By Marianne Matthews
An article published today (April 2, 2014) in The Journal of the American Medical Association (JAMA) explores the benefits and risks of mammography screening, and the authors’ conclusions are stirring up controversy. Simply put, say the authors, a one-size-fits all approach to screening mammography is not proving to be the best practice. Rather, to maximize the benefit of mammography screening, decisions should be individualized based on patients’ risk profiles and preferences.
This is important news for the radiology community, referring physicians, and most of all, women.
The co-authors – Lydia E. Pace, MD, MPH, of Brigham and Women’s Hospital and Nancy L Keating, MD, of Harvard Medical School and Brigham and Women’s Hospital – conducted a comprehensive review of more than 50 years worth of mammography screening data, articles, and practice recommendations. Their meta-analysis included assessing the literature on the benefits of mammography, the harms of mammography, and individualizing screening decisions and promoting informed decision-making.
Among the harms of screening mammograms, Keating and Pace cite false positives. According to the authors’ report, for a 40- or 50-year-old woman undergoing 10 years of annual mammograms, the cumulative risk of a false-positive result is about 61%. An even greater harm is overdiagnosis. Essentially, that refers to the diagnosis of cancers that never would have become apparent during a woman’s life, either because she dies due to another cause or because the cancer never grew while she was still alive.
Is screening mammography overrated? Have physicians been overselling the benefits and underestimating the harms? Is the “gold standard’ tarnished? This latest evaluation of the data—“A Systematic Assessment of Benefits and Risks to Guide Breast Cancer Screening Decisions”–is likely to fuel the debate over the risks and rewards of screening mammography for a long time to come. For the complete article, click here.