Following the release of findings from the Canadian National Breast Screening Study, the American College of Radiology spoke out against the results. The medical imaging community continues its debate over the frequency of mammography procedures for women between the ages of 40 and 59 and its effectiveness in reducing deaths from breast cancer.
The CNBSS was carried out between 1980 and 1985, following more than 89,000 women through 25 years of follow-up research. The participants were randomly divided into two groups – one would receive mammograms once a year over a period of five years and the other would not undergo any mammograms. The beginning time frame of five years was the screening period, as follow-ups were conducted over the course of the next two decades.
The researchers, led by Anthony Miller, M.D., of the University of Toronto, found that during the span of the study, 3,250 women in the mammography group and 3,133 in the non-mammography group were diagnosed with breast cancer. Of those diagnosed, 500 and 505, respectively, died from their cancer. According to the authors, 22 percent of the detected breast cancers in the trials were over-diagnosed.
“Our data show that annual mammography does not result in a reduction in breast cancer-specific mortality for women aged 40 to 59 beyond that of physical examination alone or usual care in the community. The data suggest that the value of mammography screening should be reassessed,” the authors wrote in their study.
But the findings are controversial, and there are groups that feel they need to be questioned. In particular, the ACR and Society of Breast Imaging believed the validity of this diagnostic imaging study to be incorrect.
Groups fire back
Within a day of the study’s release, the ACR and SBI released a statement, combating the results of the CNBSS. The organizations felt that the findings were flawed and misleading due to low-quality mammography equipment and a significant lack of mammogram training for the participating radiologists.
“The results of this BMJ study, and others resulting from the CNBSS trial, should not be used to create breast cancer screening policy as this would place a great many women at increased risk of dying unnecessarily from breast cancer,” said officials in a statement on ACR’s website.
Additionally, Daniel Kopans, M.D., from Massachusetts General Hospital, pointed out that the machines were second-hand equipment that produced substandard digital imaging for examination. He also claimed that the radiologists from CNBSS did not receive specific training in interpreting mammogram studies, which was more or less confirmed by the authors who said the examiners received one full month of training before the study began.
“It would be an outrage for women if access to screening was curtailed because of the poor results in the Canadian National Breast Screening Study, when it has been known for years that the trial was compromised from the start,” he said in an email to AuntMinnie.
Though compelling, the Canadian Mammogram study has numerous flaws in its design that lead to many questions regarding its validity. Additionally, the advent of new technologies, such as low-dose mammography equipment, has improved the detection abilities of radiologists. Because of this, the argument over annual mammograms to prevent breast cancer continues to grow in the health care industry.
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