Reston, VA (July 20, 2011) - The American College of Radiology (ACR) and Society of Breast Imaging applaud and support updated American College of Obstetricians and Gynecologists’ (ACOG) recommendations that women begin getting annual mammograms at age 40. The updated ACOG recommendations now correspond with those of the American Cancer Society, ACR, Society of Breast Imaging (SBI), American Society of Breast Disease (ASBD) and many other major medical associations with demonstrated expertise in breast cancer care.

Tabar et al, an update to a landmark study that involved 130,000 women followed over 29 years, re-confirmed that regular mammography screening reduced the breast cancer death rate by 30 percent. This follows the report of the largest breast cancer screening trial ever performed (Hellquist et al), involving a million women over 16 years, which proved that mammography screening reduced breast cancer deaths in women 40-49 by 29 percent. Both fit with National Cancer Institute data that shows that since mammography screening became widespread in 1990, the U.S. breast cancer death rate, previously unchanged for 50 years, has dropped 37 percent.

Women ages 40 and older are strongly encouraged to seek annual mammograms. Those with a family history of breast cancer or other factors that place them at elevated risk for the disease should speak with their doctor about being screened even earlier.

The updated ACOG recommendations, now in-step with those of breast cancer experts, differ from the guidelines of the United States Preventive Services Task Force (USPSTF).

ACOG, like ACR, SBI, and others, placed greater importance on saving lives while the USPSTF was primarily concerned with reducing false positive studies, most of which are resolved by a few additional mammographic views or ultrasound. The USPSTF relied largely on computer modeling to argue that, in women 40-49, only those with a family history of breast cancer or other high-risk factors should be screened and that women 50-74 be screened biennially. However, there is no scientific data to support the age of 50 as a biological threshold for screening. It has been artificially marked by inappropriate grouping of data.

Moreover, 75 percent of women who develop breast cancer are not considered at high-risk for the disease. Screening only high risk women would miss three-quarters of breast cancers. The USPSTF conceded that biennial screening of those 50-74 would miss up to a third of cancers present.

ACR and SBI Statement on BMJ Article Regarding Effect of Mammography on Breast Cancer Death Rates

There is a large body of evidence that mammography screening saves lives. In the mid 1980’s there was a dramatic increase in the number of American women screened. The sudden increase in breast cancer incidence seen in national statistics was followed by an abrupt decrease in deaths that began five to seven years later. This decrease in deaths in conjunction with the onset of screening confirms the favorable results of randomized trials, case-control studies and large population-based evaluations of mammography screening.

Yet, a report in the July 28 British Medical Journal claims there is no evidence that mammography screening served a direct role in reducing breast cancer deaths in European countries where screening has been implemented. The authors compared breast cancer mortality trends in three pairs of adjacent countries (Sweden vs. Norway; Northern Ireland vs. Republic of Ireland; and Belgium vs. Netherlands). Each comparison included a country that introduced mammography screening some years earlier than the other. Comparing breast cancer death rates from 1989-2006, the authors observed similar trends in breast cancer death reduction in each pair. They claim mortality trends are more likely influenced by therapy improvements than mammography screening.

The conclusions of the BMJ study authors have little bearing on, or resemblance to, screening in the United States. Improvements in therapy have, likely, played a role in the decrease in breast cancer deaths, but therapy cannot cure advanced cancers. Early detection via mammography is clearly the major reason for the decrease in deaths in the U.S. This is the life-saving effect that the authors of the BMJ study expected to see in Europe (as was seen in cervical cancer screening). 

While one may intuitively expect to see more dramatic differences in breast cancer death rate declines — based on timing of mammography introduction in Europe — there are several reasons why the analysis published in BMJ failed to do so:

1. The mortality data are contaminated with deaths attributable to breast cancer diagnoses that occurred before screening was introduced. During the period 1986-1996 (and thus, also 1993-2003) half of the breast cancer deaths are attributable to a diagnosis before screening was even offered, much less fully implemented. That leaves insufficient time to measure a population wide effect.

2. Just because two nations share similar geography, does not mean their breast cancer mortality trends are easily compared. Compared with Norway, Sweden had roughly 10 percent greater breast cancer incidence during the study period. It was even greater before the study period began. That would influence mortality rates over time — as mortality rates are a function of incidence rates over time and their corresponding survival. The authors did not adjust for incidence rate differences between comparison nations.

