WASHINGTON — A better mammogram? Increasingly women are asked if they wish ainstead of the unchanging X-ray — and now U.S. health officials are starting a outrageous study to tell if the newer, infrequently pricier choice really improves screening for breast cancer.
It’s the latest quandary in a margin that already vexes women with opposing discipline on when to get checked: Starting at age 40, 45 or 50? Annually or every other year?
The issue:can save lives if they locate assertive breast cancers early. But they also can mistreat by visit fake alarms and by spotting tumors that grow so solemnly they never would have posed a hazard — overdiagnosis that means some women bear unneeded treatment.
That trade-off is a pivotal doubt as doctors start recruiting 165,000 women nationally to review potentially some-more profitable 3-D mammograms — famous scientifically as “tomosynthesis” — with customary two-dimensional digital mammography.
The 3-D mammograms have been marketed as being means to find some-more cancers.
“But the thought isn’t so much anticipating some-more cancers as anticipating the cancers that are going to be life-threatening,” pronounced Dr. Worta McCaskill-Stevens of the National Cancer Institute, which is appropriation the new investigate to tell possibly the 3-D scans truly pinpoint the tumors that matter most.
It’s one of the largest randomized trials of mammography in decades, and scientists designed the investigate to do some-more than answer that pivotal 3-D question. They wish the commentary also, eventually, will help transparent some of the difficulty surrounding best screening practices.
“The many critical thing about this study is that it’s moving us to individualized screening as against to what we have now, which is one-size-fits-all screening,” likely study chair Dr. Etta Pisano, a radiologist at Boston’s Beth Israel Deaconess Medical Center.
“We are going to have a much better bargain of how to screen women so that we do the slightest volume of harm.”
Who needs a mammogram?
That depends on whom you ask. Guidelines change for women at normal risk of. (Those at increasing risk, since of family story or genetics, already get opposite advice.)
The American College of Radiology recommends annual mammograms starting at age 40.
The American Cancer Society urges annual checks starting at 45 and switching to every other year at 55, nonetheless it says women 40 to 44 still can opt for a mammogram.
And the U.S. Preventive Services Task Force, a supervision advisory group, recommends starting at age 50, with mammograms every other year. It, too, says 40-somethings can select progressing screening.
What about 3-D mammograms?
Standard mammograms take X-rays from two sides of the breast. With tomosynthesis, additional X-rays are taken at opposite angles — not truly three-dimensional but a mechanism compiles them into a 3-D-like image. First authorized by the Food and Drug Administration in 2011, they’re not nonetheless customary in partial since of questions that the new study aims to answer.
Some studies have found tomosynthesis detects some-more cancer with fewer fake alarms; they’re mostly advertised as quite useful for younger women’s.
How to decide?
Understand that mammograms come with pros and cons, and import them, pronounced Dr. Otis Brawley, the American Cancer Society’s arch medical officer.
Breast cancer is distant reduction common at age 40 than at age 50 and beyond. After menopause, tumors tend to grow some-more solemnly and women’s breast hankie becomes reduction unenlightened and easier for mammograms to yield a clearer image.
Consider: For every 1,000 women screened every other year until their 70s, starting at 40 instead of 50 would forestall one additional death — but create 576 some-more fake alarms and 58 additional unneeded biopsies, the charge force estimated. Also, two additional women would be treated for tumors that never would have turn life-threatening — that overdiagnosis problem.
As for what form to choose, some insurers, including Medicare, cover the 3-D version, and a tiny series of states charge coverage. Other insurers may need women to compensate $50 to $100 some-more out of pocket. Whoever eventually pays, additional time to investigate the scans adds to the cost.
The new study
About 100 mammography clinics opposite the U.S., and a few in Canada, will enroll healthy women ages 45 to 74 who already are formulation to get a slight mammogram. They’ll be incidentally reserved to get possibly the unchanging or 3-D chronicle for 5 years. Most will be screened annually but post-menopausal women who don’t have certain cancer risk factors will be screened every other year.
Researchers will lane every woman’s results including samples from biopsies and genetic and other tests, as good as how any cancer patients fare. The hulk database hopefully will help them provoke out some-more information about which women advantage many from what form and magnitude of screening.
“Mammography has been provocative over many decades. It’s critical that women have a better bargain of how mammography is critical for them formed on their age and other risk factors,” pronounced McCaskill-Stevens.