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    What price reassurance?

     

    In contrast, the American College of Obstetricians and Gynecologists (ACOG), the American Medical Association, and the American Cancer Society recommend starting screening at age 40 and conducting it annually, with varying age recommendations as to when to stop. Unfortunately, while the US government doesn’t need to worry about the plaintiff’s bar, ob/gyns do, so I doubt many of my colleagues plan to deviate from the ACOG guidelines based on Ong and Mandl’s study.

    However, it is clearly time to develop a more rational and cost-effective approach to breast cancer screening, one that combines demographic, family history, and clinical parameters such as those found in the Gail Model (a version is found at the National Cancer Institute website at www.cancer.gov/bcrisktool/) with genomic and perhaps biochemical tests. I predict that breast cancer screening will follow the evolution seen in obstetrics with aneuploidy screening, wherein maternal age as the sole criteria for testing was replaced by multiple parameters (eg, biochemical, sonographic, and now cell-free fetal DNA testing). But even in such a setting, for an individual woman, the desire to be reassured by screening should be respected. The question is: Who pays the price for such reassurance?

     

    References

    1. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011;61(4):212–236.

    2. National Cancer Institute. Performance measures for 1,838,372 screening mammography examinations from 2004 to 2008 by age: based on BCSC data through 2009. http://breastscreening.cancer.gov/statistics/performance/screening/2009/perf_age.html. Accessed April 19, 2015.

    3. Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L; U.S. Preventive Services Task Force. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151(10):727–737, W237–42.

    4. Ong MS, Mandl KD. National expenditure for false-positive mammograms and breast cancer overdiagnoses estimated at $4 billion a year. Health Aff. (Millwood). 2015;34(4):576–583.

    5. Tosteson AN, Fryback DG, Hammond CS, et al. Consequences of false-positive screening mammograms. JAMA Intern Med. 2014;174(6):954–961.

    6. US Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151(10):716–726.

    7. US Preventive Services Task Force. Draft Recommendation Statement: Breast Cancer: Screening. http://www.uspreventiveservicestaskforce.org/Page/Document/Recommendatio.... Accessed April 21, 2015.

    Charles J. Lockwood, MD, MHCM
    Dr. Lockwood, Editor-in-Chief, is Dean of the Morsani College of Medicine and Senior Vice President of USF Health, University of South ...

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