3. While Sweden began introducing screening in 1986, not all counties did so that year. Not all women received a mammogram in 1986. It takes time to invite the population to screening. Full implementation didn't occur until 1992-1993.

4. Not all women who develop breast cancer have been invited to screening. Not all those invited to screening attend screening.

5. The study did not demonstrate how effectively mammography is functioning in comparison countries. The effectiveness of mammography on a population-wide basis is influenced by the attendance rate and the accuracy of the screening.  

Women 40 or over increase their risk of dying from breast cancer by not getting annual mammograms. Mammography also provides opportunity for a wider range of treatment options, and increases odds that less aggressive treatment can be successful. This not only save lives, but quality of life as well.

The American College of Radiology and Society of Breast Imaging continue to recommend that women get annual mammograms starting at age 40. Those with a family history of breast cancer (or other factors that place them at elevated risk for the disease) should speak with their doctor about being screened even earlier.  

FDA Safety Communication: Breast Cancer Screening - Thermography is Not an Alternative to Mammography

Date Issued: June 2, 2011

Audience:

• Women
• Health Care Providers
• Cancer Advocacy Organizations
• National Association of Attorneys General

Medical Specialties: Radiology, Pathology, Internal Medicine, Obstetrics/Gynecology, Oncology, Nursing, General Practice, Breast Surgery, Acupuncture, Osteopathy, Chiropractic.

Product:
Thermographic systems use an infrared camera to produce images (thermograms) that show the patterns of heat and blood flow on or near the surface of the body.

Purpose:
The FDA is issuing this communication to alert the public, including women and health care providers, that thermography is not a replacement for screening mammography and should not be used by itself to diagnose breast cancer. The FDA is not aware of any valid scientific data to show that thermographic devices, when used on their own, are an effective screening tool for any medical condition including the early detection of breast cancer or other breast disease.

Public health agencies and national medical and professional societies agree with FDA that mammography is still the most effective method of detecting breast cancer in its earliest, most treatable stages. These organizations include the American Cancer Society, the American College of Radiology, the Centers for Disease Control and Prevention, the National Cancer Institute and the Society for Breast Imaging.

Summary of Problem and Scope:

Certain facilities, websites, and mobile units are promoting the use of thermography as a stand-alone evaluation tool for screening and diagnosing breast cancer, claiming that is a substitute for or superior to mammography. They also claim that thermography can detect pre-cancerous abnormalities and diagnose breast cancer long before mammography and that compressing the breast during mammography will cause or spread cancer by pushing cancer cells into additional locations in the body. The FDA is concerned that women will believe these misleading claims about thermography and not receive needed mammograms.

Recommendations to Women:

• Have regular mammograms according to screening guidelines or as recommended by your health care provider.
• Follow your health care provider's recommendations for additional breast diagnostic procedures such as various mammographic views, clinical breast exam, breast ultrasound, MRI or biopsy; additional procedures could include thermography.
• Remember that thermography is not a substitute for mammography and should not be used by itself for breast cancer screening or diagnosis.

The ACR and Society of Breast Imaging Statement on Radiation Received to the Thyroid from Mammography

Some Americans have expressed concern, due to an erroneous media report, that the small amount of radiation a patient receives from a mammogram may significantly increase the likelihood of developing thyroid cancer. This concern simply is not supported in scientific literature.

The radiation dose to the thyroid from a mammogram is extremely low. The thyroid is not exposed to the direct X-ray beam used to image the breast and receives only a tiny amount of scattered X-rays (less than 0.005 milligray). This is equivalent to only 30 minutes of natural background radiation received by all Americans from natural sources.

For annual screening mammography from ages 40-80, the cancer risk from this tiny amount of radiation scattered to the thyroid is incredibly small (less than 1 in 17.1 million women screened). This minute risk should be balanced with the fact that thyroid shield usage could interfere with optimal positioning and could result in artifacts - shadows that might appear on the mammography image. Both of these factors could reduce the quality of the image and interfere wiht diagnosis. Therefore, use of a thyroid shield during mammography is not recommended.

Patients are urged not to put off or forego necessary breast imaging care based on this erroneous media report.

For more information on this issue, please see Summary of Thyroid Cancer Risks Due to Mammography by R. Edward Hendrick, PhD, FACR.

For more information on why you should start annual mammograms at 40 years of age, please visit www.MammographySavesLives.org.

April 4, 2011 - copied with permission from the American College of Radiology (ACR)

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