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Friday, August 17, 2012

Women endangered by high rate of false-positive mammograms


Women endangered by high rate of false-positive mammograms

Tuesday, October 18, 2011 by: S. L. Baker, features writer http://www.naturalnews.com
(NaturalNews) According to mainstream medicine, mammograms are the key to surviving breast cancer because they supposedly catch the disease early for quick treatment. What this advice invariably leaves out is evidence that exposure to the radiation used in the tests may actually cause breast cancer in some women.

For example, a study presented at the annual meeting of the Radiological Society of North America (RSNA) concluded annual mammography screening significantly increases breast cancer risk in women with a genetic or familial predisposition to the disease (http://www.naturalnews.com/027641_m...).

Now there's another reason to be concerned about the push for women to have yearly mammograms. In a new study by University of California at San Francisco (UCSF) research shows that among women who receive a decade of annual mammograms, more than half of those women will be called and told the gut-wrenching news that their tests are positive when they are actually cancer-free. The victims of false-positive results -- not a malignancy -- are then subjected to more tests. In fact, one in twelve of these women will undergo invasive, potentially breast-scarring biopsy surgery.

"This study provides accurate estimates of the risk of a false-positive mammography and breast biopsy for women undergoing repeat mammography in community practice, and so provides important information about the potential harms of undergoing regular mammography," states Karla Kerlikowske, a professor of medicine at the UCSF School of Medicine. Karla is also the co-author of the study, which was just published in the Annals of Internal Medicine.

False-positive mammogram results are rampant

The research, led by Group Health Research Institute of Seattle for the Breast Cancer Surveillance Consortium, investigated false-positives in mammography by studying the records of approximately 170,000 women between the ages of 40 and 59 from seven regions around the United States. Almost 4,500 of these research subjects were diagnosed with invasive breast cancer.

The study found that women who started having mammograms at age 40 instead of 50 were far more likely to have false-positive findings that resulted in more expensive and needless medical tests, including biopsies.

Just by changing breast screening from every year to every other year, the researchers documented that a woman's risk of having a false-positive finding dropped from 61 percent to 42 percent (about a third) over the course of ten years. What's more, they found that if radiologists would simply review a patient's previous mammograms it "may halve the odds of a false-positive recall."

The U.S. Preventive Services Task Force guidelines now recommend biennial mammograms starting at age 50 and continuing until age 74. However, many doctors still recommend annual mammograms, often beginning at age 40.

The new study concluded that after a decade of yearly screening, a majority of women will receive at least one false-positive result. Out of these, 7 to 9 percent will face having a biopsy and the risks that involves -- from anesthesia complications to scarring to infection -- although these women are, in fact, cancer-free.

And what about the argument that yearly mammograms are needed to catch cancer early enough to cure? The researchers found that women screened every two years were not significantly more likely to be diagnosed with late-stage cancer.

"We conducted this study to help women know what to expect when they get regular mammograms over the course of many years," study leader Rebecca Hubbard, PhD, an assistant investigator at Group Health Research Institute, explained in the media statement. "We hope that if women know what to expect with screening, they'll feel less anxiety if - or when - they are called back for more testing. In the vast majority of cases, this does not mean they have cancer."

Sources for this article include:

http://www.ucsf.edu/news

http://www.annals.org/

http://www.naturalnews.com/024901.html
=======================

The expert branded a woman hater for saying breast cancer screening ruins lives
By Jerome Burne
PUBLISHED: 23:46, 26 March 2012 | UPDATED: 06:25, 27 March 2012
 
'It is a biological fact of life that we cannot avoid getting cancer as we get older,' said Professor Gotzche
What could be more sensible than having a mammogram?
If a tiny tumour is growing in your breast, you want to find it as soon as possible and treat it before it has a chance to spread and become life-threatening.
This simple idea is the basis of a worldwide breast scanning industry that costs billions every year.
The UK programme was launched in 1988, and according to triumphant figures released last week it is screening more women than ever before — nearly 1.9million a year (at a cost of around £96 million).
‘By bringing forward detection and diagnosis, screening helps us find those cancers that might otherwise not be caught until later in life,’ said Sarah Sellars, assistant director for the NHS Cancer Screening Programmes.
However, some experts question whether national screening programmes for breast cancer are such a good idea.
For more than a decade, Peter Gotzsche, a leading Danish professor and statistician, has argued they are a serious mistake: not only do they do little to reduce the death rate from breast cancer, but because women haven’t been told the truth about the risks of mammography, some endure painful disfigurement and completely unnecessary treatment that may have shortened their lives.
Two years ago, when he looked at the figures produced to mark the 20th anniversary of the UK screening programme, Professor Gotzsche’s analysis suggested that for every 2,000 women screened regularly for ten years, just one will benefit from the screening.
At the same time, ten healthy women will, as a consequence, become cancer patients and be treated unnecessarily.
The director of the NHS cancer screening programme, Julietta Patnick, says Gotzsche’s analysis is ‘inaccurate’.
Rather than one life being saved for every ten women who received unnecessary treatment, she says, the true figure was much closer to a one-to-one ratio.
But Gotzsche has blue-chip credentials — he is professor of clinical research design and analysis and leader of the Nordic Cochrane Center at Rigshospitalet in Copenhagen, and an expert in the statistics needed to assess the risks and benefits of screening.
 
