JustCare

Tag: Mammograms

  • 3D mammograms outperform 2D mammograms

    3D mammograms outperform 2D mammograms

    A new study reveals the benefits of 3D mammograms over 2D mammograms, reports Ronnie Cohen for NPR. With a 3D mammogram, digital breast tomosynthesis, you are less likely to be asked to come back for additional testing. The 3D machine also appears to detect some cancers sooner.

    The study by Liane Philpotts, MD, published in the journal, Radiology, found fewer misdiagnoses from the 3D imaging. She sees it as a “win, win, win.”

    With 3D imaging–DBT machines–providers are able to see many more layers and angles of the breast. Radiologists can look at each layer of tissue. For people with dense breasts, the technology is of particular benefit.

    To be clear, this study does not answer with certainty the question as to whether 3D imaging detects breast cancers earlier than 2D imaging or is more likely to save lives. The 3D imaging is more expensive, so how much value it adds is important to understand.

    It will take another six or so years before we know for sure the value of DBT. That’s when a large clinical trial will end that actually studies and compares 3D and 2D technology. For now, there is only “indirect evidence suggesting the potential of DBT screening in improving survival outcomes.” 

    3D imaging has only been in use since 2011, when the Food and Drug Administration first approved it. Already, though, more than nine in ten facilities that do mammography have one or more DBT machines. Almost half of all machines are DBT.

    The study looked at more than 250,000 screenings to determine the breast cancer cases found with screening mammograms over the course of 13 years. Over the last ten years, it looked at 3D screenings.

    Here’s more from Just Care:

  • When to avoid preventive care services

    When to avoid preventive care services

    Medicare covers a wide array of preventive care services, which can offer tremendous benefits. But, some preventive care services may cause more harm than good for people towards the end of life. Liz Szabo reports for Kaiser Health News on when to avoid preventive care services.

    Mammograms and cervical cancer screenings: Experts say that people with terminal cancers of the lung, colon and pancreas generally should not be getting a mammogram or cervical cancer screening. Similarly, people in their late eighties and older with multiple chronic conditions usually do not need these services. The risks of harm outweigh the benefits.

    Experts further say that people with severe dementia and other chronic conditions near the end of life also do not need mammograms. Not only will a mammogram not improve their quality of life, it may lead to unnecessary surgeries.  It may also lead to painful hormonal therapies that can increase risk of stroke. Moreover, a mammogram is unlikely to identify a deadly disease. The research shows that only one woman in a thousand who gets a mammogram over a lifetime does not die because the cancer was  detected before it spread.

    Prostate cancer screenings: Experts also say that older people who already have a deadly cancer or who are at grave risk of dying within ten years are not likely to be helped by prostate screenings, PSA tests. PSA tests tend to identify tumors that are extremely slow-growing and do not need to be treated. And more than two in three prostate cancer screenings find something that does not need to be found. The follow-up biopsy causes infections in about 6 percent of men, 1 percent of whom end up in the hospital. These screenings have been deemed “low value” in men 75 and older. Research shows that men who receive surgery or radiotherapy for prostate cancer are no more likely to live ten years than men who receive active monitoring.

    Colonoscopies: Colonoscopies can lead to intestinal tears. And, people 75 and older are more likely to get a tear than younger people. Colonoscopies can also lead to dehydration and fainting in older adults.

    Skin cancer removal: People in their late eighties and older also might want to avoid removing skin cancers that are not life threatening. Caring for the skin after the cancer is removed can be problematic. And wounds may not heal. More than 25 percent of people report problems with their wounds healing.

    In sum, if you are wondering why some people should avoid these “harmless” tests, it is that the tests can lead to false positives, stress, and unnecessary invasive procedures as well as medical complications.

    Here’s more from Just Care:

  • Be sure to get your cancer screenings

    Be sure to get your cancer screenings

    Recent data from the Centers for Disease Control reveals that we need to do a better job of getting cancer screening tests.  Screenings for breast, cervical and colorectal cancer were below targets in 2013. Some twenty percent or more of women are still not getting one or more of these tests.

    The CDC in fact found no improvement in cancer screening rates between 2010 and 2013.

    1. Only about three out of four women (73 percent) between the ages of 50 and 74 received a mammography screening.  The recommendation is a screening every two years for people in that age group. (For more information, check out “Do mammograms do more harm than good?“)
    2. Four out of five women (80 percent) reported getting a Pap smear to test for cervical cancer, fewer than in previous years.
    3. Fewer then six out of ten women (58.2 percent) between 50 and 74 reported getting a screening for colorectal cancer.

