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USPTF Rebuttal Letter
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May 24th, 2011

Dear Patients:

I wanted to take a few minutes to provide information and clear up the recent controversy regarding screening mammography.  We have received questions from both providers and patients and we are sure you have as well.  Hopefully this information will be helpful in answering your questions and addressing patients’ concerns.

As you probably know, the U.S. Preventive Services Task Force (USPSTF) recently withdrew its support for screening mammography for women 40-49 and for women over 75, and recommended that women ages 50-74 be screened every two years instead of annually.  In addition, they recommended against Clinical Breast Examination and Breast Self-Examination.

Clinicians involved with diagnosing and treating breast cancer disagree with these new guidelines.  The American Cancer Society, American College of Radiology, Society of Breast Imaging, American College of Surgeons and Susan Komen Foundation continue to recommend annual screening mammography beginning at age 40.

Here are some of the real problems with the USPSTF recommendations:

  • The 16-member USPSTF panel did not include any physicians specializing in breast cancer screening, diagnosis or treatment.
  • In our own practice at Norwalk Radiology and Mammography Center, we have diagnosed 112 breast cancers in women under 50 since mid-2007 – more than one every other week!  Most of these would have gone undiagnosed in the early stages, had the USPSTF guidelines been in force.
  • Screening mammography is the most carefully studied test in medical history, with multiple comparison studies world-wide showing a 30% to 63% decrease in breast cancer deaths overall in women undergoing screening mammography.  USPSTF chose to ignore virtually all of these studies, and claimed only a 15% reduction in breast cancer deaths in women 40-49.  The actual decrease in this age group was between 23% and 44%. *
  • The USPSTF claimed that false positive exams cause “harm” to patients by increasing pain and anxiety.  In fact, the vast majority of screening mammograms actually relieve anxiety about breast cancer.  For most women, it is a “good news” exam.  In addition, those women who need additional evaluation after their screening exam are happy to undergo the additional tests if it means finding an abnormality at the earliest possible stage.

We all know that there is no perfect test in medicine, and that mammography is no exception.  However, it is by far the best weapon we have in our war against breast cancer, and it is a proven one.  We urge you to follow the recommendations of the American Cancer Society:

SCREENING MAMMOGRAM EVERY YEAR, BEGINNING AT AGE 40.

Please feel free to call to discuss this issue in more depth.

Yours very truly,

Heather Frimmer M.D.
Director of the Suite for Women’s Imaging
Norwalk Radiology and Mammography Center
148 East Avenue
Norwalk, CT 06851

*Hendrick, R.E.; Helvie, M.A. United States Preventive Services Task Force Screening Mammography Recommendations: Science Ignored. AJR 2011;196:1W112-W116

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Mammography Facts
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April 17th, 2011

News reports and articles about mammography are constantly in the press.  Some of the information can be confusing and difficult to interpret.  For example, in 2009, the US Preventative Services Task Force recommended against annual screening mammography for women in their 40′s.  This recommendation has been vehemently rejected by all major medical organizations with expertise and experience in breast cancer diagnosis and treatment.  The American Cancer Society, American College of Radiology and Society of Breast Imaging, amongst other major organizations, continue to recommend annual screening mammography beginning at age 40.

Mammography is the best available tool to screen for breast cancer and the only screening test for breast cancer which has been proven to save lives. A mammogram can detect an abnormality in the breast up to 1-2 years before a patient or doctor can feel any change. If a woman waits for a breast cancer to become a lump that can be felt, the cancer is more likely to have already spread to her lymph nodes or elsewhere in the body. The goal of screening mammography is detect breast cancer early when treatment is more effective and less harmful.

  • Mammography has reduced the death rate from breast cancer by 30%.
  • 1 in 5 breast cancers occur in women age 40 to 49.
  • 40 % of lives saved by mammography are for women in their 40′s.
  • The ten year risk for breast cancer for a 40 year old woman is 1 in 69.
  • Incidence of breast cancer steadily increases from age 40 to age 75.  There is no abrupt change at age 50.
  • 3/4 of women diagnosed with breast cancer have no family history of breast cancer and are not considered high risk. Screening only women with risk factors will miss the vast majority of breast cancers.

Mammography is not a perfect test.  Some cancers are not visible on mammography, especially in women with dense breast tissue.  Certain women may benefit from additional acreening tests such as breast ultrasound or MRI based on their individual risk factors. In addition, approximately 10 % of women will be called back from their screening mammogram for additional mammographic or ultrasound imaging and possibly needle biopsy. Most women are happy to undergo this evaluation if it means finding an abnormality at the earliest possible time.

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Radiation In The Press
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October 28th, 2010

Norwalk Radiology & Mammography Center takes special care during every examination to use the lowest radiation dose possible while producing the best images for evaluation.

We have formal Quality Assurance and Quality Control guidelines that are followed daily:

  • The CT Scanners are checked weekly to ensure that they are within manufacturers’ specification.
  • We have a standard, provided by our Radiation Physicist, for radiation levels that are at or lower than those specified by the manufacturer and American College of Radiology (ACR) guidelines.
  • We subscribe to a philosophy of ALARA – As Low As Reasonably Achievable -where radiation dose is concerned.
  • All Radiologists and Technologists  have signed a “pledge” of adherence proposed by Imaged gently.org as a promise to follow ALARA
  • We review the radiation dose after each CT scan to ensure that the level of radiation did not exceed our established standard.
  • We subscribe to “Image Gently” www.imagegently.org

The risk from a typical Chest CT corresponds to a reduction in our life expectancy by 2 minutes.

A similar reduction in life expectancy is caused by:

  • Crossing the street 5 times (based on the average probability of being killed while crossing a street)
  • Taking a few puffs of a cigarette (each cigarette smoked reduces life expectancy by l0 minutes)
  • An overweight person eating 20 extra calories (e.g., a quarter of a slice of bread and butter)
  • Driving 5 miles in an automobile

Putting it in perspective:

  • Drinking 2 cups of coffee per day is 18 times more of a health risk than an average CT scan
  • Driving 65 mph instead of 55 mph is 29 times more of a health risk than an average CT scan
  • Being 15 lbs. overweight is 326 times more of a health risk than an average CT scan

It would take having 10 consecutive abdomen-pelvis CTs, on the same day, to increase your risk of “possibly” developing cancer by 1 out of one million.

*(a circumstance that would almost never occur in any hospital in the USA)

Another way of looking at it……

What does it really mean?

  • U.S. statistics indicate that irrespective of personal medical history or lifestyle, the potential risk of developing an invasive neoplasm is 37.5% for women and 44.9% for men.
  • Everyone’s statistical risk of dying from cancer in the United States is 25%.
  • The average CT examination “might” increase these odds by 0.025%, However this theory has never been scientifically proven.

Again, please understand that Norwalk Radiology & Mammography Center takes special care during every examination to use the lowest radiation dose possible while producing the best images for evaluation.

For additional information, please refer to the following websites:

www.acr.org

http://www.radiologyinfo.org/en/safety/index.cfm?pg=sfty_xray

IAEA Radiation Protection of Patients

http://rpop.iaea.org/RPOP/RPoP/Content/InformationFor/Patients/index.htm

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