Once a mammogram picks up something that might be a tumour, you're on your way to becoming a cancer patient
Yet for almost ten years there has been a concerted campaign to discredit him, while scanning authorities in the UK, U.S. and Europe have done little to address his criticisms.
Many women will be vaguely aware that recently there have been some criticisms of mammograms.
Some may recall the news last October that the NHS leaflet on scanning given to women is to be reviewed following claims it exaggerated benefits and did not spell out the risks.
Analysis of the problems quickly becomes technical and is only available in hard-to-obtain, specialist journals.
Which is why Professor Gotzsche has written a book, Mammography Screening: Truth, Lies And Controversy.
He claims there has been a shocking campaign by the authorities to keep his alternative analysis from women.
The first time he raised concerns was in 2000.
Professor Gotzsche set out his case in an explosive article in the medical journal The Lancet.
Based on analysis of the results of the screening programme in Sweden it concluded mammography was ‘unjustified’ — and it generated a furious response.
Experts in the screening industry expressed ‘dismay’ that it would erode public confidence in screening and urged women to ignore it.
The Department of Health issued a press release saying the NHS Breast Screening programme was a success and there was no new evidence in The Lancet report.
‘Our review was described as riddled with misrepresentations, inconsistencies and errors of method and fact,’ says Professor Gotzsche.
‘But often the attacks didn’t even challenge my research — they were simply personal. I was said to be ignorant, careless and on a crusade against screening.’
His report was originally commissioned by the Danish Board of Health, but when it was delivered the board tried to classify it as a ‘non-paper’, so it couldn’t even be accessed through the country’s Freedom of Information Act.
One of Professor Gotzsche’s chief opponents, Laszlo Tabar, was the author of one of the Swedish trials analysed in The Lancet.
He claimed it showed scanning to be effective and safe and still holds that view.
Recently Tabar said scanning was the best thing to happen for women in 3,000 years, adding: ‘There are still people who don’t like mammography.
'Presumably, they don’t like women.’
Professor Gotzsche says: ‘People who like women, and women themselves, should no longer accept the pervasive misinformation they’re consistently exposed to.’
But what can be wrong with checking to catch breast cancer as early as possible?
If every tumour that showed up on a mammogram eventually spread around the body, no one could object. But cancer isn’t like that.
‘It is a biological fact of life that we cannot avoid getting cancer as we get older,’ says Professor Gotzsche.
‘It’s so common nearly all middle-aged people will have some sign of it and most of them will die without having had any symptoms as a result.’
In other words, scanning finds cancerous changes that would otherwise never have caused a problem in your lifetime.
But once a mammogram picks up something that might be a tumour, you’re on your way to becoming a cancer patient because there are no reliable ways of telling if you’ve got the slow-growing or disappearing type, or if it is going to become dangerously invasive.
You will be sent for a biopsy and, if it’s cancerous, you get the full cancer works — surgery, chemotherapy and radiation, and possibly have your breast removed.
Thousands who would otherwise have remained perfectly healthy — because their cancers would never have caused a problem — become cancer patients.
In his book, Professor Gotzsche quotes a British woman who described what it could involve.
Her scan found a carcinoma in situ — a type of cancerous change in a cell that, in most cases, does not develop into the potentially lethal, invasive form of the disease.
‘I expect I have been classified a screening success,’ she said.
‘Yet everything about my experience tells me the opposite. Screening has caused me considerable and lasting harm.
'Two wide excisions, one partial mutilation (sorry, mastectomy), one reconstruction, five weeks’ radiotherapy, chronic infection, four bouts of cellulitis (a bacterial skin infection), several general anaesthetics, and more than a year off work.’
Thousands of women don’t go through anything as gruelling, but the sheer number overdiagnosed comes as a shock.
Professor Gotzsche has calculated that each year about 70,000 British women are recalled after a ‘false positive’ mammogram result.
In some cases, the cell changes detected by the mammogram weren’t cancerous.
But Professor Gotzsche is really concerned about cells that are cancerous but would never have caused problems.
Known as overdiagnosed cancers, they result in women treated unnecessarily.
Working out how many women had this unnecessary treatment is very complicated, which is why the debate gets so fierce.
‘The crucial question is, how many lives does it save?’ Professor Gotzsche adds.
‘Is it enough to justify the harms inflicted on the healthy population?’
The screening programme officially saves an estimated 1,400 lives every year, but the professor found this couldn’t be true.
By using these figures, says Professor Gotzsche, the NHS has failed to give women honest information on which to make a decision and that just one life is saved while 10 women will be treated unnecessarily.
Some scanning experts have launched vicious personal attacks in response to Professor Gotzsche’s statistical analysis.
‘What is remarkable to me,’ wrote one, ‘is that this man calls himself a scientist since he obviously, knowingly ignores the scientific method to further his own agenda. I cannot believe his is so intellectually deficient.’
Professor Gotzsche has never said women shouldn’t be scanned — he believes women should get a realistic estimate of the benefits and risk, which, right now, they aren’t. That, he says, is a scandal.
Mammography Screening: Truth, Lies And Controversy by Professor Peter Gotzsche (Radcliffe Publishing, £24.99).


