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Entries in Mammograms (9)

Tuesday
Jan082013

Breast Cancer Screenings Cost Medicare $1B Annually

Comstock/Jupiterimages(NEW YORK) -- Medicare spends almost as much money screening for breast cancer as it does treating it, according to a new study published in JAMA Internal Medicine.

Breast cancer screenings cost Medicare $1.08 billion annually, lead researcher Dr. Cary Gross and his team at the Yale School of Medicine found.  Given that Medicare spends $1.36 billion a year on breast cancer treatment, Gross said he expected the screenings costs to be much lower.

"It should be a call to do further research to identify the best screening strategy," Gross said.  "If we're spending more, does it really help the patients?"

Gross said his study can't conclude whether mammograms are effective, but it does take a good look at where the money is going to prompt further study.

Gross and his colleagues also found that areas where people spent more money on breast cancer screenings didn't have better outcomes than those that didn't.  However, the study was somewhat limited because it only followed up with patients for two years.

"You could argue when it comes to screening, that if you invest more in screening, maybe you'll spend less in treatment," he said.  "But we didn't find that."

About $410.6 million of the total screening costs went toward women over 75 years old, a controversial age group because of a 2009 United States Preventative Services Task Force recommendation that said older women might not benefit from the screenings.

However, the American Cancer Society and several other medical organizations ignored the USPSTF recommendations because they drew different conclusions from the data, said Dr. John Huff, the imaging director of the Vanderbilt Breast Clinic in Tennessee.  Huff did not work on the study.

The American Cancer Society still recommends annual breast cancer screenings for women over 40.

"I think the biggest question is not so much the cost, which we certainly need to be aware of, but the question of what we get for that cost and what value we place on what we get," Huff said, addressing over-diagnosis and over-treatment.

Not unlike slow-growing prostate cancer that doesn't always require treatment, some breast cancers might not need surgery, chemotherapy and radiation, Huff said.  But before the medical community can determine whether over-diagnosis and over-treatment is at play, it must find a way to determine which patients have slow-growing breast cancers and which don't.

"There are some breast cancers that might not need aggressive treatment, but we unfortunately are currently unable to identify which ones they are," Huff said.  "So it's nice to say we might be over-diagnosing or over-treating, but until we have evidence that helps us understand which people those are, it's hard to separate those out as a group.  So we're left being a little less targeted."

Copyright 2013 ABC News Radio

Friday
Aug032012

Breast Cancer: Komen Oversells Mammograms, Doctors Say

iStockphoto/Thinkstock(NEW YORK) -- Two Dartmouth Medical School professors have called out Susan G. Komen for the Cure, accusing the pink-ribbon organization of overstating the benefits of mammograms in its advertisements.

The accusation comes about six months after the breast cancer charity came under fire for cutting Planned Parenthood funding, which it claimed was not a politically motivated decision.  According to the foundation's most recent Form 990, it netted about $114 million in 2010.

The ad in question ran last October in several major magazines, and said, "The five-year survival rate for breast cancer when caught early is 98 percent.  When it's not?  23 percent."

"It sounds like you'd have to be crazy not to get screened.  It sounds like a huge benefit," said Dr. Steven Woloshin, co-author of the article in BMJ, the British medical journal.  "The statistic is totally distorted."

The problem is that a five-year survival rate is easy to manipulate, he said.  The ad compares five-year survival rates for early-stage cancers and late-stage cancers, which Woloshin said is not a meaningful way to measure the benefits of screening.  Here's why:

Suppose three women are diagnosed with breast cancer at age 67 when a doctor finds a small lump, and they die of the disease three years later, when they're 70.  That five-year survival rate is a miserable 0 percent because no one lived five years past their diagnosis dates.

Now, suppose the same women were diagnosed when they were 64 because the cancer showed up on mammograms, but they still die of breast cancer at age 70, he said.  The new five-year survival rate is a triumphant 100 percent, even though the women actually survived cancer the same length of time.  They just didn't know how long they had it.

"If there were an Oscar for misleading statistics, using survival statistics to judge the benefit of screening would win a lifetime achievement award hands down," Woloshin and his co-author Lisa Schwartz wrote.

More useful numbers, Woloshin said, are derived from randomized trials.  They show that 0.53 percent of women in unscreened trial groups died over 10 years -- compared with 0.46 percent of the women who were screened.  That's not much of a difference, the authors said.

