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Entries in Screening (34)

Monday
Nov192012

HIV Testing for Everyone? Experts Say Yes 

ABC News Radio(WASHINGTON) -- About 1.2 million people in the U.S. are HIV-positive. And about one in five of them doesn't know it.

In an effort to broaden the front in the war on AIDS, experts now says almost everyone should be tested for the AIDS virus -- probably including you.
 
Those who don't know they are infected are believed to transmit about 20,000 new cases of AIDS each year.
 
The U.S. Preventive Services task force now recommends that all people ages 15 to 65 get tested for AIDS. Those younger or older who have increased risk factors should also be screened, according to the task force's new recommendations.
 
Risk factors include:

  • unprotected sex with multiple partners
  • any partner with HIV
  • any injection drug use, and
  • exchanging sex for money

The task force also says that all pregnant women should be tested for the HIV virus.
 
Earlier diagnosis means earlier treatment, and that means sharp reductions in the spread of AIDS and in AIDS-related deaths.
 
Copyright 2012 ABC News Radio

Wednesday
Jul182012

Prostate Cancer: Surgery Rarely Best, Researcher Suggests

iStockphoto/Thinkstock(NEW YORK) -- Robert Ginyard is a 49-year-old small business owner from Baltimore. He started having prostate-specific antigen (PSA) testing earlier than most -- age 40 -- because his father had been diagnosed with prostate cancer when he was in his 40s. When, at age 47, his PSA went from 4.8 to 7.1 he was referred to see a urologist. His biopsy showed cancer.

And then there's Eddie Carrillo, 67, a contractor from Los Angeles. He saw his doctor when he was 53 for abdominal discomfort and had a PSA of 7. His biopsy also showed cancer.

Ginyard said he discussed his options at length with his wife and two daughters. Ultimately he opted for surgery. After six months of difficulty with urinary continence and sexual performance, he found himself cancer-free and with no difficulties. He says he is "100 percent satisfied" with his decision to remove his prostate.

Carrillo said he felt pretty healthy, had a number of family members who had side effects from treatment for prostate cancer, and "just didn't like invasive operations." He selected a "watch and wait" approach. For the last 14 years, he has undergone periodic PSA testing and prostate biopsies. He is still feeling healthy, living with prostate cancer. His approach to prostate cancer is "not to be afraid of it. Deal with it, because you can't run from it and it can be lived with."

Two men who opted for very different approaches to basically the same disease.

Now, a new study is stirring the coals as to whether doctors should urge more men to opt for Carrillo's approach and avoid prostate cancer surgery. At stake, potentially, is the health of millions of American men. And not all doctors agree that surgery -- and PSA testing along with it -- should be taken off the table.

The goal of a new study in the New England Journal of Medicine was to see whether observation would be better than surgery for early prostate cancer.

It included 731 men diagnosed with prostate cancer after having high PSA levels. Half of the men were assigned to have surgery, while the other half were assigned to be observed -- with PSA testing every six months and bone scans to look for tumor spread -- every five years.

After 12 years, 47 percent of men assigned to surgery died, compared to 49.9 percent of men assigned to observation -- a difference that was not statistically significant. Meanwhile, more than one in five of the men who underwent surgery had adverse effects from their operation -- though men with very high PSA scores (greater than 10) did have a significant benefit from surgery.

Based on their findings, Dr.Timothy Wilt, lead author on the study, concluded that "observation is a wise and right decision for men with prostate cancer detected by PSA." He said that his study agreed with the recent recommendation by the United States Preventive Services Task Force (USPSTF), which in May 2012 said that PSA should not be tested in men for prostate cancer screening.

Nearly all of the experts contacted by ABC News acknowledged that this study helps identify which patients do not require surgery for their prostate cancer.

However, most of these experts disagreed with the notion that all prostate cancer detected with PSA should simply be observed.

"With early diagnosis and improvements in treatment during the past 20 years, the prostate cancer death rate has decreased by 44 percent in the U.S.," said Northwestern University's Dr. William Catalona, medical director of the Urological Research Foundation and the doctor who developed the PSA test for cancer screening. "This trial should not provide men with another excuse not to get tested or treated for prostate cancer."

