Dr. Bray Links

Friday, October 31, 2014

Cancer Screening for Women - Some Controversies


"Review Finds Mammography's Benefits Overplayed, Harms Dismissed

Talk to women here in the office, and it quickly becomes clear that we're confused about what to do about mammograms. And no wonder.

Two months ago, a widely publicized Canadian study found that mammograms did not reduce breast cancer deaths, but that study was fiercely criticized by the nation's radiologists as "incredibly flawed and misleading."

A few weeks earlier, an analysis found that screening all women annually starting at age 40, as the American Cancer Society recommends, costs $6.5 billion more a year more than following the U.S. Preventive Service's Task Force recommendation that women be screened every other year starting at age 50.

Now, the latest entries — two studies that try to put all the previous research on mammography's harms and benefits in perspective.

Mammograms are a key screening tool for breast cancer. But critics say they're not good enough.
  
First, researchers at Harvard took a broad look at all the research on mammograms since 1960 — more than 50 years of study. They also looked at evidence on the harms of false positives and overdiagnoses, in which a woman is treated for a cancer that would never have proved deadly. And they reviewed whether current efforts to try to personalize a woman's cancer risk helped a woman figure out whether it was worth her while to get a mammogram.

Their conclusion: The benefits of mammography, though real, have been oversold, while the harms have been minimized."

http://www.npr.org/blogs/health/2014/04/01/297826238/review-finds-mammographys-benefits-overplayed-harms-dismissed

http://www.nytimes.com/2012/11/22/opinion/cancer-survivor-or-victim-of-overdiagnosis.html

http://www.nytimes.com/2014/02/12/health/study-adds-new-doubts-about-value-of-mammograms.html

http://www.nejm.org/doi/full/10.1056/NEJMoa1206809

Yale Cancer Center Studies Find Lifestyle Changes Improve Biomarkers Associated with Breast Cancer Recurrence and Mortality

http://medicine.yale.edu/cancer/news/article.aspx?id=7483


"Older Women May Actually Be More At Risk For Cervical Cancer

Women are often told they don't have to get a Pap test for cervical cancer if they're over 65, but the data behind that recommendation might underestimate their cancer risk, researchers say.

That's because many studies don't take into account that many women have had hysterectomies. The surgery removes a woman's risk of cervical cancer; no cervix, no cancer. And 20 percent of the women over age 20 in this study said they had had that surgery.

When they looked at cancer rates only in women who hadn't had a hysterectomy, the researchers found that the odds of having cervical cancer were higher; 18.6 per 100,000 women, compared to 11.7 cases without that adjustment.
  
And while earlier studies had found that women's risk of cervical cancer peaks in their early 40s, this analysis found that the risk was highest for women in their late 60s. They had a cervical cancer rate of 27.4 cases per 100,000. The rate was higher for African-American women, at 53 per 100,000, compared to 24.7 for white women.

"We started to come to notice that maybe hysterectomy wasn't being taken into account in all studies," says Anne Rositch, an assistant professor in the department of epidemiology and public health at the University of Maryland Medical School and first author of the study. It was published online Monday in the journal Cancer.

Many people think that colon cancer screening is no walk in the park. This giant inflatable colon on display at the University of Miami Health System campus was intended to help them think otherwise.
  
The U.S. Preventive Services Task Force, an independent body that sets practice guidelines, says that women over 65 who aren't at high risk don't need to be screened for cervical cancer. "There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits," the task force guidelines say.

That might be because it can be harder to screen older women for cervical cancer, Rositch told Shots, because of changes in the cervix after menopause. Or it could be because the USPSTF reviewers saw those studies saying that older women have a lower risk. But a study on screening in older women published last year found that women who had ages 55 to 79 who did have a Pap test lowered their cancer risk over the next 5 to 7 years."

http://www.npr.org/blogs/health/2014/05/12/311881892/older-women-may-actually-be-more-at-risk-for-cervical-cancer

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