Scientists Find Mammography is Still "Gold Standard" for Breast Cancer Detection but Recommend Research into More Accurate Methods (dateline March 14, 2001)

"With all its limitations, film mammography remains the gold standard against which new imaging technologies will be measured," said Joyce C. Lashof, MD, FACP, in an Institute of Medicine/National Academy of Sciences news release. "To date, no quantum leap has been made in this area. At the same time, many of the newer tools offer certain advantages and deserve to be studied further," said Dr. Lashof, who chaired the Committee on Technologies for Early Detection of Breast Cancer. The report was released by the U.S. Institute of Medicine and National Research Council of the National Academies in March 2001.

According to the report, no technology is 100% accurate in detecting all breast cancers or abnormalities. In fact, using several different technologies is often the best way to detect breast cancer. While mammography is currently the only exam approved by the U.S. Food and Drug Administration (FDA) to screen for breast cancer in women with no signs of the disease, other technologies (such as ultrasound or magnetic resonance imaging, MRI) may be useful in further investigating abnormalities detected with mammography.

However, the scientists also expressed concern that technologies approved as diagnostic breast exams may not be effective screening tools. They recommended that the FDA base their approval and coverage of new screening technologies on scientific data gathered from clinical trials and that these trials be organized in conjunction with the appropriate federal agencies and breast cancer organizations. Additionally, the National Cancer Institute (NCI) should sponsor clinical trials every 10 to 15 years to re-evaluate the effectiveness of existing technologies, such as mammography. Because the U.S. population is rapidly aging, the NCI should also investigate whether mammography screening would be beneficial to women over age 70.

In the meantime, women should be given greater access to mammography to help screen for breast cancer. Currently, the Centers for Disease Control and Prevention’s (CDC) Breast and Cervical Cancer Prevention and Treatment Act provides free mammograms and Pap smears to approximately 15% of financially underprivileged women. However, the scientists recommend setting the goal of reaching 70% of these women. Former President Clinton also signed a bill last October 2000 that requires Medicare to cover the cost of treatment for women diagnosed with breast or cervical cancer as a result of the government screening program.

While mammography is currently the most effective method of detecting technology, the committee did acknowledge that mammography has its limitations. For instance, mammography can miss up to 15% of breast cancers, especially in young women with dense breasts (density shows up as white regions on mammogram films and can eclipse cancer). Furthermore, while mammography can detect many early-stage breast cancers, some fast-growing cancers may not be visible on a mammogram film when they are still small enough to be treated effectively.

Conversely, the number of breast abnormalities and cancers detected in women has risen significantly since routine mammography was implemented. The scientists admit that the early detection of abnormalities will be problematic until there is a better understanding of the biology and genetics of these abnormalities. Until physicians are able to distinguish between those abnormalities that will progress to invasive cancer (and require treatment) and those which will never become a threat (and thus do not require treatment), breast cancer screening will contribute to an inevitable overdiagnosis and overtreatment of some breast abnormalities. At the same time, the committee emphasizes that improved detection methods and treatment advances have helped to reduce the number of deaths from breast cancer in the last decade.

Until more improved screening methods exist, women should follow the American Cancer Society’s guidelines to help detect breast cancer early when the chances for successful treatment and survival are the greatest:

• All women between 20 and 39 years of age should practice monthly breast self-exams and have physician performed clinical breast exams at least every three years.
• All women 40 years of age and older should have annual screening mammograms, practice monthly breast self-exams, and have yearly clinical breast exams. The clinical breast exam should be conducted close to and preferably before the scheduled mammogram.

Younger women with a family or personal history of breast cancer should talk to their physicians about beginning annual mammograms before age 40.

Additional Resources and References

• The March 8, 2001 Institute of Medicine/National Academy of Sciences news release, "New Technologies for Breast Cancer Detection Demand More Study; Film Mammography Remains Gold Standard," and information on how to order the full report is available at http://www4.nas.edu/onpi/webextra.nsf/web/brcancer?OpenDocument
• The New York Times report, "Scientific Review Backs Mammograms" was published on March 9, 2001, http://www.nytimes.com/
• The USA Today report by Rita Rubin, "Cancer Study Cites ‘Overdiagnosis," was published on March 9, 2001, http://www.usatoday.com/
• To learn more about mammography, please visit http://www.imaginis.com/breasthealth/mammography.asp
• To learn more about supplemental breast imaging exams, such as ultrasound or MRI, please visit http://www.imaginis.com/breasthealth/menu-diagnosis.asp
• The Imaginis report, The Case for Mammography: What One Flawed Study and Critics of the Exam Don’t Address," is available at http://www.imaginis.com/breasthealth/rebuttal.asp