"Rather than characterizing the study as showing no benefit from surgery compared to observation, this study provides evidence that surgery will reduce metastasis and death from prostate cancer particularly in men with intermediate or high risk tumors," said Bruce Trock, professor and director of the Division of Epidemiology in the Brady Urological Institute.

Many even felt that the study actually supports testing for PSA.

"This study does not undermine the value of PSA but underscores the importance of proper use of PSA in appropriate populations," said Dr. Phillip Kantoff, professor of medicine at Harvard's Dana Farber Cancer Institute. "The USPSTF fails to distinguish the value of PSA in saving lives from the problem of overtreatment."

While the experts could not agree on how to interpret the findings of this study, they all felt that more research was needed to find better tools to identify which prostate cancers would be slow-growing and harmless -- and which ones could be lethal. Technological advances such as prostate MRI and targeted biopsy are promising options undergoing study.

In the meantime, Ginyard and Carrillo had similar advice for patients who get the news they have prostate cancer.

"Really take time to do your research," Ginyard said. "Make the decision by gathering as much information as you can."

"Make sure you get a second opinion," said Carrillo.

Doctors agreed that this is sound advice.

"Prostate cancer is not a one-size-fits-all disease. It's really a spectrum," said Dr. Martin Sanda, a urologist at Harvard's Beth Israel Deaconess Medical Center.

"The message to patients should be, get tested, have a biopsy if necessary, but be very careful before agreeing to treatment," said Dr. Peter Scardino, chief of surgery at Memorial Sloan-Kettering Cancer Center in New York. "Make sure you have a cancer that really poses a serious risk to your life and health and that the treatment is not worse than the disease."

Copyright 2012 ABC News Radio

Monday
Jul162012

New PSA Testing Recommendations Ignites Debate Again

iStockphoto/Thinkstock(NEW YORK) -- Although the United States Preventive Services Task Force (USPSTF) recently recommended against routine screening for prostate cancer for most men, a panel of experts from the American Society for Clinical Oncology (ASCO) says that many men could benefit from regular testing.

The panel of ASCO experts recommended that men with more than 10 years to live discuss with their doctors the risks and benefits of screening and whether they should get their levels of prostate-specific antigen (PSA) tested. A high level of PSA may indicate the presence of cancer. The USPSTF, on the other hand, said back in May that routine PSA screening could lead to false positives, which in turn could mean overdiagnosis and overtreatment.

Treatment for prostate cancer, the task force noted, may cause a number of problems including erectile dysfunction and urinary incontinence.

ASCO, however, agreed with USPSTF that screening is not recommended for men with 10 years or less to live. Additionally, ASCO did not include a specific age recommendation, only life expectancy. Doctors are not required to abide by ASCO or USPSTF guidelines -- they are only recommendations.

"A lot of men that have a long life expectancy would benefit from screening, especially those that will be diagnosed with aggressive forms of prostate cancer," said Dr. Robert Nam, an ASCO panel co-chair and head of genitourinary cancer care at the Sunnybrook Research Institute in Toronto. "Men with aggressive prostate cancer can benefit from early treatment."

Nam added that the ASCO recommendations include talking with health care providers about other factors to take under consideration, including family history.

He also said that the panel agreed with USPSTF's concern about over-treatment, but is urging men who find out they have high PSA levels to learn how significant the results really are before getting treatment.

"The meaning of a result may be entirely different for different people," he said. "For example, the risk is much greater for an African American male with a family history of prostate cancer than it is for a Caucasian male with no family history, even if they have the same PSA score."

The American Cancer Society and the American Urological Association also agree that men should discuss their options with their doctors before undergoing screening.

In response to the USPSTF guidelines, the American Urological Association said men "who are in good health and have a 10-15 year life expectancy should have the choice to be tested and not be discouraged from doing so." The association also said the USPSTF's "blanket statement" should not be applied to at-risk populations, such as African Americans.

ABC News reached out to the USPSTF for a response to the ASCO recommendations, but the task force, a government-funded panel of independent primary care providers tasked with making preventive health recommendations, has not yet responded.

Nam said despite the recommendations, there is no clear answer on how beneficial PSA testing is. The panel based its decisions on a systematic review of studies done by the Agency for Healthcare Research and Quality (AHRQ). The USPSTF also used AHRQ data, but according to Nam, the data were a bit older and a couple of the studies were not very reliable.

