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Not all women with dense breasts need more imaging; ACP advises 'smarter' cancer screening

News from Annals of Internal Medicine

American College of Physicians

1. Many women with dense breasts do not need additional imaging

Free abstract: http://www.annals.org/article.aspx?doi=10.7326/M14-1465

Not all women with dense breasts are at high enough risk for breast cancer to justify additional imaging after a normal mammogram, according to a study published in Annals of Internal Medicine. Women with specific types of dense breasts who also have a high 5-year cancer risk should discuss supplemental screening strategies with their doctors.

Having dense breasts puts women at higher risk for cancer and makes it more difficult to detect cancer using digital mammography. Many states have laws requiring that women be notified if they have dense breasts and be advised that they should discuss additional screening with their doctor. While supplemental imaging may increase cancer detection, it also may increase false-positive rates.

Researchers studied screening data from the Breast Cancer Surveillance Consortium (BCSC) to determine which women with dense breasts might benefit from supplemental screening to detect cancer that may have been missed on mammography. They found that more than half of women with extremely dense breasts did not have a high risk for interval cancers, or aggressive cancers diagnosed within 12 months after a normal mammogram. Interval cancer rates were highest among women with extremely dense breasts and a BCSC-calculated 5-year breast cancer risk of 1.67 percent or greater and women with heterogeneously dense breasts and a BCSC-calculated 5-year risk of 2.50 percent or greater.

The authors of an accompanying editorial write that these findings provide compelling evidence that breast density should not be the sole criterion to guide decisions about supplemental breast cancer screening. They suggest that federal legislation on the management of screening in women with dense breasts is premature and that resources should instead focus on identifying women at high risk for interval breast cancer.


2. ACP advises 'smarter screening' for 5 common cancers

FREE CONTENT:
Screening advice: http://www.annals.org/article.aspx?doi=10.7326/M14-2326
Value framework: http://www.annals.org/article.aspx?doi=10.7326/M14-2327

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The American College of Physicians (ACP) offers high value advice for when and how average risk adults without symptoms should be screened for five common cancers: breast, colorectal, ovarian, prostate, and cervical. Screening for Cancer: Advice for High Value Care from the American College of Physicians is published in Annals of Internal Medicine.

ACP's advice is published along with a companion piece that outlines a framework for thinking about the value of varying intensities of cancers screening. In A Value Framework for Cancer Screening, ACP speculates about pressures that encourage overly intensive low value screening, or screening that minimizes the benefits of screening while maximizing the potential for harms.

ACP reviewed clinical guidelines and evidence synthesis issued by several organizations to inform its recommendations. ACP's paper provides a convenient resource for physicians and patients to get high value advice about cancer screening. ACP's advice applies to adults without symptoms who are at average risk. Various screening strategies exist for each of the cancers highlighted in the paper, which is available under embargo.

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