NLM Director’s Comments Transcript
Mammogram’s Effectiveness and Risks: 02/24/2014

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Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

Here is what's new this week in MedlinePlus.

Mammograms for middle age women failed to reduce breast cancer deaths and the screening resulted in an over-diagnosis of breast cancer – compared to breast exams and usual care, suggests a comprehensive Canadian study and an accompanying editorial recently published in BMJ.

The study’s six authors, all from Toronto, found the overall hazard ratio of death from breast cancer was not statistically significantly less for women ages 40-59, who received annual mammograms for five years as well as annual breast examinations, compared to peers who only received a breast physical examination. The health of all the women in the study was followed for 25 years - from 1980-2005.

During the study period, there were 500 deaths among the 3250 women who received an annual mammogram and 505 deaths among the 3133 participants who were not screened for breast cancer.

Moreover, among the women who received an annual mammogram about 22 percent of the discovered breast cancers were incorrectly diagnosed as potentially life-threatening. A BMJ press release accompanying the study explains in this context over-diagnosis means less harmful cancers were detected that would not result in a patient’s death during their lifetime.

The latter findings imply an over-diagnosis of breast cancer fosters unnecessary medical procedures as well as higher care expenses, which have significant medical policy implications.

While the study’s authors noted the importance of breast cancer education, early diagnosis, and careful clinical care, they write the study suggests mammography (and we quote): ‘does not result in a reduction in breast cancer specific mortality for women aged 40-59 beyond that of physical examination alone or usual care in the community’ (end of quote).

The study’s authors also conclude (and we quote): ‘our results support the views of some commentators that the rationale for screening by mammography should be urgently reassessed by policy makers’ (end of quote).

An editorial that accompanies the study notes the research is the first long term study with contemporary clinical protocols to screen women for breast cancer, provide recommended in-office breast examination procedures, as well as provide breast cancer patient education.

The editorial’s authors add (and we quote): ‘These important features may make this study more informative for a modern setting, compared to other randomised trials’ (end of quote).

A report about the study in the New York Times notes the current findings historically follow a 2009 U.S. National Preventive Services Task Force recommendation against annual mammograms for women before age 50 and a recommendation to the extend screening for women after 50 to every two years instead of annually. The Times adds the accumulation of evidence about the hazards of intensive cancer screening — coupled with current findings that suggest mammograms comparatively do not prevent breast cancer deaths — seem confounding after a generation of health educational efforts that encouraged women to obtain an annual mammogram.

The Times’ story notes the current study (and the Task Force’s recommendations) underscore the importance of a new generation of evidence that compares some of mammography’s risks with the procedure’s clinical benefits.

MedlinePlus.gov’s mammography health topic page explains a mammogram is an x-ray picture of the breast that can be used to check for breast cancer in women who have no signs or symptoms of the disease.

Information about the safety, accuracy, and quality of mammograms (from the Susan G. Komen Foundation) is provided in the ‘related issues’ section of MedlinePlus.gov’s mammography health topic page. An updated, helpful overview of mammography from the American Cancer Society is available in the ‘overviews’ section of MedlinePlus.gov’s mammography health topic page.

Some tips about talking with your doctor regarding the confusing evidence about mammography (from the Mayo Foundation for Medical Education and Research) are found in the ‘related issues’ section of MedlinePlus.gov’s mammography health topic page.

MedlinePlus.gov’s mammography health topic page also provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about mammography as they become available on MedlinePlus.gov.

To find MedlinePlus.gov’s mammography health topic page type ‘mammography’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘mammography (National Library of Medicine).’ MedlinePlus.gov also has health topic pages on breast cancer, breast disease, and diagnostic tests.

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