Several doctors told ABC News they approach screening with their patients in a way that is more consistent with ASCO's recommendations.

"It's a much more reasonable and balanced approach than the USPSTF," said Dr. Peter Scardino, chief of surgery at Memorial Sloan-Kettering Cancer Center in New York. "The idea that we stop recommending PSA screening altogether is not tenable."

Scardino said some strong studies have found PSA testing led to a reduction in cancer-specific and overall mortality. Other studies, however, have found PSA testing to have no effect on the number of deaths.

Dr. Gerald Andriole, chief of urologic surgery at Washington University School of Medicine in St. Louis, said after discussing the risks and benefits of screening with his patients, many of them still opt for testing.

"They are worried about having prostate cancer and generally would prefer to have the test, knowing it is imperfect, than not getting tested at all. At least it gives them some information on which to make health decisions," he said.

An approach known as active surveillance involves monitoring low-risk cancers, but not treating them.

"Data to date suggest that with this approach we can identify the more aggressive, large cancers and still successfully treat them," said Andriole. "Active surveillance is apt to be better than early treatment with surgery or radiation therapy for many men with low-risk cancers and should lessen overtreatment."

Experts also agree that the development of better testing could someday provide a more definitive answer to questions about whether to perform routine screening.

Copyright 2012 ABC News Radio

Friday
Jul132012

Soldiers and Veterans Should Have Annual PTSD Screenings, Report Says

iStockphoto/Thinkstock(WASHINGTON) -- Servicemen and women returning from the war zones get screened for post-traumatic stress disorder, but a new report says too little happens after that.

An Institute of Medicine study says that of those who show symptoms, just 40 percent get referred for more treatment. The report also recommends that all service members and veterans should be screened at least once each year.
 
The review, mandated by Congress and funded by the Pentagon and the Veterans Administration, says many soldiers don't get PTSD treatment, worried it could jeopardize their careers.

"[There is] a certain amount of fearfulness around having psychological diagnosis, that it may affect a soldier's potential for promotion and a certain worry around the acceptability of the diagnosis," said report committee chair Dr. Sandro Galea at Columbia University.

The report also notes that there's no real systematic tracking of soldiers to pinpoint the most effective treatments. Galea says there's work to be done but he's optimistic.

"It will need a concerted system-wide effort on behalf of DOD [Department of Defense] and VA to raise awareness among all its ranks of the importance of PTSD, of the potential benefit of treatment and to implement specific programs," he says.

Copyright 2012 ABC News Radio

Monday
May212012

Govt. Panel Scuttles Prostate Cancer Testing Recommendations

iStockphoto/Thinkstock(WASHINGTON) -- The governmental advisory panel tasked with issuing cancer screening guidelines made a final recommendation on the most common form of prostate cancer screening, suggesting it's not needed, regardless of age.

On Monday, the United States Preventive Services Task Force, or USPSTF, put forth this guideline on prostate-specific antigen (PSA) blood tests, which more than 20 million American men get each year. The formal recommendation follows draft guidance the task force issued in October 2011. These guidelines drive the screening decisions of doctors throughout the country.

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The PSA blood test is the traditional way to detect evidence of prostate cancer, which is the most common cancer diagnosed in American men. The National Cancer Institute estimates that in 2012, almost 250,000 new cases and more than 28,000 prostate cancer-related deaths will occur.

The task force maintains that PSA tests do more harm than good. Dr. Michael LeFevre, co-vice chairman of the task force, said the medical procedures arising from the tests could have serious downsides, including blood clots, heart attacks, strokes and possibly death. Other complications include impotence and urinary incontinence.

"Of 1,000 men who are screened, at most one man will avoid a prostate cancer death," LeFevre said. "Two to three will have blood clot, heart attack, stroke or even death from treatment of the prostate cancer. One in 3,000 men screened will die of surgical complications from the treatment."

However, the medical community is split on Monday's recommendation. And most urologists -- the doctors who arguably treat the most cases of prostate disease -- do not agree with the task force's guidelines.