This problem is further exacerbated by overdiagnosis, which happens when mammograms detect cancers that never grow or cause symptoms, he said.

For every woman saved by an early screening, two to ten are falsely diagnosed, the authors wrote.  This means patients endure biopsies, chemotherapy and radiation even though they don't have a threatening cancer.

"There's no way for an individual to know they've been overdiagnosed," Woloshin said, explaining that the only way to tell whether this has happened to a specific person is if that person is diagnosed, does not seek treatment and eventually dies of something else.

Doctors have seen evidence of overdiagnoses in long-term follow-ups to randomized trials and analyses of population data, he said.

In response to the article, Komen's vice president of research, Chandini Portteus, stood by the foundation's stance on mammograms, calling the screenings "the best widely available detection tool that we have today."

She said Komen has contributed funds toward even earlier detection.

"We think it's simply irresponsible to effectively discourage women from taking steps to know what's going on with their health," Portteus said, adding that the foundation is also funding research to determine which tumors will spread.

Woloshin said his article is not saying mammograms are bad.

"Some people benefit while other people are harmed," he said.  "If you don't know, you can't make an informed decision."

Copyright 2012 ABC News Radio

Tuesday
May012012

Transgender Woman Wins Insurance Coverage for Mammogram

Courtesy Beth Scott(NEW YORK) -- Beth Scott was told by her doctor she needed a mammogram, a cancer screening that health insurance usually covers.

She had the mammogram in June 2010, paying $385 out of pocket. But when she submitted the claim to her insurance company, Scott was denied coverage, because Scott is transgender.

But in an appeal that lasted almost two years, the Transgender Legal Defense and Education Fund intervened and announced this week that it had resolved Scott's claim, winning a landmark battle with Aetna.

"I am really pleased and glad it went smoothly," said Scott, 44, who for 11 years has worked as a data integrity specialist for a high-tech company, through which she gets her insurance.

"It's something that gives me hope -- by the fact that Aetna apologized and reimbursed me," she said. "Their willingness to treat transgender people is a positive sign."

Her settlement clarified that "these denials would not happen in the future," said TLDEF staff attorney Noah Lewis. "It also added a provision to allow transgender individuals to change their sex on their insurance records by providing a birth certificate or driver's license."

Lewis said denying health coverage for transgender employees was a "widespread problem and not an isolated incident."

Scott's claim was denied on the grounds that it fell under her policy's exclusion treatments "related to changing sex." She was born biologically male but developed breasts after she underwent estrogen treatments when transitioning to female.

But TLDEF argued that the insurance company's interpretation was "overbroad" and should apply only to medical treatments prescribed to change an individual's sex characteristics. It said that a mammogram had nothing to do with a sex change.

"Transgender people should have their health care needs covered by insurance just like everyone else," said Lewis.

"But as long as exclusions remain in place, Ms. Scott's case makes clear that they cannot be used to deny other medically necessary care simply because someone is transgender," he said.

In 2007, she made the physical switch from male to female, first undergoing the surgical shaving of her Adam's apple and following that with hormones. Neither treatment was covered by Aetna.

Aetna told ABC News that it couldn't talk specifically about Scott's case because of privacy laws but clarified that the ruling had been made by a self-funded Aetna health plan run by Scott's employer.

"What we can say, in general, is that a mammogram is covered in a situation like the one described," said Aetna spokeswoman Cynthia B. Michener in an email to ABC News. "Any denial would have been an error corrected by Aetna in administering the claims in the appeals process."

Since 2009, the company has covered breast cancer screenings for female-to-male transgenders who have not had a mastectomy, as well as prostate cancer screenings for male-to-female transgenders who have retained their prostate, according to Michener.

But advocacy groups are fighting for full medical coverage for sex change treatments.

"The consensus in the medical community is that [being transgender] is a medical condition," said Jennifer Levi, director of the Boston-based Transgender Rights Project at Gay and Lesbian Advocates and Defenders, or GLAD. "It's legitimate and real and has an established protocol for treatment."

Advocates say it is a discriminatory practice when an employer knowingly hires employees who are transgender and then excludes them from basic workplace benefits, as, they say, was the case with Scott.

