February 2014
The Breast Cancer Screening Controversy
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Marcia C. Javitt
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Marcia C. Javitt, adjunct professor of radiology at the Uniformed Services University of Health Sciences and AJR section editor for women’s imaging, talked with AJR InBrief about the escalating debate surrounding breast cancer screening in the February 2014 issue of AJR.
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There is fierce debate about breast cancer screening. Who should be screened? How often? With which imaging modality? What about false positives and false negatives? A recent New York Times opinion piece went so far as to declare, “We Are Giving Ourselves Cancer.” How important is breast cancer screening?
Breast cancer screening saves lives. Careful analysis of available evidence shows that the likelihood of preventing breast cancer death exceeds the risk of overdiagnosis. The stakes are high in this discourse because women’s lives hang in the balance.
How is the controversy affecting the practice of radiology?
The question of whether screening mammography does more harm than good has the potential to shake up the state of medical knowledge, alter our views of ethical practice, and alter our application of screening principles.
What does current research say about the potential for harm versus the number of lives saved by screening?
Because the absolute radiation exposure of mammography is low, the radiation risk is also low.
Meta-analyses of randomized controlled trials with women invited to screening after age 40 years show a 20–25% decrease in breast cancer deaths [1, 2]. This is strong evidence that screening mammography reduces breast cancer mortality.
What is happening in technology development that will affect screening accuracy?
Technical innovations, including digital breast tomosynthesis, improved quality standards, and such new screening modalities as whole breast ultrasound are likely to improve breast cancer detection.
We know that genetics plays a role in risk factors for breast cancer. How can that information be used to enhance patient care?
As personalized medicine unfolds, unlocking genetic clues to individual patient risk profiles is essential. Linking imaging findings to genetic expression of tumor aggressiveness will provide us with a tailored approach to breast cancer diagnosis and treatment while minimizing concerns about overdiagnosis.
Read Dr. Javitt’s Section Editor’s Notebook in the February issue of AJR.
References:
- Smith RA, Duffy S, Tabár L. Screening and early detection. In: Barbiera GV, Esteva FJ, Skoracki R, eds. Advanced therapy of breast disease, 3rd ed. Shelton, CT: People's Medical Publishing House, 2011
- Humphrey LL, Helfand M, Chan BK, et al. Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force. Ann InternMed 2002; 137:347–360