"PSA screening is the only test we have," says Dr. William Catalona, a professor of urology at Northwestern University. "The great majority of doctors who deal with prostate cancer patients believe that the task force underestimated the benefits and overestimated the harm. Perhaps it is because none of the Task Force members were urologists."

"There is no mention of the dramatic decline in the number of men with advanced prostate cancer," says Dr. Patrick Walsh, professor of urology at Johns Hopkins University. "In 1990, 21 percent of men at diagnosis had metastatic prostate cancer to bone. Today it is 4 percent. This is clearly a dramatic effect of PSA testing."

"[The new recommendations] fail to recognize that in the absence of PSA testing, a man will not know that he has the disease until he has symptoms, at which time the cancer is too far advanced to cure," Walsh said.

And Dr. Gerald Andriole, chief of urology at Washington University School of Medicine, called the task force's recommendations "too draconian on categorically dismissing PSA."

"In some respects we have not been using PSA as well as we could," Andriole said. "However, to post a headline that says 'No More PSA Testing' is throwing the baby out with the bathwater."

Primary care physicians differed on whether the recommendations are a good idea. Some, like Dr. Jacques Carter, assistant professor of medicine at Harvard Medical School, insisted that "screening for prostate cancer saves lives." Others, like Dr. Jim Jirjis, director of adult primary care at Vanderbilt University, said they had already begun to recommend against the tests. Still, others said that the decision needed to be made on a case-by-case basis.

"I agree that screening for prostate cancer in men in general is a bad idea," said Dr. John Messmer, associate professor of family and community medicine at Penn State Hershey College of Medicine. "That being said, the possibility of obtaining a PSA on a man with particular circumstances should still be an option."

As for the millions of middle-aged and older men who find themselves in the middle of this debate, the consensus among the physicians is for them to communicate openly with their doctors.

"This does not preclude a patient from asking for the test and the physician offering the test," says LeFevre. "There should be an open and honest discussion with significant known harms."

And while the USPSTF's recommendations may drastically reduce the number of men who undergo a PSA blood test, those considered to have a strong family history of prostate cancer -- in other words, more than one first degree relative with prostate cancer before the age of 69 -- may still want to consider getting it.

Copyright 2012 ABC News Radio

Tuesday
May012012

Universal Heart Screening Recommended for Newborns

Hemera/Thinkstock(NEW YORK) -- All newborns should undergo a standard screening for life-threatening heart defects, according to new recommendations published in the Lancet.

Researchers suggested that a pulse oximetry, a low-cost, non-invasive device that tests patients' blood oxygen levels, is more accurate at detecting such heart conditions than a standard clinical examination, and it should be used internationally as routine assessment in all newborns before they leave the hospital.

"The findings of this meta-analysis provide compelling evidence for introduction of pulse oximetry as a screening method in clinical practice," Dr. Shakila Thangaratinam, lead author of the study, wrote in a statement. "The sensitivity of the test is higher than present strategies based on antenatal screening and clinical examination, and the false-positive rate is very low, especially when done after 24 hours of birth."

The device showed an accuracy rate of 99.9 percent, and detected 76.5 percent of all congenital heart-defect cases and had a low false-positive rate of .14 percent. The findings were based on 13 studies that included nearly 230,000 newborn babies.

Congenital heart defects, or flaws in the structure of the heart and blood vessels, are the leading cause of death in newborns, but outcomes can drastically differ if the condition is found early and babies have corrective surgery quickly. The test is intended to detect critical congenital heart disease, not minor heart defects such as heart murmurs.

Since 2011, four states in the United States have passed laws that require newborns to undergo the basic test.

"I agree with the recommendations to use the low-cost screening test of pulse oximetry to help diagnose newborns with congenital heart disease," said Dr. Dennis Mello, director of pediatric cardiac surgery at Ochsner Medical Center in New Orleans. "Pulse oximetry, however, will not detect all patients with congenital heart defects. The cost of pulse oximetry is low and its use could be easily implemented in clinical practice."

Each test averages about $5 to $7 per baby, said Dr. Thomas Anderson, a pediatric cardiologist at The Children's Hospital of Philadelphia who is a proponent of the screening.

Anderson helped to implement the screening for all babies born in the state of New Jersey, the first state to pass legislation mandating the test.