Copyright 2012 ABC News Radio

Monday
Apr302012

Benefits Outweigh Risks for Mammograms for Women in 40s

Comstock/Jupiterimages(WASHINGTON) -- Do mammograms cause more harm than good? The newest study of breast cancer screening comes down in favor of them. The research, published in the Annals of Internal Medicine, found that the benefits of mammography screenings outweigh the risks -- at least if the tests are done every other year in high-risk women in their 40s.

Women who fit the category had to have at least a two-fold higher risk of developing breast cancer than the average woman. Factors that put women at such risk include having dense breast tissue (about 13 percent of women ages 40 to 49) or having a first-degree relative with the disease (about 9 percent of women ages 40 to 49).

"Benefits" of screening were characterized by increase in life-years and decrease in breast cancer deaths. "Harms" were defined as false positives that can lead to follow-up surgical procedures, pain and anxiety.

Data for the study were taken from three national research groups, including the Breast Cancer Surveillance Consortium (BCSC), Cancer Intervention and Surveillance Modeling Network (CISNET) and the Oregon Evidence-Based Practice Center.

"This research provides important new evidence to support the use of personalized, risk-based breast cancer screening approaches," said Dr. Jean Mandelblatt, lead author of the study and associate director for population sciences at Georgetown Lombardi Comprehensive Cancer Center.

Nevertheless, Mandelblatt said, "I know that women want to know what they should do and the message remains unchanged. They should talk about their risk factors and preferences for the harms of screening with their health care providers to make the best decision for themselves."

Yearly mammograms are currently recommended by the American Cancer Society in women 40 and over, and women should continue their yearly screening as long as they're in good health. These guidelines are different from those of the U.S. Preventive Services Task Force, which currently suggest that women only start receiving mammograms every two years at age 50.

But Dr. Barbara Monsees, professor of women's health and radiology at Washington University School of Medicine in St. Louis, said that most women who develop breast cancer have no known risk factors, and therefore oncologists will miss most cancers if those screenings only happen once every two years.

"Younger women have faster-growing tumors and need to be screened yearly, not every other year," she said.

Copyright 2012 ABC News Radio

Wednesday
Apr112012

FDA Panel Approves Ultrasound Device for Spotting Hidden Breast Tumors

iStockphoto/Thinkstock(WASHINGTON) -- A U.S. Food and Drug Administration panel Wednesday approved the widespread use of an automated ultrasound machine that would give doctors a detailed image of dense breast tissue, helping them to spot cancerous tumors.

The FDA reviewed the safety and effectiveness of the Automated Breast Ultrasound, a device that uses an automated, Xerox-like system to get ultrasound images of breast tissue. ABUS is intended to screen women with dense breast tissue, for whom traditional mammograms may be inadequate.

"We know that mammography is limited by breast density," said Robert Smith, senior director of cancer screening at the American Cancer Society. "Sometimes the glandular tissue is so dense that radiation doesn't penetrate it. You can't see anything."

The dense tissue makes it easy for tumors to hide on traditional mammograms.

Some research estimates that about 40 percent of women have dense breast tissue.

According to ABUS' manufacturer, U-Systems, the device provides 3-D images of breast tissue and is intended for use along with mammograms, not in place of them, and to "increase breast cancer detection" in women with dense breasts who have already received a benign mammogram.

"This panel review, part of the FDA process for assessing new technology, brings us one step closer to an approved adjunctive screening tool for women with dense breasts," said Ron Ho, president and chief executive officer of U-Systems, in a statement.

Some say ultrasound is a valuable tool for finding breast tumors not easily spotted with other tests. Others say greater detection of abnormal spots on ultrasounds would lead to more biopsies but not necessarily better outcomes for women with breast cancer.

Mammograms are the gold standard of breast cancer screenings, and the U.S. Preventive Services Task Force recommends that women over age 50 get a mammogram once every two years to screen for breast cancer. Some groups, such as the American Cancer Society and the American College of Obstetrics and Gynecology, recommend that women begin getting mammograms at age 40.

For women at an increased risk of breast cancer, such as those with dense breasts or those who have had breast cancer before, doctors may use additional screening tools, such as MRIs or ultrasound, to check their breasts for problems.

