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    Friday, September 20, 2002

    Keeping Abreast: We may not be sure if breast cancer screening makes any difference in mortality, but that isn’t stopping the radiologists from finding ways to expand screening programs, not to mention their profits. Now, they’re suggesting that mammograms should be supplemented by ultrasound exams. The study in question was presented at a conference so it can’t be critiqued, and it only involved women with dense breasts (i.e. young and big breasts) which are difficult to image adequately with mammography. They don’t recommend giving up on mammography, though:

    "Ultrasound misses 25 percent of cancers and that's unacceptable," Kolb said. "Ultrasound must be used as an adjunct to mammography."

    For now, ultrasound screening isn't an accepted technique so insurance won't cover it. The cost is about $100. Kolb recommends women with dense breast who choose to pay for the test find someone who does at least five breast ultrasounds a day.


    I recommend women take this with a grain of salt. The majority of those dense breasts are in women younger than fifty - an age group in which breast cancer screening is of questionable benefit to begin with. Widespread adoption of ultrasound as a screening method will only serve to increase healthcare costs even further without providing any clear benefit.

    More Big Breasts: There’s just no escaping the fixation on big breasts. In other breast news this week, a study confirms the higher rate of false postive mammograms in women with dense breasts. Taken in conjunction with the ultrasound report, you would be tempted to think that using ultrasound along with mammograms would cut down on the number of false positives, but that’s not necessarily so. Widespread use of ultrasounds could result in even more false positives.

    Meanwhile, in the New England Journal of Medicine, researchers conclude that big breasts are hereditary. That’s a surprise? They justify their research with the contention that big breasts (or dense breasts) place patients at an increased risk of breast cancer, so it’s worthwhile looking into the genetic source of dense breasts. But wait a minute. The relationship of breast density to breast cancer isn’t at all certain, as this, this, this, and this shows.

    Maybe they just wanted the chance to work with big breasts.

    UPDATE: An "everyday oncologist" writes to say the dense breasts are more likely related to hormone levels, which is probably true:

    I think that the link between breast density and cancer is probably due to estrogen. The risk of breast cancer is highest in patients at the highest quintiles for endogenous estrogen levels. I believe that mammographic density is a surrogate for estrogen levels, and I do not understand why the article did not measure those.
     

    posted by Sydney on 9/20/2002 08:19:00 AM 0 comments

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