Widely used CAD mammography tool fails to find invasive breast cancer, causes needless tests and stress

Thursday, July 28, 2011 by: S. L. Baker, features writer
http://www.naturalnews.com/033161_CAD_mammography_breast_cancer.html
(NaturalNews) Computer-aided detection (CAD) technology, which analyzes mammography images and marks suspicious areas for radiologists to review, has been widely hyped and pushed on women as a way to insure invasive breast cancer is spotted on mammograms. And it has grown into a huge industry, adding millions of dollars to the cost of healthcare.

The problem is, CAD simply doesn't work -- at all. That's right. Despite the fact CAD is now applied to the large majority of screening mammograms in the U.S. with annual direct Medicare costs exceeding $30 million (according to a 2010 study in the Journal of the American College of Radiology), new research by University of California at Davis (UC Davis) scientists shows the expensive technology is ineffective in finding breast tumors.

But it does something extremely well. It causes enormous stress by greatly increasing a woman's risk of being called back for more costly testing following a CAD analyzed mammogram.

The new research, just published in the Journal of the National Cancer Institute, used data from the Breast Cancer Surveillance Consortium to analyze 1.6 million mammograms. Entitled "Effectiveness of Computer-Aided Detection in Community Mammography Practice," the study specifically looked at screening mammograms performed on more than 680,000 women at 90 mammography facilities in seven U.S. states, between the years of 1998 and 2006.

The results are being hailed as the most definitive findings to date on whether the super popular mammography tool is effective in locating cancer in the breast. The findings? CAD is a waste of time and money.

The false-positive rate increased from 8.1 percent before CAD to 8.6 percent after CAD was installed at the medical centers in the study. What's more, the detection rate of breast cancer and the stage and size of breast cancer tumors were similar regardless of whether or not CAD was used.

"In real-world practice, CAD increases the chances of being unnecessarily called back for further testing because of false-positive results without clear benefits to women," Joshua Fenton, assistant professor in the UC Davis Department of Family and Community Medicine, said in a statement to the media. "Breast cancers were detected at a similar stage and size regardless of whether or not radiologists used CAD."

This isn't the first time the CAD technology has been questioned by researchers. The current study follows a previous study of the computer aided mammography tool that was published by Dr. Fenton in the New England Journal of Medicine in 2007.

That examination of mammography screening results in 43 facilities, including seven that used CAD, found that CAD was actually linked to reduced accuracy of mammogram screenings and produced no difference in the detection rate of invasive breast cancer.

"In the current study, we evaluated newer technology in a larger sample and over a longer time period," Fenton noted in a statement to the press. "We also looked for the first time at cancer stage and cancer size, which are critical for understanding how CAD may affect long-term breast cancer outcomes, such as mortality."

CAD software was first approved by the Food and Drug Administration back in 1998, but its use only skyrocketed after Medicare began covering it in 2001. According to 2009 Medicare data, using CAD adds another $12 to the costs of having a mammogram (about $81 for film mammography and $130 for digital mammography), representing a 9 percent to 15 percent additional cost for CAD use.

