize in, and are dedicated to treating breast cancer, and therefore read ONLY imaging related to the breast.
In the last few years, some experts have questioned whether DCIS
(ductal carcinoma-in-situ) is a breast cancer.
DCIS means that the cells that line the milk duct have become cancerous which is where most breast cancers begin. As time passes, the entire lumen of the ducts can be filled with the cancer cells. The duct wall then becomes weakened and the DCIS can break through the duct wall and involve the supporting tissues surrounding the duct which contains blood vessels and lymphatics. Now, the breast cancer is a locally invasive breast cancer. This situation can provide the stage when these cancer cells have the opportunity to travel by these conduits to the local lymph nodes in the axilla. This is analogous to sludge within a water pipe. As the sludge begins to accumulate with time, the sludge fills the entire diameter of the pipe which increases the pressure within the pipe and the pipe bursts with water gushing out.
Some experts believe that some DCIS reverts back to normal cells. However, no one has ever proven this theory! The naysayers who state that DCIS is not a cancer feel that women are being over-treated with lumpectomies and radiation therapy or mastectomies and therefore, increase the cost of medicine. Some of the disbelievers feel at the very most we should follow the DCIS with mammography as these cancers are never destined to bother them. These claimed “medical experts” are not dedicated breast radiologists who have read and followed thousands of women with their mammographic studies and other breast imaging techniques for years to know what they espouse to be true, is in fact, true.
With the advent of modern day mammography in the late seventies, DCIS diagnosis has increased yearly from an average of 3% to an average of 20-30% of all breast cancer diagnoses. This is wonderful news for women because women do not die from the DCIS within the breast. However, we all know this can happen but only when the breast cancer becomes locally invasive breast cancer that spreads beyond the breast to the axilla at which time the cancer could spread to vital organs.
Having been a clinical breast radiologist for over 30 years, I have diagnosed many cases of DCIS. There are some women who have chosen not to have surgery at the time of their diagnosis. It may take years; however, I can attest that all of these cancers progressed to locally invasive breast cancer.
So this monthly KCBC newsletter includes an article about a study recently presented at the American Society of Breast Surgeons annual meeting that negates the naysayers of medical experts who state that DCIS can be followed with mammography as DCIS is never destined to bother them.
Kamilia Kozlowski, M.D.
Medical Director of KCBC
ASBrS: No, we’re not overtreating DCIS
By Kate Madden Yee, AuntMinnie.com staff writer
April 15, 2016 — More than 50% of women diagnosed with ductal carcinoma in situ (DCIS) that is inadequately excised will develop a recurrence of the disease or invasive breast cancer within 10 years. This finding indicates that DCIS isn’t being overtreated, according to research presented at the American Society of Breast Surgeons (ASBrS) meeting in Dallas.
The study addresses a key question in the mammography screening debate: whether DCIS is being overdiagnosed and overtreated, Dr. Sadia Khan of the University of Southern California said at an ASBrS press conference. Some have suggested that DCIS should simply be tracked with regular mammography, but this approach could be dangerous, she said.
“DCIS mortality rates tend to be low, but recurrences may lead to more advanced breast disease and therefore more aggressive treatment later,” Khan said. “Given our results, a ‘watch-and-wait’ strategy would be harmful for many women.”
Watch the margins
Khan and colleagues included 1,919 pure DCIS cases, 720 of which were treated with tumor excision alone. Patients were classified into two groups based on the margin of disease-free tissue surrounding the excised tumor.
Women with margins smaller than 1 mm were advised to have a repeat surgical procedure; of these, 124 refused the additional surgery and were considered undertreated DCIS patients for the purpose of the study. The remaining women, 596, had cancer-free margins of at least 1 mm and were considered adequately treated.
The researchers also categorized women by severity of disease: grades I and II (low) or III (high).
Women with low-grade or high-grade DCIS and inadequate disease-free excision margins had a higher probability of recurrence at five and 10 years postdiagnosis than women who had adequate excision margins, Khan and colleagues found.
Cancer recurrence in women with DCIS
Women with adequate margin excision (≥ 1 mm)
Women with inadequate margin excision (< 1 mm)
Low-grade DCIS recurrence rate
At 5 years
At 10 years
High-grade DCIS recurrence rate
At 5 years
At 10 years
“These recurrence rates even for excision alone are too high, regardless of grade — and the rates for women with inadequate excision are worse,” Khan said. “It’s unacceptable. We need to continue with the DCIS treatment standard we have now, which is surgery that results in disease-free margins of 1 mm or more.”
