JACR: Quality of life vs. imaging outcomes for mammo needs a closer look

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By decreasing false-positive mammographic results through adherence to the ACR BI-RADS recommendations, radiologists can answer critics of early and frequent screening while still reducing cancer deaths, according to an article published in this month's Journal of the American College of Radiology.

David Seidenwurm, MD, of Radiological Associates of Sacramento, Calif., wrote that the importance of both quality of life and longevity in healthcare decision-making requires minimizing negative impacts of mammography when screening low-risk populations, and current practice differs significantly from the successful randomized trials, in terms of front-loading costs of false-positive exams and overtreatment.

He noted that the recent debate regarding the new guidelines for mammographic screening for breast cancer provided by the U.S. Preventive Services Task Force has revealed a fundamental contradiction in the thinking about the utility of diagnostic imaging.

“Although much of the discussion has centered on the effects of annual screening beginning at age 40 on all-cause mortality in women of average risk, another central strain in the discussion has involved the relative importance, or unimportance, of the anxiety caused by false-positive findings and the psychological, as well as the physical, consequences of overdiagnosis and overtreatment,” said Seidenwurm.

The article said that many have disregarded the anxiety argument, referring to it as “demeaning to women.” However, Seidenwurm suggested that since screening takes time and can cause discomfort and stress for women, it may in fact cause harm in the screening of low-risk populations. “It is reasonable to consider the psychological as well as the physical consequences of screening."

Seidenwurm noted that despite anxiety being considered an “adverse impact on quality of life,” many radiologists and physicians have deemed patient anxiety as “insignificant in determining the comparative effectiveness or relative value of diagnostic imaging.”

In countering this case, he offered, “the ramifications of the argument that anxiety is unimportant in defining the efficacy of imaging are complex and require further exploration before this point of view can be accepted by our specialty.”

Seidenwurm believed that as a solution to this disagreement, “the most efficient evidence-based approach is to reduce the number of false-positive results while maintaining a sufficient cancer detection rate to derive the benefits of screening average-risk women in a relatively low risk decade of their lives.” In order to achieve this goal, he suggested that the frequency of screening be reduced, noting that this idea is most likely improbable at present, or by practicing mammography in a manner similar to that practiced in the randomized trials that proved its benefits.

“Full appreciation of the costs and benefits of screening provides the basis for making the best decisions for individuals and populations,” wrote Seidenwurm.