The U.S. Consecration Services Task Force (USPSTF) plans to update the breast cancer screening guide, which was finally issued in 2016. For transparency, it has drafted the research plan it will use for the update plan, and this draft plan is open for comment until 17 February.
However, an expert in breast screening has raised an issue with the whole plan.
Daniel Kopans, MD, professor of radiation at Harvard Medical School and founder of the Department of Breast Imaging at Massachusetts General Hospital, Boston, argues that previous USPSTF guidelines on breast cancer screening are “based on analyzes flawed scientific data ”and the research plan, as described, follow this.
It has also been objected, again, that the USPSTF panel does not have experts on breast screening on the panel.
Writing in a statement on Aunt Minnie, a radiation website, he warns of the dangers of not listening to experts: “The COVID-19 pandemic has shown the attractive effects of avoid science, evidence, and expert analysis and advice while avoiding science guided by non-expert advice. “
Controversy over previous directions
The current USPSTF guidance on breast cancer screening, issued in 2016, was largely unchanged from the guidelines previously issued in 2009. It recommended mammogram screening every 2 years for 50 women. to 74 years of age, but women aged 40 to 49 should make individual decisions about screening in partnership with their doctors.
The guidance on younger women has been widely criticized by many experts, as previously reported Medscape Medical News, and the 2-year interval was also questioned.
The American College of Radiation and the Breast Imaging Association both recommend annual mammograms beginning at age 40.
In the update the USPSTF is now planning, it has the opportunity to “go back to the body’s flawed decision in 2009” about not recommending screening for women in their 40s, Kopans argument.
But to do so, a number of factors need to be addressed in order to provide a fair and impartial review of the science and evidence in favor of breast screening, he continues, although he is concerned that the draft plan, as currently defined, that.
One major problem, he argues, is that the USPSTF, in its draft plan, has not included statistical models from the U.S. National Cancer Institute and the Cancer Intervention and Analysis Model Network (NCI / CISNET) to plot the possible outcomes of several screening protocols. All of these NCI / CISNET models predict that most lives are saved by annual screening starting at age 40, he says.
Without these models, the USPSTF “measures in their predictions,” he argues.
Second, even though a reduction in advanced-stage disease may be a “useful endpoint”, Kopans points out that it is still important to remember that women diagnosed at all stages of breast cancer are dying of the disease. “Reducing the size of cancers within stages has also been shown to be a major benefit of screening that reduces deaths,” he says.
Third, he complains in his statement that “there is a false claim that the incidence of breast cancer background has not increased over time. “Kopans states that this is the primary source of misinformation that has been used to promote” false major overdiagnosis concepts “as well as” false claims that have not been reduced in advanced cancers. “
To emphasize his point, Kopans explains that data clearly shows that the baseline incidence of breast cancer has gone up by 1% -1.3% per year, going back to co- at least 80 years. This rise is pre-screen, which didn’t begin until the mid-1980s.
“If the right and growing baseline is used, not only does there appear to be an ‘overdiagnosis’ of invasive cancers, but there appears to have been a significant reduction in frequency. invasive cancers, “he writes.” By using the right baseline frequency and output it is also clear that there has been a significant reduction in the rate of advanced cancers “.
To date, randomized controlled trials have not compared screening times (e.g., annual vs. every second or third year). But based on the CISNET models, Kopans stressed that annual screening is considered to provide the greatest reduction in deaths. “All women aged 40-74 should be encouraged to be screened each year,” he says.
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