Author Interviews, Mammograms / 21.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23631" align="alignleft" width="132"]Stacey Fedewa, MPH Strategic Director, Screening and Risk Factor Surveillance Surveillance and Health Services Research program American Cancer Society Stacey Fedewa[/caption] Stacey Fedewa, MPH Strategic Director, Screening and Risk Factor Surveillance Surveillance and Health Services Research program American Cancer Society MedicalResearch.com: What is the background for this study? Response: In 2009, the U.S. Preventive Services Task Force (USPSTF) no longer recommended routine mammography for women aged 40–49 and ≥75 years (younger and older women, respectively). Whether mammography usage and physician recommendation among younger (40-49 years) and older (75+ years) women changed in response to these recommendations is unclear, so we compared changes in women’s self-reported mammography screening practices and physician recommendation for mammography between 2008 and 2013 using the National Health Interview Survey in younger and older women. MedicalResearch.com: What are the main findings? Response: Overall mammography prevalence for younger and older women did not change between 2008 and 2013, except in higher-socioeconomic younger women. During the corresponding study period, physician recommendation fell by 5.0% for younger women and 5.8% for older women, which may reflect physician adherence to the 2009 USPSTF updated BC screening recommendations.
Author Interviews, Breast Cancer, Fertility, Gender Differences, Karolinski Institute, Mammograms, Radiology / 14.04.2016

MedicalResearch.com Interview with: [caption id="attachment_23484" align="alignleft" width="200"]Frida Lundberg | PhD Student Dept. of Medical Epidemiology and Biostatistics Karolinska Institutet Frida Lundberg[/caption] Frida Lundberg | PhD Student Dept. of Medical Epidemiology and Biostatistics Karolinska Institutet Medical Research: What is the background for this study? Response: Fertility treatments involve stimulation with potent hormonal drugs that increase the amount of the sex hormones estrogen and progesterone. These hormones have been linked to breast cancer risk. Further, as these treatments are relatively new, most women who have gone through them are still below the age at which breast cancer is usually diagnosed. Therefore we wanted to investigate if infertility and fertility treatments influences mammographic breast density, a strong marker for breast cancer risk that is also hormone-responsive. Medical Research: What are the main findings? Response: We found that women with a history of infertility had higher absolute dense volume than other women. Among the infertile women, those who had gone through controlled ovarian stimulation (COS) had the highest absolute dense volume. The results from our study indicate that infertile women, especially those who undergo COS, might represent a group with an increased risk of breast cancer. However, the observed difference in dense volume was relatively small and has only been linked to a modest increase in breast cancer risk in previous studies.  As the infertility type could influence what treatment the couples undergo, the association might also be due to the underlying infertility rather than the treatment per se.
Annals Internal Medicine, Author Interviews, Breast Cancer, Mammograms / 12.01.2016

[caption id="attachment_20523" align="alignleft" width="120"]Susan K. Boolbol, MD, FACS Chief, Division of Breast Surgery Chief, Appel-Venet Comprehensive Breast Service Co-Director, Breast Surgery Fellowship Mount Sinai Beth Israel Associate Professor of Surgery Icahn School of Medicine at Mount Sinai New York, NY 10003 Dr. Boolbol[/caption] MedicalResearch.com Interview with: Susan K. Boolbol, MD, FACS Chief, Division of Breast Surgery Chief, Appel-Venet Comprehensive Breast Service Co-Director, Breast Surgery Fellowship Mount Sinai Beth Israel Associate Professor of Surgery Icahn School of Medicine at Mount Sinai New York, NY 10003 Medical Research: What is the background for these new recommendations? Dr. Boolbol: To make this final recommendation, the Task Force conducted a comprehensive review of the science since its 2009 recommendation and considered the public comments it received on its 2015 draft recommendation statement. Based on all of this, the task force issued their recommendations. Medical Research: What are the main changes from current guidelines? Dr. Boolbol: Presently, there are several different guidelines and recommendations regarding screening mammography. Depending on the group issuing the guidelines, the recommendations vary from annual mammography beginning at 40 years old to biennial mammograms from 50 to 74 years old. The Task Force continues to find that the benefit of mammography increases with age, and recommends biennial screening in women ages 50 to 74.
Author Interviews, Breast Cancer, Geriatrics, Mammograms / 07.01.2016

[caption id="attachment_20467" align="alignleft" width="133"]Professor Charles Hennekens MD Dr.P.H Sir Richard Doll Professor Senior Academic Advisor to the Dean Charles E. Schmidt College of Medicine Florida Atlantic University 777 Glades Road Boca Raton, FL 33431 Prof. Hennekens[/caption] MedicalResearch.com Interview with: Professor Charles Hennekens MD Dr.P.H Sir Richard Doll Professor Senior Academic Advisor to the Dean Charles E. Schmidt College of Medicine Florida Atlantic University 777 Glades Road Boca Raton, FL 33431 Medical Research: What is the background for this study? What are the main findings? Prof. Hennekens: Randomized evidence indicates clear benefits of mammography in middle age and, at present, most guidelines recommend regular mammography for women up to age 74.  In collaboration with colleagues at Baylor Medical College and Meharry Medical School we were able to link the Surveillance, Epidemiology, and End Results (SEER) data to the Medicare administrative claims data.  We found that, up to 84 years, screening was more common among whites than blacks and women receiving regular annual screening mammography had lower risks of mortality from breast cancer.
Author Interviews, Breast Cancer, Lancet, Mammograms, Radiology / 05.12.2015

