Issue of Mammography False Alarms Must be Addressed

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mammography false positive

According to a recent study, the problem of possible dangers from mammography have been brought out center fold in a New York Times op-ed piece stating that “the false alarms in breast cancer screening are a problem that needs to be fixed."

The op-ed article was predicated on a commentary published online December 30 in JAMA Internal Medicine, which accompanied a small prospective study of a decision aid to help women to get a better handle on the benefits and risks of breast cancer screening.

That study involved women aged 75 years and older, who were given a decision aid pamphlet detailing the risks and benefits of mammography screenings. They reported being better informed about the possible exchanges and seemed to feel less apprehensive about their definitive choices, report Mara A. Schonberg, MD, MPH, and colleagues from Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, Massachusetts.

In the commentary, H. Gilbert Welch, MD, MPH, and Honor J. Passow, PhD, from the Geisel School of Medicine at Dartmouth University in Hanover, New Hampshire, determine that of 1000 US women aged 50 years who are screened year-round for a decade, 0.3 to 3.2 will be spared from dying of breast cancer, 490 to 670 will have at least 1 false-positive result, and 3 to 14 will be overdiagnosed and overtreated.

“A screening program that falsely alarms about half the population is outrageous" and that "whether you blame the doctors or the system or the malpractice lawyers, it's a problem that needs to be fixed,” said Welch when discussing their findings in the op-ed pages of the New York Times.

In search for at least a temporary solution to the problem, Schonberg and colleagues proffered their decision aid to 84 women, 45 of whom agreed to participate and completed the study. The women, with an average age of 79 and had no history of breast cancer, were handed a pamphlet describing breast cancer risk, life expectancy, competing mortality risks, and possible outcomes of screening. The pamphlet also comprised a values-clarification exercise and asked participants about their intentions in regards to screening following reading the pamphlet.

The authors discovered that the decision aid helped to boost participants' knowledge of the risks and benefits of mammography, as calculated by a median of 1 more question answered correctly on a 10-question index.

Furthermore, among women with a life expectancy of 9 years or less, who would be least likely to benefit from screening, a considerably smaller fraction said they intended to have screening after reading the pamphlet as opposed to before.

"In contrast, we found no difference in screening intentions among women with more than a 9-year life expectancy," the researchers write.

There were no major declines from pre- to post-test in decisional conflict or the number of women who said they preferred to take an active role in decision-making.

All in all, 42 of the 45 women said that they found the decision aid useful and helpful, and 43 said they would recommend it to others.

In their commentary, Welch and Passow acknowledged that their calculations of risks and benefits range widely and that women may prefer better estimates of potential results, such as breast cancer deaths prevented, percentages of false-positive results, and frequency of overdiagnosis.

"Our suspicion is that the top priority for most women would be to have a more precise estimate of the benefit in the current treatment era. It has been 50 years since a randomized trial of screening mammography has been done in the United States. Given the exposure of tens of millions American women to this intervention, perhaps we are due for a second look," they wrote.

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