Societies Warn of Study’s Mixed Messages on Screening Recommendations

The American College of Radiology (ACR) and Society of Breast Imaging (SBI) are concerned about mixed messages and the strong emphasis on perceived negative aspects of screening mammographies in an article recently published in JAMA.

“The report says that screening with mammography decreases deaths from breast cancer, and that we agree with,” Carol H. Lee, MD, chair of the ACR Breast Imaging Communications Committee, said in an interview with Diagnostic Radiology. But this message is being lost in the discussion of the harms, she noted. Receiving a call back for more views or an ultrasound cannot be equated to potentially having your life saved.

Lee also pointed out that in reporting overall breast cancer reduction resulting from screening mammography, the authors gave a figure of 19 percent, which is the lowest estimate. “Depending on which study you look at, the rate is as high as in the mid-forties.”

According to a release,, more recent randomized control trials, particularly the largest (Hellquist et al) and longest running (Tabar et al) breast cancer screening studies in history respectively, have reconfirmed that regular mammography screening cut breast cancer deaths by roughly one-third (about double claimed in the JAMA article) in all women aged 40 and over – including women ages 40 to 49.

Concern over the article’s message extends to the mainstream media, which is also emphasizing the possible harm from mammography without putting it into context. The news reports are telling women that they should decide whether or not to have a mammogram based on their individual risk factors, ignoring the fact that the majority of breast cancers occur in women who do not have any identifiable high risk factors or family history of breast cancer. “So if you only limit screening to women who have a family history of breast cancer, you’re going to miss most breast cancers,” said Lee.

The United States Preventative Services Task Force (USPSTF) made similar suggestions to those of the JAMA article, however an analysis published in the American Journal of Roentgenology, using the task force’s own methodology, showed that if USPSTF breast cancer screening guidelines were followed, approximately 6,500 additional women each year in the U.S. would die from breast cancer. It is also likely that thousands more would endure more extensive and expensive treatments than if their cancers were found early by a mammogram.

Mammography isn’t perfect, Lee acknowledged. There are some false positives and some women undergo biopsies that are negative. Nor do mammographies prevent all breast cancers, she said. “It has limitations, but it is clearly the best means we have for picking up early, potentially curable breast cancers. We know it works and it’s been demonstrated over and over again to work.”