    If you have Medicare, it will cover these screenings in full.  It also covers several other preventive tests in full if you qualify, including nutrition counseling, weight-loss counseling, smoking cessation counseling.

  • Health screenings may have risks

    Health screenings may have risks

    For a long time now, we’ve heard about the benefits of preventive care, including screenings.  And, preventive care can have many benefits. So, preventive care services are generally covered in full whether you have Medicare or are in a commercial health plan.  But, health care screenings, in particular, can have risks as well.  The U.S. Preventive Services Task Force grades different preventive care tests based on the degree of benefit they offer.

    The Task Force uses five different grades. An “A” grade means that there is a high likelihood that the net benefit of the test is substantial.  Services with a “B” grade are likely to have only a moderate benefit, but the Task Force still recommends them. A “C” grade means that the net benefit is likely to be small and the patient and provider should discuss the risks.  The Task Force discourages services with a “D” grade. An “I” grade means that there is not enough evidence to know whether there is a net benefit or a net risk to the service.

    In short, screenings may turn up issues that warrant addressing. But, the question is how. Doctors often don’t know whether there’s a problem that should lead to more tests or a surgery. For example, some tumors may never grow large or present a health risk. So, they do not need to be removed. Risk to the patient can come from removing a tumor that does not present a health risk.  Surgery involves its own set of risks, including bacterial infections.

    Screenings for prostate cancer get a “D” from the U.S. Preventive Services Task Force. (An update is in progress here.) They often lead to unnecessary treatments. The Prostate Cancer Foundation suggests that as many as two in five men treated for prostate cancer had tumors that would never have presented a health or life risk.  But, the radiation treatment many men opt for can cause incontinence and erectile dysfunction.  And, hormone therapy treatment can lead to depression and osteoporosis.

    Task Force grades for breast cancer screenings vary.  The Task Force gives breast self-exams a “D” and recommends against teaching breast self-exams.  And mammograms get a “C” for women under 50 and a B for women between 50 and 74. This information is in the midst of being updated. But, you can see the most updated information here.

    H. Gilbert Welch, a professor of medicine at Dartmouth College, explains these risks in his book “Should I be Tested for Cancer?“ His simple answer is the book’s subtitle: “Maybe not.”

    A good primary care doctor will talk to you about your care needs and help you decide which screenings to get and which to avoid.

  • Do mammograms do more harm than good?

    Do mammograms do more harm than good?

    For sure, mammograms contribute to the income of radiologists and other professionals who provide medical services to screen for breast cancer as well as the medical device manufacturers.  And, the U.S. Preventive Services Task Force recommends a mammogram every other year for women between 50 and 74, suggesting that for this age group mammograms do more good than harm. But, the Task Force once again does not recommend mammograms for women under 50, concluding that, for younger women, mammograms do more harm than good.

    Since the U.S. Preventive Services Task Force last looked at the value of mammograms for women in 2009, according to Shannon Brownlee and Lisa Simpson, “the number of studies of mammography has grown, and if anything, the evidence is even stronger: we are consistently over-diagnosing and over-treating breast cancer — and younger women are paying the highest price.”  There’s a better than even chance that women under 50 who get mammograms for ten years will receive a false positive and need further unnecessary testing, increasing psychological stress and costs for them.

    There’s also mounting evidence that between one in three and one in five breast cancers that mammograms detect do not need to be treated or could be treated later in women’s lives.  For now though, doctors cannot know the difference between those cancers that need treatment and those that do not.

    The Cochrane Collaboration reviewed seven trials involving 600,000 women between the ages of 39 and 74, half of whom were randomly chosen for screening before a lump could be felt. They reported that the studies with the most reliable data showed that mammography screening did not reduce a woman’s chance of dying of breast cancer.

    At the end of the day, women should consult with their doctors about whether they need screening mammograms more frequently than the U.S. Preventive Services Task Force recommends.  They should understand the benefits and harms.  The Cochrane Collaboration has a good information sheet capturing the scientific evidence.

    The evidence on mammograms provides powerful reasons to heed the advice of the U.S. Preventive Services Task Force. Today, we collectively spend an estimated $4 billion a year on false positive mammograms and breast cancer overdiagnoses. Without compelling evidence of lives saved and little risk, it’s hard to see the benefits of more mammograms as worth their psychological and financial costs.