"Since it went into effect in August 2011, we've screened about 50,000 to 60,000 babies," said Anderson. "These babies are ready to go home and look healthy and nice and pink, but then they have this underlying condition and these are the babies that collapse or go into shock and potentially die, so detecting these babies right upon birth is certainly beneficial."

Since New Jersey enacted its legislation, Indiana, Maryland and Virginia have followed suit, Anderson said. Most other states have legislative proposals in the works.

Anderson said some experts argued that false-positives will cause unneeded stress for families and the tests will add extra costs to a health care system that has an already-strained budget. But Anderson argued that the detection of severe heart disease in a baby before leaving the hospital eliminates other extreme costs, like emergency room visits and expensive surgical repair.

While nearly all U.S. hospitals already have the need testing equipment, many around the world are stretched for resources. Anderson said it is worth investing in the inexpensive device because of the potential lives saved and high costs avoided.

Copyright 2012 ABC News Radio

Wednesday
Apr252012

US Men Ignoring 2008 Prostate Screening Guidelines 

Hemera/Thinkstock(CHICAGO) -- Warren Buffett’s decision to undergo prostate cancer screening reflects the reality that nearly half of American men 75 and older continue being tested despite official recommendations against doing so, researchers reported Tuesday.

“PSA screening for more than 40 percent of men 75 or older is inappropriate,” said Dr. Scott G. Eggener, an assistant professor of surgery at University of Chicago Medical Center, whose research confirms that older men aren’t heeding 2008 guidance from the U.S. Preventive Services Task Force.

“Selective screening is reasonable to consider for the healthiest men over age 75, but for the large majority of men in this age group, early detection can lead to treatment of a disease that will probably never cause a problem,” he said.

In 2008, the USPSTF issued a recommendation that found limited benefit for screening men ages 75 and older for prostate cancer. Last year, the task force drafted guidelines that said prostate screening was of limited benefit for helping men of any age live longer, and that harms of unnecessary treatments often outweigh benefits.

Eggener and his colleagues set out to determine whether men were paying attention to the guidelines. They found that in 2005, two years before issuance of the guidelines, 43 percent of men 75 and older underwent prostate-specific antigen (PSA) testing, which measures levels of a protein in the blood.

In 2010, when the guidelines had been out for two years, the screening rate among those men rose slightly to 43.9 percent, according to results appearing in this week’s issue of JAMA.

Last week, Buffett, the 81-year-old CEO of Berkshire Hathaway, announced that he would undergo radiation treatment beginning in mid-July for Stage 1 prostate cancer, and that a CT scan, bone scan and MRI found no evidence it had spread.

At the time, top U.S. urologists and prostate surgeons reacted to the announcement by saying that most men with newly diagnosed prostate cancer are likely to die from something else.

However, there are exceptions, as world-renowned prostate cancer expert Dr. Patrick Walsh, a urology professor at Johns Hopkins Medical Institutions in Baltimore, pointed out to ABC News, citing a University of Rochester study appearing last year in the journal Cancer that found half of the deaths from prostate cancer “occur in men who are diagnosed after the age of 75.”

“The fact is that older men who are diagnosed with prostate cancer oftentimes have more advanced disease than younger men -- the opposite of what we used to believe,” Walsh said.

Some older men can have aggressive Stage 1 tumors, which despite being confined to the prostate gland, contain highly abnormal cells capable of spreading quickly, Walsh said.

Dr. William J. Catalona, director of the Clinical Prostate Cancer Program at Northwestern University in Chicago, told ABC News that Buffett’s case “shows how valuable the PSA test is, especially in view of a rumor I heard that the USPSTF will probably release its final recommendation against PSA screening in the next few weeks.”

Catalona described PSA testing as “the most effective way to detect prostate cancer in its curable stages and if used intelligently it reduces the chances of dying from prostate cancer by nearly 50 percent. Warren Buffett is no dummie.”

Eggener and his colleagues reviewed cancer data from the National Health Interview Survey, which follows a representative group of 87,500 Americans. They focused on men aged 40 and older who said they underwent prostate cancer screening as part of a routine exam. Screening rates were unchanged between 2005 and 2010 in all age groups, Eggener and his colleagues reported. They found PSA screening more common among men 75 and older than those 40 to 49 and 50 to 59.

