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NLM Director’s Comments Transcript
Mammography Counseling Challenges: 05/19/2014

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Can We Talk?
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the National Library of Medicine.

Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

Here is what's new this week in MedlinePlus.listen

I’m Rob Logan, Ph.D., senior staff, U.S. National Library of Medicine, for Donald Lindberg, M.D, the Director of the National Library of Medicine.

Here is what’s new this week in MedlinePlus.

Mammography’s mixed risks and benefits underscore the need to improve counseling women to make screening and breast cancer treatment decisions, suggests a new, comprehensive systematic review and an accompanying editorial recently published in the Journal of the American Medical Association.

The systematic review, which is based on an analysis of research about mammography screening from 1960-2014, suggests mixed risks and benefits for women. Regarding benefits, the review’s two authors find mammography screening is associated with a 19 percent overall reduction in breast cancer mortality. By age groups, the authors report the reduction in breast cancer mortality (from mammogram screening) is 15 percent for women in their 40s and 32 percent for women in their 60s.

Regarding risks, the review’s two authors find the cumulative risk of false-positive results is about 61 percent for a 40 or 50 year old woman who undergoes 10 years of annual mammograms. For the latter group, the authors estimate about 19 percent of the cancers diagnosed during the same 10 year period would not have become clinically apparent without screening. Hence, the review’s authors suggest cancer potentially can be over-diagnosed among these patients.

The review’s authors add a related problem is the potential to over-treat newly discovered tumors that may be less of a health threat if they do not metastasize (or spread).

To counsel women, the review’s authors write (and we quote): “Decision aids have the potential to help patients integrate information about risks and benefits with their own values and priorities’ (end of quote). However, the review’s authors concede (and we quote), ‘…(decision aids) are not yet widely available for use in clinical practice’ (end of quote).

The authors of an editorial accompanying the systematic review explain its findings suggest (and we quote): ‘screening mammograms may reduce breast cancer mortality and that potential benefit should be underscored in discussions with women. However, the benefit of mammography is less than once hoped and the potential harms are greater than anticipated…’ (end of quote).

The editorial’s authors add a core problem in trying to counsel patients is a clinically imprecise ability to estimate a woman’s individually tailored benefit or risk from screening and breast cancer. Similarly, a New York Times blog recently added new tests are needed to better distinguish among benign, latent, and dangerous breast cancer tumors.

Even if better individually tailored risk and benefit data were available, the editorial’s authors explain there are other challenges to counsel patients. The editorial’s authors write (and we quote) ‘People make decisions based on facts and also values and personal preferences. A shared decision-making discussion (between physicians and patients) that only focuses on data is not complete’ (end of quote).

The editorial’s authors urge physicians to (and we quote): ‘find a way to discuss an individual’s patients’ values and personal philosophies regarding health care in a neutral and nonjudgmental manner’ (end of quote).

The editorial’s authors note mammography now accounts for almost $8 billion in health care expenditures in the U.S. They add unlike most nations, the U.S. recommends mammography and other breast cancer screening for women at age 40. In most other countries, the editorial’s authors explain women are recommended to begin mammograms at age 50 or later, and at less frequent intervals than suggested to women in the U.S.

While the editorial’s and the review’s authors suggest innovative efforts are needed to improve the understanding of mammogram screening as well as breast cancer risks and treatment, all the authors acknowledge counseling patients is increasingly complex and challenging.

Meanwhile, MedlinePlus.gov’s mammography health topic page explains a mammogram is an x-ray picture of the breast, which can be used to check for breast cancer in women, who have no signs or symptoms of the disease.

Some insights about the accuracy of mammograms (that discusses their risks and benefits) is provided by Susan G. Koman for the Cure within the ‘related issues’ section of MedlinePlus.gov’s mammography health topic page.

An overview about mammogram safety and efficacy (from the National Cancer Institute) is provided in the ‘start here’ section of MedlinePlus.gov’s mammography health topic page. The website also contains information to help women obtain high quality mammograms.
MedlinePlus.gov’s mammography health topic page additionally provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about mammography as they become available on MedlinePlus.gov.

To find MedlinePlus.gov’s mammography health topic page type ‘mammography’ in the search box on MedlinePlus.gov’s home page, then, click on ‘mammography (National Library of Medicine).’ MedlinePlus.gov also has a comprehensive health topic page on breast cancer.

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Please email Dr. Lindberg anytime at: NLMDirector@nlm.nih.gov

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A written transcript of recent podcasts is available by typing 'Director's comments' in the search box on MedlinePlus.gov's home page.

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A disclaimer — the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider.

It was nice to be with you. I look forward to meeting you here next week.