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The US Preventive Services Task Force (USPSTF) plans to update its breast cancer screening guidelines, which were last published in 2016. For transparency, it has released the draft research plan which he will use to formulate the update, and that draft plan is open for comment until February 17.
However, an expert in breast cancer screening challenged the whole plan.
Daniel Kopans, MD, professor of radiology at Harvard Medical School and founder of the Breast Imaging Division at Massachusetts General Hospital in Boston, argues that previous USPSTF guidelines on breast cancer screening “were based on flawed analyzes scientific data “and research plan, as noted, perpetuates this.
He also objected, once again, to the USPSTF panel not having breast cancer screening experts on the panel.
In a comment on Aunt Minnie, a radiology website, he warns of the dangers of not listening to the experts: “The COVID-19 pandemic has demonstrated the tragic consequences that result from ignoring the science, the evidence , analysis and expert advice while being guided by inexperienced advice. “
Controversy over previous directives
The current USPSTF breast cancer screening guidelines, which were released in 2016, were largely unchanged from previous guidelines released in 2009. They recommended mammography screening every 2 years for women aged 50 to 74 years old, but that women aged 40 to 49 should make individual decisions about screening in partnership with their doctors.
The advice on younger women has come under harsh criticism from many experts, as previously reported by Medscape Medical News, and the interval every 2 years has also been questioned.
The American College of Radiology and the Society of Breast Imaging both recommend annual mammograms from the age of 40.
In the update the USPSTF is now planning, he has the opportunity to “review the group’s flawed decision in 2009” not to recommend screening for women in their 40s, Kopans argues.
But for this to happen, a number of factors must be taken into account to present a fair and impartial review of the science and evidence in favor of breast cancer screening, he continues, while fearing that the draft plan, as it is currently exhibited, do not.
A big problem, he argues, is that the USPSTF, in its draft plan, did not include statistical models from the US National Cancer Institute and the Cancer Intervention and Surveillance Modeling Network (NCI / CISNET) to project the results. potential of various screening protocols. These NCI / CISNET models all predict that the most lives are saved by annual screening starting at age 40, he points out.
Without these models, the USPSTF “will guess in its predictions,” he argues.
Second, even though a reduction in late-stage disease is a potentially useful “surrogate,” Kopans stresses that it is still crucial to remember that women diagnosed with all stages of breast cancer die from the disease. . “Reducing the size of cancers during stages has also been shown to be a major benefit of screening which reduces deaths,” he says.
Third, he contends in his commentary that there is a “false statement that the background incidence of breast cancer has not increased over time.” Kopans says this has been the main source of misinformation that has been used to promote “the false concepts of massive overdiagnosis” as well as a “false claim that there has been no reduction in advanced cancers.”
To make his point, Kopans explains that the data clearly shows that the baseline incidence of breast cancer has increased steadily by 1% to 1.3% per year, for at least 80 years. This increase predates screening, which didn’t really start until the mid-1980s.
“If the correct increasing baseline is used, not only is there no apparent ‘overdiagnosis’ of invasive cancers, but there appears to have been a major reduction in the incidence of invasive cancers,” writes -he. “Using the correct baseline incidence and extrapolation, it is also clear that there has been a significant reduction in the rate of advanced cancers.”
To date, there have been no randomized controlled trials comparing screening intervals (eg, Annual vs. every two or three years). But based on CISNET models, Kopans pointed out that annual screening is estimated to provide the greatest reduction in deaths. “All women between the ages of 40 and 74 should be encouraged to be screened annually,” he says.
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