Diagnosing the Headlines with Dr. David Brousseau
In our inaugural feature of Diagnosing the Headlines, Dr. David Brousseau provides expert insight on a new draft recommendation proposing that annual mammograms should begin at age 40.
Diagnosing the Headlines is a new series from Envision’s Clinical Center of Excellence that aims to provide expert insight on important healthcare topics that have captured headlines and to unpack the key takeaways that are the most important to patients and clinicians.
On May 10, a federal task force released a new draft recommendation proposing that annual mammograms should begin at age 40, a decade earlier than screenings typically begin.
In our inaugural feature of Diagnosing the Headlines, Dr. David Brousseau, an Envision Site Medical Director and the Chief of Radiology at Mercy Medical Center in Merced, California, provides background on the United States Preventative Services Task Force (USPSTF) and what we should focus on from its recommendations, in addition to where the USPSTF can continue to improve to meet expert consensus in the imaging community.
The following article includes lightly edited excerpts from our Q&A with Dr. Brousseau:
This topic drove a lot of headlines last month. What did you take away from the federal task force’s recommendations?
The USPSTF recently updated its breast cancer screening guidelines, which were initially released in 2009. This most recent version now recommends biannual mammography screening for women ages 40 to 49. The previously issued guidelines excluded these age groups from their recommendation for biannual screening.
Unfortunately, the value of mammographic screening on an annual basis continues to go unrecognized despite their own models demonstrating a further 20 percent reduction in mortality for annual versus biannual screening. The task force also continues to avoid making any recommendations about supplemental screening with ultrasound or MRI for women with dense breasts in whom screening mammography has lowered sensitivity yet considerable lifesaving value. From the perspective of the breast imaging community, the task force continues to place unreasonable overemphasis on issues, such as the rate of biopsy and inconvenience of callback imaging (and presumably of greater significance to them, the associated expense), involved in the overall screening process.
Expert evaluation and consensus throughout the breast imaging community has demonstrated screening efficacy in the 40 to 49 age group for decades. Fortunately, during the last seven years, more published data in association with the many voices from our imaging community and women throughout the U.S. have made the value of screening in this population irrefutable, and the USPSTF data analysis can no longer ignore the importance of screening this additional population of women.
If I were a woman anywhere in the 35-45 age range, I may have felt a lot of anxiety reading these headlines. How would you approach conversations with this patient demographic?
We should recognize that these guidelines are intended as a map for the payer community and do not necessarily have the best interests of young women first and foremost.
Women making choices about when to start and how frequently to perform breast cancer screenings should not be confused about the evolving landscape of the USPSTF guidelines. Trust your doctors and avoid confusing headlines that have more to do with the cost of healthcare than its efficacy and impact on your personal health.
Major medical societies, such as the American College of Radiology (ACR), American College of Obstetrics and Gynecology, Society of Breast Imaging and American College of Surgeons, all recommend that annual screening mammograms begin at age 40. The doctors who contribute to these guidelines only have the patient’s best interests in mind when establishing recommendations. The ACR recommends screening mammography annually, beginning at age 40. A baseline mammogram at age 35 is also a best practice.
What are the positive outcomes we can talk about around early screenings? What does data tell us about early detection?
The data from randomized controlled trials around the world continue to demonstrate a significant reduction in mortality, estimated at more than 40 percent in women who participate in regular screening mammography. There are also associated benefits from early detection, including the need for less aggressive treatment with lower morbidity. Most experts now agree that breast cancers detected at less than 10 mm in size are now essentially curable with appropriate treatment, which can be as simple as a lumpectomy with or without follow-up oral hormonal therapy and nothing more.
Can you sum up the bottom line that we should take from this news?
Early detection is the key to conquering all cancers, and mammography remains our best tool to achieve early detection.
David Brousseau, MD, PhD, is an Envision Site Medical Director and Chief of Radiology at Mercy Medical Center, in Merced, California. He is also medical director of cancer imaging programs at Mercy Medical Center (lung and breast CA and PET imaging, in addition to guiding biweekly Tumor Board).