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Preventive care experts have been dividing for years on the best way to counsel women about when to get bad cancer screening. But a new study suggests that women could benefit from individualized approaches to mammograms rather than universal guidelines.
The study, published Thursday in JAMA Oncology, examines personalized screening protocols tailored to the risk of developing bad cancer. The study showed that not offering mammograms to women at low risk of bad cancer could reduce the harms badociated with screening while retaining the benefits. And it could even be more profitable.
Mammograms, the gold standard for the detection of bad cancer, present the risk of false positive results, that is, to incorrectly identify a cancer that does not occur. do not really exist. Or they could overdiagnose – lighting up for bumps and bumps that might never have become cancerous. This means that some women undergo biopsies, surgeries, chemotherapy or radiation that they would never have needed.
Although the damage is real, the benefits are also the same: Early detection can save lives.
The Task Force on Preventive Services and the American Cancer Society choose their ideal benefit-risk ratio when issuing guidelines. Since 2009, the US Preventive Services Task Force – an independent group of experts in disease prevention – recommends that women undergo mammograms every two years starting at age 50. American Cancer Society Recommends Women to Switch from Annual Mammography to 45 "
Both guidelines – both from reliable sources – reflect a difference in how both organizations evaluate the benefits and disadvantages badociated with screening. But the new study proposes a screening strategy that takes into account the individual risk of each woman.
The researchers performed simulations on a hypothetical cohort of over 360,000 women to test the effectiveness and costs of stratified screening by risk. They took data from the National Health Services Service Program in the UK to model the results.
The team, led by Dr. Nora Pashayan, a physician and public health researcher at University College London, compared three interventions: age-based screening and stratified screening depending on the risk depending on each woman's genetic profile and her estimated susceptibility to developing bad cancer. They tested 100 low risk definitions that determined when they decided not to select their hypothetical patients. Theoretical patients below this threshold were not screened, and patients at or above the level were examined according to British guidelines.
Fewer women were screened, the number of overdiagnosed bad cancers decreased, and the number of bad cancer deaths prevented by screening. Pashayan and her colleagues have determined that to maximize the benefit-abuse ratio, the 30% of women at the lowest risk do not need mammograms.
The researchers also examined population-level profitability to determine the financial impact of screening and overdiagnosis of patients. They found a plateau where costs continued to rise, but the benefits stabilized.
"If you are just cost-effective, you will only filter out the very high-risk group," Pashayan said. 19659002] Related: Too much screening has misled us about the true risk factors for cancer, experts say
Dr. Lydia Pace, Director of Policy and Advocacy Program for Women's Health at Brigham and Women & # 39; s Hospital, said she was addressing screening by examining the potential benefits and harms of each patient, as suggested by the study
. Most patients want to make the decision, "said Pace.
Part of this process takes into account the preferences of a patient.Pace weighs a patient's genetic profile, but also his personal fears and its willingness to accept the risk, when making a screening decision.
Because the study relies on a hypothetical data model in the UK, the results might not translate But that does not mean that his findings are irrelevant to the US, said Pace, and this may reflect where screening protocols are directed: towards personalized care.
This article is reproduced with the permission of STAT It was published on July 5, 2018. Find the original story here
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