The study authors said their data likely underestimated the rate of men not undergoing PSA testing enough, because self-reports are lower than rates found when researchers review actual medical records.

They recommended monitoring of the effect of the 2011 USPSTF recommendations.

Copyright 2012 ABC News Radio

Thursday
Apr122012

Lung Cancer Screening Would Save Thousands of Lives at a Low Cost

Hemera/Thinkstock(NEW YORK) -- Thousands of lives could be saved without breaking the bank if health insurers covered lung cancer screening, a new study found.  

When the topic of cancer screenings comes up, most think of breast, colon, cervical or prostate cancer. But lung cancer, despite being the leading cause of cancer deaths each year -- according to Medical News Today, is somehow left out. Unlike other cancer tests, the majority of insurance companies do not cover screening for lung cancer.

A low dose CT Scan is now an option for screening high risk patients for lung cancer, and a new study published this month in Health Affairs shows that these screenings are less costly and could save thousands of lives.
 
Researchers found that lung cancer screenings for men and women between the ages of 50-64 with a history of smoking a pack of cigarettes a day for at least 30 years would cost about as much as a colonoscopy. And both are less than the mammograms and pap smears for detecting breast and cervical cancers.

Researchers said that annual lung cancer screenings would reduce the risk of mortality, saving an estimated 15,000 patients each year, at a relatively low cost.
 
Therefore, the study suggests insurance companies make coverage of valuable lung cancer screenings available to high risk tobacco smokers under 65.
 
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

Tuesday
Apr032012

Ultrasounds, MRIs Can Find More Breast Cancer, Says Study

iStockphoto/Thinkstock(PITTSBURGH) -- Here's one more study to add to the breast cancer screening debate: Annual mammogram screenings, combined with ultrasounds and MRIs, significantly increase the detection of cancer in women who had an elevated risk of breast cancer, new research has found.

Scientists at the University of Pittsburgh School of Medicine examined data from the American College of Radiology Imaging Network trial. Out of more than 2,600 women who were at increased risk of breast cancer (they had dense breast tissue and at least one other risk factor, such as a family history of the disease), 53 percent of the cancers were detected through mammograms. Ultrasounds picked up 33 additional cases of breast cancer, and MRIs found nine more that were not detected by either ultrasounds or mammograms.

"For women with dense breasts who are at higher risk, cancers tend to be more advanced," said Dr. Wendie Berg, the trial's principal investigator and professor of radiology at the University of Pittsburgh School of Medicine. "The combination of ultrasound and mammography is quite effective in finding the cancers."

The research was published Tuesday in the Journal of the American Medical Association and funded by the Avon Foundation and the National Cancer Institute.

While women with dense breast tissue may be at higher risk of developing breast cancer, the conundrum is compounded by the fact that mammograms are less likely to detect the cancer, so researchers said this is where supplemental screening tools can help.

Of note from the study, although more cancers were detected (adding ultrasound led to 242 patients undergoing biopsies), only 7.4 percent of these women ended up having cancer.

Federal guidelines currently suggest that women older than 50 receive a mammogram once every two years. But those guidelines clash with recommendations from the American College of Obstetrics and Gynecology, and the American Cancer Society. Both organizations recommend women begin getting annual mammograms at age 40.

The new research comes on the heels of a Norwegian study published Sunday in the Archives of Internal Medicine, which found that women who underwent regular mammogram screenings had an estimated 15 percent to 25 percent of breast cancers diagnosed, but raised the question as to whether the tumors might actually vanish without treatment.

Overdiagnosing and false-positives have long been part of the debate about breast cancer screenings, but Berg said most overdiagnosing occurs in women who have ductal carcinoma in situ, a cancer that hasn't spread past the milk ducts and is usually less severe than other forms of the disease.

"Oftentimes, DCIS will never come to matter in a woman's lifetime, but we didn't look at that," said Berg. "For these invasive cancers, it's hard to argue that they're not important because those are the ones more likely to spread and matter."

"The fundamental problem is that we have no evidence that detecting these cancers by ultrasound actually saves lives," said Dr. Daniel B. Kopans, a professor of radiology at Harvard Medical School. "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."

Copyright 2012 ABC News Radio







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