The study results are important because many highly publicized DCIS studies have examined survival rates and not recurrence. But recurrence — especially of invasive disease — leads to more radical treatment than DCIS, which can have a significant negative effect on a woman’s life.
“Treatment for invasive breast cancer recurrence might include lymph node dissection, extensive radiation, or mastectomy, which could significantly lower a woman’s quality of life going forward,” Khan said in a statement released by ASBrS. “Preventing women from living with the aftermath of a subsequent treatment for invasive cancer is as important a goal as saving a life.”
Knoxville Comprehensive Breast Center is bringing back bone densitometry (DXA) to our facility.
Many of our patients and referring physicians have asked us to bring this service back to KCBC and we have listened to you!
What is DXA?
A bone density test is the only test that can diagnose osteoporosis before a broken bone occurs. This test helps to estimate the density of your bones and your chance of breaking a bone. The National Osteoporosis Foundation recommends a bone density test of the hip and spine by a central DXA machine to diagnose osteoporosis. DXA stands for dual energy x-ray absorptiometry.
You can find out whether you have osteoporosis or if you should be concerned about your bones by getting a bone density test. Some people also call it a bone mass measurement test. This test uses a machine to measure your bone density. It estimates the amount of bone in your hip, spine and sometimes other bones. Your test result will help your healthcare provider make recommendations to help you protect your bones.
Who should have a DXA?
The National osteoporosis Foundation recommends that you have a bone density test if:
you are a woman age 65 or older
you are a man age 70 or older
you break a bone after age 50
you are a woman of menopausal age with risk factors
you are a postmenopausal woman under age 65 with risk factors
you are a man age 50-69 with risk factors
A bone density test may also be necessary if you have any of the following:
an X-ray of your spine showing a break or bone loss in your spine
back pain with a possible break in your spine
height loss of ½ inch or more within one year
total height loss of 1½ inches from your original height
If you have any questions about whether or not you need a DXA, you should call your primary care physician or call KCBC at 865-584-0291 and we will be glad to help you.
Lymphedemais an incurable but treatable medical condition caused by injury, trauma or congenital defects in the lymphatic system.
When the impairment becomes so great that the lymphatic fluid exceeds the lymphatic transport capacity, swelling results as an abnormal amount of protein-rich fluid collects in the tissues of the affected area.
Over time, lymphedema (especially if poorly treated) often results in number of complications including infections, disfigurement, pain, and disability. In fact, it may occasionally prove fatal to its sufferers. But while lymphedema cannot be cured, it can be very effectively managed, thus significantly reducing risk.
The recognized standard of care for lymphedema is Complete Decongestive Therapy (CDT). CDT comprises four interacting elements applied in two phases (acute and ongoing): manual lymph drainage (MLD), compression therapy, lymph drainage exercises, and skin care. Each of these four elements are interdependent and imperative to the overall success of treatment however the most basic element is the application of compression to the swollen body part. Compression is to lymphedema what medication is to many other diseases – indispensible!
It is estimated that two to three million Americans suffer from lymphedema, possibly more. Due to a lack of awareness, information, and education (even within the medical community), lymphedema is often misdiagnosed or undiagnosed. Delays in diagnosis or treatment can result in rapid and unchecked progression of the disease.
Why This Legislation Is Needed
Currently, Medicare, and consequently many other policies, do not cover one of the critical components of lymphedema treatment, the medically necessary doctor-prescribed compression supplies used daily in lymphedema treatment. As a result, many patients suffer from recurrent infections, progressive degradation in their condition and eventual disability because they cannot afford the compression supplies required to maintain their condition.
Medicare’s failure to cover compression treatment supplies stems from the fact that these items cannot be classified under any existing benefit category in Medicare statute (law). The Center for Medicare Services (CMS) does not have the authority to add or redefine benefit categories, only Congress does, hence the need for this legislation. Please visit and help support:
The Cancer Risk Assessment Center at KCBC is here for providers or individuals to learn more about their cancer risk, ways to lower that risk, and provide genetic counseling and testing. Through a risk assessment, we examine information regarding personal and family history that can influence cancer risk. The results will allow us to develop a personalized treatment plan with the expectation of prevention and or early detection for cancer. Below is more information regarding cancer risk and risk factors:
What does cancer risk mean? Risk is the probability that an event will happen. When talking about cancer, risk is used to describe the chance a person will develop cancer.
