The recently sparked breast cancer screening controversy raged on at this year's Radiological Society of North America conference, held Nov. 29 through Dec. 4 in Chicago.
New guidelines disputed at RSNA
Audited attendance figures for the event were not available, but organizers estimated that 57,000 to 60,000 attendees were present this year, based on on-site and pre-registration. That estimate was on par with the 59,000 that attended in 2008, said an RSNA representative.
Radiologists at this year's conference used the forum to continue chipping away at mammography screening recommendations issued in November by the U.S. Preventive Services Task Force. The independent advisory group set off a firestorm less than two weeks before the start of the annual RSNA conference by suggesting that most women delay regular mammography screenings until age 50, and that they then only should have the test every two years (Nov. 23, p. 10).
“The net effect of the task force's recommendations is that screening would begin too late and occur too little, simply to save money,” said Stephen Feig, a radiology professor at the University of California Irvine School of Medicine and president-elect of the American Society of Breast Disease, during a news briefing panel addressing the task force's recommendations. Meanwhile, in Washington, the House Energy and Commerce Committee's Health Subcommittee was engaged in a contentious debate over the task force's recommendations, with some lawmakers supporting them and others saying they represented a step toward rationing of healthcare services.
During the RSNA panel, Feig said he was particularly concerned about the task force's recommendation that women in their 40s forgo mammography since roughly 20% of women who die from breast cancer are diagnosed with the disease during that decade of their life.
But while radiologists attending the conference overwhelmingly supported mammography as the current best tool for catching and diagnosing early-stage breast cancer, a number of sessions highlighted the fact that imaging researchers are still sorting out the benefits and dangers of mammography, particularly in comparison to other screening techniques such as ultrasound and MRI.
One study from Netherlands-based University Medical Center Groningen found, for example, that annual mammography may increase high-risk women's chance of developing breast cancer by 2.5% even though the radiation dose is low. Another study sponsored by the Avon Foundation and the National Cancer Institute found that annual MRI and ultrasound screenings may be the best bet for detecting cancers in women at high and increased risk for developing breast cancer. But the study also noted that while both technologies are more likely than mammography to detect tissue abnormalities, they are also more likely to result in false-positive findings.
“We've always recognized that mammography is not perfect—that it struggles with dense breast tissue and that there needs to be other tools,” said Mary Mahoney, director of breast imaging at the University of Cincinnati Academic Health Center and vice chair of the RSNA public information committee. She spoke after a briefing on elastography, a developing ultrasound technology that may help reduce unnecessary breast biopsies. “That's where MRI, ultrasound and other technologies come in. But, it would be premature to say any of these will replace mammography at some point. We still need to see how everything will sift out.”
Send us a letter