For more information:

http://www.naturalnews.com/mammograms.html 

POPULAR MAMMOGRAPHY TOOL NOT EFFECTIVE FOR FINDING INVASIVE BREAST CANCER

July 27, 2011
(SACRAMENTO, Calif.) — Computer-aided detection (CAD) technology is ineffective in finding breast tumors, and appears to increase a woman’s risk of being called back needlessly for additional testing following mammography, a large UC Davis study has found.

Joshua Fenton
The analysis of 1.6 million mammograms in seven states has delivered the most definitive findings to date on whether the popular mammography tool is effective in helping find breast cancer.
"In real-world practice, CAD increases the chances of being unnecessarily called back for further testing because of false-positive results without clear benefits to women,” said Joshua Fenton, assistant professor in the UC Davis Department of Family and Community Medicine. “Breast cancers were detected at a similar stage and size regardless of whether or not radiologists used CAD."
The study examined screening mammograms performed on more than 680,000 women at 90 mammography facilities in seven U.S. states from 1998 to 2006.  The false-positive rate typically increased from 8.1 percent before CAD to 8.6 percent after CAD was installed at the facilities in the study.  In addition, the detection rate of breast cancer and the stage and size of breast cancer tumors were similar regardless of CAD. The study, entitled “Effectiveness of Computer-Aided Detection in Community Mammography Practice,” was published online today in the Journal of the National Cancer Institute and used data from the Breast Cancer Surveillance Consortium.
Computer-aided detection software, approved by the Food and Drug Administration in 1998, analyzes the mammogram image and marks suspicious areas for radiologists to review. Its use has skyrocketed in recent years since Medicare began covering it in 2001. CAD is now applied to the large majority of screening mammograms in the U.S. with annual direct Medicare costs exceeding $30 million, according to a 2010 study in the Journal of the American College of Radiology.
According to 2009 Medicare data, insurers including Medicare typically paid about $12 per screening mammogram for CAD in addition to the costs of the mammogram (about $81 for film mammography and $130 for digital mammography), representing a 9 percent to 15 percent additional cost for CAD use.
The current study builds on Fenton’s initial assessment of the technology published in the New England Journal of Medicine in 2007. That report, which examined mammography screening results in 43 facilities, including seven that utilized CAD, found that CAD was associated with reduced accuracy of interpretation of screening mammograms but no difference in the detection rate of invasive breast cancer.
Critics of the research findings in the New England Journal of Medicine said the study was based on use of an older kind of CAD technology, and so did not accurately reflect its usefulness.“In the current study, we evaluated newer technology in a larger sample and over a longer time period,” said Fenton.
“We also looked for the first time at cancer stage and cancer size, which are critical for understanding how CAD may affect long-term breast cancer outcomes, such as mortality.”
The authors write that the results of real-world studies of CAD may differ from results from pre-clinical studies. They suggest that these differences may arise because radiologists in clinical practice don’t always adhere as strictly to use of the technology as designed, as have radiologists in protocol-driven studies.
Fenton’s co-authors are at Group Health Research Institute, Cancer Research and Biostatistics, and the University of Washington, in Seattle; the National Cancer Institute, in Bethesda, MD; University of Vermont, in Burlington; Oregon Health and Science University, in Portland; and Emory University, in Atlanta.
The study was conducted within the national Breast Cancer Surveillance Consortium, which is funded by the National Cancer Institute.  Additional support was provided by the American Cancer Society, along with state public health departments and cancer registries throughout the U.S.
Breast Cancer Surveillance Consortium
The Breast Cancer Surveillance Consortium (BCSC) is a research resource for studies designed to assess the delivery and quality of breast cancer screening and related patient outcomes in the United States. The BCSC is a National Cancer Institute-funded collaborative network of seven mammography registries with linkages to tumor and/or pathology registries. The network is supported by a central Statistical Coordinating Center. Currently, the Consortium's database contains information on over 8 million mammographic examinations, 2.3 million women, and 100,000 breast cancer cases (85,000 invasive cancers and 17,000 ductal carcinomas in situ). For more information, visit http://breastscreening.cancer.gov.
The Center for Health Policy Research (formerly called the Center for Health Services Research in Primary Care) conducts research on health-care access, delivery, costs, outcomes and related health policy to improve the organization, quality and effectiveness of the practice of medicine, especially primary care. The Center is a resource for the university and health system on comparative effectiveness research. Center faculty conduct original research, offer consulting services to agencies in both public and private sectors, and provide research training to fellows, graduate students and junior faculty. Established as an interdisciplinary unit, the center includes more than 80 health-care researchers who represent disciplines ranging from business management and psychiatry to preventative medicine, epidemiology and statistics. For more information, visit www.ucdmc.ucdavis.edu/chpr.

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