What is a risk factor? A risk factor is anything that increases a person’s chance of developing cancer. Risk factors influence the development of cancer but usually do not directly cause the cancer. Some people with multiple risk factors never develop cancer, while others with no known risk factors do.
Knowing risk information and risk factors can help a person and providers make informed decisions regarding lifestyle and healthcare decisions such as cancer screening tests (like mammogram or colonoscopy), as well as what age to start screening tests, or if another intervention like surgery or medication is available to lower cancer risk.
Evaluation at the center is available to any person concerned about their cancer risk due to personal or family history. A comprehensive risk assessment may include genetic testing. If genetic testing is appropriate for the individual, then pre and post-test genetic counseling is completed. This counseling becomes critical in order for an individual to know the implications, benefits, and limitations to testing.
Many times in order for health insurance companies to cover genetic testing costs a person needs to be evaluated by a board-certified provider with experience and training in cancer genetics. This can include medical geneticists, physicians and nurses with additional training in genetics, or genetic counselors.
In the past year many changes have occurred regarding breast cancer screening. Multiple recommendations have been released from the American Cancer Society, National Comprehensive Cancer Network, US Preventative Services Task Force (USPSTF), and American College of Obstetricians and Gynecologists. Each agency has different ages to begin and end screening, as well as frequency of imaging. Some of this variability in screening is only in reference to women at average risk for breast cancer. The new recommendations from the American Cancer Society and the USPSTF are not intended for women who have a moderate or high risk for breast cancer. The problem this poses is whether both the healthcare provider and woman know her risk level for breast cancer?
Recently our staff at Knoxville Comprehensive Breast Center came across the following NPR Story about BRCA and genetic testing that was on the radio yesterday 03/14/2016 from an oncologist at UT-Southwestern Medical Center. Oncologist Theodora Ross discusses the hereditary nature of cancer and her own predisposition to breast and ovarian cancer, which led her to have a double mastectomy and to have her ovaries removed.
As part of our continuing effort to provide vital information to our patients, we strongly recommend the following article.
Women Should Continue to Begin Annual Mammography Screening at Age 40
January 11, 2016
Washington, DC – If followed, new U.S. Preventive Services Task Force (USPSTF) breast cancer screening recommendations will result in thousands of unnecessary deaths each year and thousands more women enduring extensive and expensive treatment than if their cancer had been found early by an annual mammogram. To ensure access to mammography, Congress delayed for two years any changes to insurance coverage based on these recommendations, while breast cancer experts vet the recommendations and the process by which they were created. Women ages 40-and-older, and their families, should continue to impress upon lawmakers and their health care providers that they want fully insured access to annual mammograms.
As our shared goal is to save the most lives possible from breast cancer, the American College of Radiology (ACR) and Society of Breast Imaging (SBI) continue to recommend that women get yearly mammograms starting at age 40. New American Cancer Society (ACS) breast cancer screening guidelines, and previous data used by the USPSTF to create its recommendations, state that annual screening in women 40-and-older saves thousands more lives each year than screening at a later age and/or less frequent screening.
“Following these USPSTF recommendations would result in lethal consequences
By Mary Newell, MD and Peter R. Eby, MD FSBI, and the Breast Screening Leadership Group
While randomized controlled trials (RCT’s) are the most stringent way to assess whether a certain test of treatment decreases death from a disease, there are other data that can be used to further understand the effect of a test as well. Delivering screening mammograms to the community, i.e., service screening, provides an opportunity to evaluate the effect the test has on the general population when widely used by women.
After RCT’s showed that screening mammography saves lives, population-based national screening programs were put in place in the 1980s and 90s throughout the world. Screening mammography is now a routine part of health care in at least 26 countries (1). Data from many of these programs have been analyzed to see if they confirm the RCT results – that invitation to mammography screening, and more directly, exposure to mammography screening, decreases breast cancer deaths.