[caption id="attachment_19820" align="alignleft" width="180"]Prof Stephen Duffy BSc MSc CStat Professor Of Cancer Screening Wolfson Institute Of Preventive Medicine Queen Mary University of London Prof. Stephen W. Duffy[/caption] MedicalResearch.com Interview with: Prof Stephen Duffy BSc MSc CStat Professor Of Cancer Screening Wolfson Institute Of Preventive Medicine Queen Mary University of London Medical Research: What is the background for this study? What are the main findings? Prof. Duffy: There is debate on the value of diagnosing and treating ductal carcinoma in situ (DCIS) of the breast, depending mainly on different theories about the risk of progression to invasive breast cancer if DCIS were untreated. No-one asserts that no DCIS is progressive and no-one asserts that all DCIS is progressive. There is, however, a range of opinions on the proportion of progressive disease. We found that those mammography screening units in the UK with higher detection rates of DCIS had lower subsequent rates of invasive cancers in the three years after screening.
Author Interviews, Breast Cancer, JAMA, Mammograms, UC Davis / 21.10.2015

[caption id="attachment_18491" align="alignleft" width="75"]Diana Miglioretti, PhD Diana Miglioretti, PhD[/caption] MedicalResearch.com Interview with: Diana L. Miglioretti, PhD Dean's Professor in Biostatistics Department of Public Health Sciences UC Davis School of Medicine Davis, CA  95616 Medical Research: What is the background for this study? What are the main findings? Dr. Miglioretti: Screening mammography intervals remain under debate in the United States. The US Preventive Services Task Force recommends biennial (every other year) screening, whereas other organizations recommend annual screening. To help inform their updated screening guidelines, the American Cancer Society guideline development group requested that the US Breast Cancer Surveillance Consortium conduct a study comparing cancer outcomes among women screened annually vs. biennially. Prior studies conducted by the consortium used wide intervals for defining annual and biennial mammograms. We wanted to evaluate cancer outcomes for women who more closely adhere to screening intervals. Our goal was to determine if women diagnosed with cancer following biennial screening have tumors with less favorable prognostic characteristics compared to women diagnosed after annual screening. We evaluated outcomes separately by age and by menopausal status because evidence suggests that younger women and premenopausal women may have more aggressive tumors and thus may benefit from more frequent screening. We found from this study that premenopausal women diagnosed with invasive breast cancer following biennial versus annual screening mammography were more likely to have tumors with less-favorable prognostic characteristics (e.g., later stage, larger size). For example, women with an invasive breast cancer diagnosed after a biennial screen had a 28% increased risk of a stage IIB or higher tumor, a 21% increased risk of being diagnosed with a tumor >15 mm, and an 11% higher risk of being diagnosed with a tumor with any less-favorable prognostic characteristic compared women diagnosed with breast cancer following an annual mammogram. In contrast, we found postmenopausal women not using hormone therapy and women 50 years of age or older had similar proportions of tumors with less-favorable prognostic characteristics regardless of screening interval. Relative risk estimates were close to one with no significant differences between biennial and annual screeners. Among postmenopausal women using hormone therapy at the time of the mammogram and women age 40-49, results were less clear. Relative risk estimates for biennial versus annual screeners were consistently above one, but were not as large as for premenopausal women and were not statistically significant.
Author Interviews, BMJ, Breast Cancer, Mammograms / 13.02.2014

Anthony Miller, MD Director, Canadian National Breast Screening Study Professor Emeritus, Dalla Lana School of Public Health University of TorontoMedicalResearch.com Interview with: Anthony Miller, MD Director, Canadian National Breast Screening Study Professor Emeritus, Dalla Lana School of Public Health University of Toronto MedicalResearch.com: What are the main findings of the study? Prof. Miller:  The study involved 89,835 women aged 40 to 59. All underwent an annual physical breast examination, while half were randomly assigned to undergo annual mammograms for five years, beginning in 1980. During the five-year screening period, 666 invasive breast cancers were diagnosed in the mammography arm and 524 in the controls.  Over the 25 year follow-up 180 women in the mammography arm and 171 women in the control arm died of breast cancer.  The overall hazard ratio for death from breast cancer diagnosed during the screening period associated with mammography was 1.05 (95% CI: 0.85 – 1.30).  The findings for women aged 40-49 and aged 50-59 were almost identical. After 15 years of follow-up an excess of 106 cancers was observed in the mammography arm, attributable to over-diagnosis, i.e. 22% of screen-detected invasive breast cancers, half of those detected by mammography alone. This represents one over-diagnosed breast cancer for every 424 women screened by mammography. By 2005, 3,250 of the 44,925 women in the mammography arm of the study were diagnosed with breast cancer, and 500 had died of it. The control group of 44,910 women had 3,133 breast cancer diagnoses and 505 breast cancer deaths. We conclude that annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available.
Author Interviews, Mammograms, Medical Imaging / 22.04.2013

Nancy L. Keating MD, MPH Harvard Medical School Department of Health Care Policy 180 Longwood Avenue Boston, MA 02115-5899MedicalResearch.com eInterview with Nancy L. Keating MD, MPH Harvard Medical School Department of Health Care Policy 180 Longwood Avenue Boston, MA 02115-5899 MedicalResearch.com: What are the main findings of the study? Dr. Keating: We examined data from the 2005, 2008 and 2011 waves of the National Health Interview Survey (NHIS) a national population-based in person survey to assess whether mammography rates changed following the Nov 2009 USPSTF recommendations.   Prior to 2009 the USPSTF recommended routine screening every 1-2 years for all women older than 40 years old. In 2009, the USPSTF advised against routine mammography screening in women under 50, and recommended biennial screening for women 50-74.
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