Mammography’s Crisis Offers Opportunity, Too

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Michael N. Linver, MD, FACRMichael N. Linver, MD, FACR, is committed to mammography screening to detect breast cancer—what he calls screening’s role in saving women’s lives. When it comes to mammography, Linver also has a combative side: Now that screening mammography has come under attack from some critics as a possibly less-than-effective technique, Linver is fighting back. He has cited study after study showing that the death rate from breast cancer has dramatically fallen because of mammography screening.

“If every woman in the United States had a mammogram now, we would find 500,000 breast cancers, and save 15,000 lives, this year alone,” Linver told the audience at a breast-imaging event held in White Plains, New York, on October 5, 2010, and hosted by Sectra AB, a global RIS/PACS solution provider with US headquarters in Shelton, Connecticut.

While thousands of women could be kept alive with universal mammography screening, Linver says, the reality is that draconian measures to curtail mammography screening might end up costing lives. If guidelines set forth by the US Preventive Services Task Force (USPSTF) are adopted, each year, Linver says, “6,500 more women will die” from breast cancer in the United States.

Linver, who practices at X-Ray Associates of New Mexico, PC, an Albuquerque radiology group, is vice president of the National Consortium of Breast Centers and a past president of the New Mexico chapters of both the ACR® and the American Cancer Society. He served on the original National Mammography Quality Assurance Advisory Committee to the FDA from 1994 to 1997.

Even though the USPSTF guidelines have not yet been enacted, just the threat of them—and the discouraging appraisal of screening that they offer—is keeping women from pursuing mammograms, Linver says. Since the guidelines were released, a year ago, mammographic-screening volumes in the country have fallen by 20%. “Some of that is due to the economy,” he says, “but by far, the bulk of it is due to the guidelines.”

Linver calls on radiologists, primary-care physicians, mammographers, gynecologists, and their clinical staffs to rally to the cause and fight back on behalf of breast-cancer screening. “To say nothing and do nothing is to give tacit approval to these murderous guidelines,” he says.

What USPSTF Advocates

The guidelines that so concern Linver call for a reduction in mammography screening—the exact opposite of the expanded screening that Linver says he’d like to see. “The fastest-growing segment of the US population is women aged 100 to 110,” Linver says. “People are living longer. A healthy 85-year-old woman still needs to get a screening mammogram.”

Instead, the USPSTF guidelines issued last year call for a cessation of mammography screening for women aged 40 to 49—except for high-risk patients—and no screening for women over 74, Linver says. The USPSTF guidelines also call for mammography to be performed every two years for women between 50 and 74. Breast self-exams are not recommended, nor are routine clinical breast exams, Linver adds.

When the USPSTF guidelines were issued, they were based on faulty research, Linver charges. That research suggested that false-positive results, stress from unnecessary patient call-backs, and the number of patients who needed to be screened to find relatively few cancers outweighed the benefits of screening in the age groups denoted, Linver acknowledges, but he says that the research was wrong. Studies in the United States and all over the world have consistently shown at least a 30% reduction in breast-cancer mortality rates due to screening, he says.

“To say that 1,904 women must be screened for every life saved, as the USPSTF stated in its report, implies that women 40 to 49 aren’t worth saving,” Linver says. In the United States, he says, death rates from breast cancer have fallen 30% since the implementation of widespread screening in the 1990s. “That’s with only 50% of the eligible population getting screened,” he adds.

He shares a letter that he wrote to referring physicians, explaining that 25% of the cancers detected by mammography at his breast-imaging center have been in women under 50. “Age 50 is a totally artificial division that somebody seized upon,” he says.

Linver says that he was gratified that the old guidelines calling for women to begin routine mammographic screening at 40 have been retained by the American Cancer Society (and mandated by Congress, in some instances), but he says that