The results of cohort studies and case-control studies of service screening confirm the results of RCT’s: deaths from breast cancer decrease when widespread screening programs are introduced. In a case-control trial in Western Australia by Nickson and colleagues, death from breast cancer decreased by 52% among women choosing to be screened compared to women who did not (2). A meta-analysis (summary of many different studies) of Australian and European case-control trials showed that breast cancer deaths decreased by 49% in groups of women who used screening mammography compared to those who did not (2). A cohort study published by Coldman and associates reported that groups of women who participated in Canadian service screening programs had a 40% lower death rate from breast cancer than women who did not (3). A different analysis of cohort studies found that breast cancer deaths were reduced by 43% in populations of women who were screened with mammography (4).
Service studies demonstrate that the benefit of screening mammography in terms of lives saved is even higher than RCT’s indicated. This is in part because they measure the effect of screening on women who actually had mammograms, not just those who were invited to have a mammogram. Service screening studies also tend to measure the effect of more recent screening practices that have benefited from improved mammography technology, better breast positioning techniques, and improved interpretive skills. While RCT’s laid the foundation decades ago, data from recent studies of the effects of widespread screening programs confirm that mammograms save lives.
Data from Population Service Screening
Breast Cancer Screening Programs in 26 ICSN Countries, 2012: Organization, Policies, and Program Reach. U.S. National Institutes of Health International Cancer Screening Network website. http://appliedresearch.cancer.gov/icsn/breast/screening.html. Cited March15,2015
Nickson C, Mason KE, English DR, Kavanagh AM. Mammographic screening and breast cancer mortality: a case-control study and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2012 Sep;21 (9):1479-88. PMID:22956730
Coldman A, Phillips N, Wilson C, et al. Pan-Canadian study of mammography screening and mortality from breast cancer. J Natl Cancer Inst. 2014 Oct 1;10(11). Print 2014 Nov. Erratum in: J Natl Cancer Inst. 2015 Jan’107(1). PMID:25274578
Gabe R, Duffy SW. Evaluation of service screening mammography in practice: the impact on breast cancer mortality. Ann Oncol. 2005;16 Suppl 2:153-62. Review. PMID: 15958448
ACR and SBI Continue to Recommend Regular Mammography Starting at Age 40
Both Agree With ACS That Mammography Screening Saves Lives and That Women Ages 40+ Should Have Access to Mammograms
WASHINGTON, Oct. 20, 2015 /PRNewswire-USNewswire/ — As our shared goal is to save the most lives possible from breast cancer, the American College of Radiology(ACR) and Society of Breast Imaging (SBI) continue to recommend that women get yearly mammograms starting at age 40. New American Cancer Society (ACS) breast cancer screening guidelines, and previous data used by the United States Preventive Services Task Force (USPSTF) to create their recommendations, state that starting annual mammography at age 40 saves the most lives.[pl_button type=”primary” link=”http://www.marketwatch.com/story/acr-and-sbi-continue-to-recommend-regular-mammography-starting-at-age-40-2015-10-20?mod=mw_share_facebook” target=”blank”]Read Full Article[/pl_button]
I very respectfully submit my 2 cents on this topic. I’m not in operations or on the clinical side. I am in marketing and practice relations and have been with reporters the entire day responding to this news.
As such it is on those who have an interest in this topic to put out our own stance and to do so swiftly. Our local patients (and possibly also referring doctors) are relying on our guidance, and without it, they will follow whichever organization they see as “experts.”
Additionally, the ACS’s loosening of their recommendations gives some ammunition to the US Preventive Services Task Force. If those recommendations are finalized as is (which is expected in the coming weeks), AND legislation is not passed to protect coverage of annual screening and screening mammography for women in their 40’s, then insurance companies will NOT be required to cover screening mammography. There is a lot at risk here, and we need to take steps to ensure coverage is protected.
It is with this push to protect screening mammography in mind that I share this video and petition with you. Over the summer, we interviewed 14 breast cancer survivors in our area and had them share their opinions on the Task Force recommendations. The video is not about Charlotte Radiology, but about these women’s opinions. I urge you to watch it. At the end is a link to an online petition that aims to protect coverage of annual screening mammography and mammography for women in their 40’s.
Please consider signing it and passing it along to your practices to encourage others to sign it. While they are hoping for 5,000 signatures, I believe they truly need closer to 100,000 to be recognized by the folks in D.C.