Doctors currently use handheld ultrasound devices to hunt for breast tumors in some patients. But the practice is labor-intensive and depends on ultrasound technicians, who are often few and far between at hospitals around the country.

"One of the major drawbacks of handheld ultrasound is that it takes a lot of time," said Dr. Nagi Khouri, director of breast imaging at the Johns Hopkins Outpatient Center in Baltimore. "Whole breast ultrasound is highly desirable if it can be done with ease with few if any drawbacks."

Research has shown more screening does detect more breast cancer. A study published last week in the Journal of the American Medical Association found that annual mammograms combined with ultrasound and MRI significantly increased the detection of breast cancer in more than 2,600 women at higher risk of the disease. Mammograms alone detected cancer in 53 percent of the women, and ultrasound detected 33 additional cases. MRIs found nine cases that were not detected by mammogram or ultrasound.

But only 7.4 percent of those women ended up actually having breast cancer. The findings highlighted concerns that increased detection of breast abnormalities may lead to finding more cancer when there is none, called a false positive. High numbers of false positives could result in unnecessary biopsies and other medical procedures without an actual benefit for women's health.

"The fundamental problem is that we have no evidence that detecting these cancers by ultrasound actually saves lives," Dr. Daniel Kopans, a professor of radiology at Harvard Medical School, told ABC News last week. "With all the effort that has gone into ultrasound screening over the last decade, it is surprising that no one has done a randomized, controlled trial, which is the only way to know if finding these cancers actually saves lives."

Smith said more research on the use of ultrasound and other supplemental imaging is certainly needed, but researchers may find that the risk of finding something that turns out to be nothing may be worth it for some women.

"It may be that the combination of supplemental imaging has higher false positive rate, but I think we can accept a higher false-positive rate if a woman's risk is higher," he said. "Women have said pretty clearly, whatever the risk of a false positive is, they place a higher priority on finding breast cancer early."

Copyright 2012 ABC News Radio

Thursday
Apr052012

Breast Cancer: Women with False-Positive Mammograms at Higher Risk

iStockphoto/Thinkstock(NEW YORK) -- A new study suggests "false alarms" in breast cancer screenings might not be so benign after all.

A Danish study of more than 58,000 women found those who had false-positive mammograms, meaning the results suggested breast cancer when there was none, had a 67-percent higher risk of developing breast cancer later in life compared with women who had negative mammograms.

"The excess breast cancer risk in women with false-positive tests may be attributable to misclassification of malignancies already present at the baseline assessment...or to a biological susceptibility for developing breast cancer in some women without malignancies at baseline," the study authors wrote, describing how dense, irregular breast tissue may disguise or develop into cancer.

The study was published Thursday in the Journal of the National Cancer Institute.

The U.S. Preventive Services Task Force recommends biennial mammograms for women between the ages of 50 and 74. The test, an X-ray of the breast, can detect breast cancer early and increase the odds of survival. But it can also lead to false positives, prompting unnecessary tests and procedures, not to mention anxiety.

"Any abnormal finding sends a woman into a tailspin," said Lillian Shockney, a breast cancer nurse at Johns Hopkins Hospital in Baltimore. "It's awful. But she would rather know if she has something ominous in her breast or not."

It's estimated that for one woman's life to be saved through mammography, 2,000 women have to be screened, and 200 will get a false positive. False positives usually lead to biopsies, which remove a tiny piece of the questionable tissue for further tests. But 10 of 200 women with false positives will undergo unnecessary surgery.

The link between false positives and breast cancer is unclear. But Dr. Susan Love, president of the Dr. Susan Love Research Foundation, said women who have a family history of breast cancer are more likely to have a false positive.

"It so subjective," she said of a radiologist's decision to follow up a suspicious mammogram with a biopsy. "If you had a mother with breast cancer, the radiologist and...probably you yourself would be more aggressive in following up any slightly suspicious abnormality in a screening mammogram."

But there are other, more biological explanations, too.

"Surgery or needle biopsies may cause a local inflammatory or wound-healing reaction, which increases cancer risk," or "the extra radiation from the workup for the false positive could increase breast cancer," said Love. "Or we might be picking up on some subtle change in the microenvironment, the fibrous tissue, that's more conducive to cancer growing. We just don't know."

The study included women between the ages of 50 and 69 in Denmark, a country with a universal health care system.

Dr. Marisa Weiss, president of BreastCancer.org, said American doctors would almost always follow up on suspicious mammogram results out of fear of litigation.

"The biopsy rate is higher here than in places like Denmark," she said. "We have no tolerance for uncertainty or missed diagnoses."

But with advances in diagnostic technology, the false-positive rate is falling. A study published Tuesday in the Journal of the American Medical Association found that using ultrasound and MRI in addition to mammography boosted breast cancer detection in high-risk women.

"Mammography is just one tool in the shed," said Weiss. "One thing this study shows is that additional diagnostic tools need to be used in a careful way to help identify those women who would benefit from a biopsy. We need to give women the benefit of early detection while avoiding both false positives and false negatives."

Weiss said the Danish study also highlighted the importance of routine checkups after a false positive.

"Women who had a false positive still need to be followed carefully over time," she said. "Even though the last thing you want to do is go back for another mammogram."

Copyright 2012 ABC News Radio

Sunday
Feb052012

Political Analysts Say Planned Parenthood Debate ‘Poisonous’

Comstock/Thinkstock(NEW YORK) -- The debate this week over funding between the Susan G. Komen Foundation and Planned Parenthood shows the “corrupt nature that’s happened in politics” is now impacting private groups, according to ABC News political analyst Matthew Dowd.

“This is a corrupt, poisonous part of democracy at work,” Dowd said on the This Week roundtable of the backlash that followed after the Susan G. Komen Foundation announced it was removing funding for mammogram screenings from Planned Parenthood -– before reversing course after a vocal outcry.

“A private foundation can give and dispense money any way it wants,” Dowd added. “I think foundations should be able to make a decision, and if Planned Parenthood wants to go out and raise the money” they lost from the Komen Foundation, they can do so.

AOL Huffington Post Media president Arianna Huffington said the debate showed “social media at work” as supporters of Planned Parenthood galvanized support online.

“This was about women’s health. This was an attempt to politicize it,” Huffington said. “So the attempt to politicize this issue backfired, and people said this is not a left-right issue.”

George Will disputed that idea, saying “This is not about women’s health. This is about providing 300,000 abortions a year. Planned Parenthood cleverly cast this to say we are in the mammogram business. They’re not in the mammogram business.”

“All these people describing themselves as pro-choice said it is illegitimate to choose not to be involved in abortion,” Will added.

Will said the Obama administration’s requirement for Catholic hospitals and other institutions to provide insurance policies that cover contraception services was a greater threat.

Catholic churches protested that requirement at Sunday services last week, reading letters written by church leaders saying the policy infringed on religious freedom.

“On the political side, in Pennsylvania, Michigan, Ohio, particularly, there are lots of blue-collar Catholics who hear this as more bullying,” Will said.

Dowd, who serves on the board of a Catholic hospital in Austin, Texas, agreed that it was an issue of government overreach.

“I think people that run these institutions and are in these services think…why is the federal government doing this, when we’re providing all this care,” Dowd said. “Why is big government getting involved in our business, which we know what to do?”

But Huffington said it was about making contraception available to those who work at Catholic institutions, including non-Catholics who do not oppose contraception.

“The churches are not going to be affected,” Huffington said. “We’re talking about Catholic hospitals that employ a lot of non-Catholics.”

Copyright 2012 ABC News Radio

Wednesday
Oct262011

Scan Van Brings Mammograms to the Street

Photodisc/Thinkstock(NEW YORK) -- Breast Cancer Awareness Month is in full swing with walks, runs and no shortage of pink products for purchase. But the Scan Van in New York City has been pulling in women right off the street for mammograms.

Among the food trucks and street artists, the Scan Van parks on a different street every day and encourages women to walk in and get mammograms right on the truck -- or make an appointment to get one later.

Half of the patients who walk into the truck have no insurance and no way to pay for such screening services at a doctor’s office. But the van’s services are free.

“We’re serving an underserved population, and we make it really convenient because we’re pulling up to where she’s already going to be,” said Mary Solomon, the Scan Van’s program director.

Patricia Yamada, a 65-year-old Manhattan resident, approaches her last week of radiation treatment next week. The Scan Van caught her cancer last year.

“They saved my life. I would not be here without them and the whole program,” Yamada said.

Yamada had not had a mammogram in six years and had no health insurance.

“I saw in a newsletter that the Scan Van was coming to my neighborhood, within walking distance,” Yamada said.

After the doctor at the Scan Van told her something “abnormal” had turned up in her mammogram, the organization placed her with a hospital that could provide her with care and help her with grants to pay for further services to treat what turned out to be cancer.

Yamada went through surgery, chemotherapy and now, at the end of her treatment, said she’s cancer-free.

The current Miss USA, Alyssa Campanella, has been at the Scan Van this month, urging women to go inside and get a mammogram. She told ABC News that she had come across many women who ordinarily would never have gotten a mammogram and decided to come in for testing because it's free and convenient.

“We were parked on 18th Street the other day when I saw two women looking curiously at the van. I told them what we were doing and come to find out they were looking desperately for help getting a mammogram -- they had both done self-exams and found lumps but didn’t have any insurance or a way to pay for the service.”

The world of breast cancer screening was turned upside down when the U.S. Preventive Services Task Force, which is part of the Department of Health and Human Services, released new recommendations in 2009 saying that women should have mammograms only once every two years once they’d passed the age of 50. It also recommended against breast self-exams, saying yearly exams resulted in too many false positives.

Immediately, such organizations as the American Cancer Society spoke out against the new recommendations and suggested that women over 40 should still get annual mammograms and do breast self-exams. But the USPSTF stood by its 2009 findings in its 2011 screening guide.

ABC News reported on a Swedish study in June that suggested mammograms did save lives. The longest-running breast cancer study followed more than 100,000 women for 29 years. The researchers found that seven years of mammograms equaled 30-percent fewer breast cancer deaths when compared with women who did not receive mammograms at all.

A radiologist for the Scan Van, Dr. Richard Stapen, who has reviewed hundreds of abnormal mammogram X-rays over the past six years, told ABC News that the many breast cancers he found were because the women had come in earlier rather than later. The Scan Van suggests that women over the age of 40 should get mammograms once a year.

Stapen said the most devastating cancers statistically happen between the ages of 40 and 50.

“One fourth, or 50,000 of all diagnosed cases in a year, occur between age 40 and 50, so that’s 50,000 women who if they’d waited, wouldn’t be diagnosed until age 50,” Stapen said. “I’m sure if you’re one of these 50,000 diagnosed women, you’re happy you had a mammogram between 40 and 50.”

The Scan Van program, currently in its 24th year, credits itself with finding 732 cancer cases.

As she approaches her final week of radiation treatment, Yamada said all she can think about is writing thank-you notes to the organization that she believes saved her life.

Copyright 2011 ABC News Radio

Wednesday
Oct192011

Too-Frequent Mammograms Can Mean False Positives, Study Finds

Comstock/Jupiterimages(SAN FRANCISCO) -- Here’s one more study to add to the mammogram debate: New research from the University of California at San Francisco found that mammograms often result in false positives, so much so that about half the women who get mammograms each year will receive a false positive within 10 years of their first mammogram.

“False-positive results are common in women undergoing regular mammography and can be reduced by undergoing screening every other year rather than every year,” Dr. Karla Kerlikowske, a professor of epidemiology and biostatistics and co-author of the study, told ABC News. “Women are likely to maximize their chance of benefiting from mammography and minimize the chance of harm by undergoing mammography every other year.”

Federal guidelines currently suggest that women older than 50 receive a mammogram once every two years. But that guideline clashes with recommendations from the American College of Obstetrics and Gynecology and the American Cancer Society -- both organizations recommend women begin getting annual mammograms at 40 years old.

In the study, published in the Annals of Internal Medicine, researchers examined data from nearly 330,000 women between the ages of 40 and 79 taken from a database of mammogram registries throughout the U.S. The study found that for every 10,000 women 40 to 49 years old who was given digital mammograms, two more cases of cancer would be found for every 170 false positives.

Study authors said results should help physicians make informed decisions about mammogram screenings and create personalized treatment plans for patients.

“Targeting women age 40 to 49...provides high-risk women in their 40s the same potential benefit as women in their 50s,” said Kerlikowske. “Targeted screening of women aged 40 to 49 years will more likely benefit those at high risk and not expose average- and low-risk women to unnecessary harms.”

Copyright 2011 ABC News Radio







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