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Breast Cancer Screening Where do we stand? Rakhshanda Layeequr Rahman MD

Breast Cancer Screening Where do we stand? Rakhshanda Layeequr Rahman MD Director, TTUHSC Amarillo Breast Center of Excellence Division of Surgical Oncology. US New Breast Cancer 200,000/year US Deaths 50,000/year Panhandle New Breast Cancers 900/year

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Breast Cancer Screening Where do we stand? Rakhshanda Layeequr Rahman MD

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  1. Breast Cancer Screening Where do we stand? Rakhshanda Layeequr Rahman MD Director, TTUHSC Amarillo Breast Center of Excellence Division of Surgical Oncology

  2. US New Breast Cancer 200,000/year • US Deaths 50,000/year • Panhandle New Breast Cancers 900/year • Panhandle Deaths 212/year • No. 1 Cancer in Women • No. 1 Cause of Death in Women 45 – 60 yrs How Big a Deal Is It?

  3. The elephant in the room USPSTF !!!

  4. USPSTF Level of Certainty

  5. USPSTF Recommendation Grades

  6. USPSTF Screening Guidelines

  7. USPSTF Screening Guidelines

  8. USPSTF Reactions • Detailed ACR statement on Ill advised and dangerous USPSTF mammography recommendations • ACR , SBI statement on Annals of Internal Medicine Poll regarding flawed USPSTF mammography recommendations • Why the critics of screening mammography are wrong

  9. The Real Issue • Federal healthcare legislation mandates preventive coverage without co-pays • To have this protection category A or B recommendation is a must form USPSTF • The only screening service that qualifies is “ biennial screening mammography b/w 50 and 74 yrs of age”

  10. The Aftermath • Avon Foundation survey of grant recipients in 48 states • BCCED / BCCS program changes 25% states • Elimination of mammograms < 50 yrs • Fewer mammograms for older women Result Higher rate on interval cancers and larger cancers in indigent population

  11. …so what do we do?...

  12. Consider Basic Facts I Since widespread use of screening mammography, breast cancer mortality has dropped 30% Majority of breast cancer deaths are in women who never had a mammogram or had one >2 years ago

  13. Consider Basic Facts II USPSTF focused on mortality outcome studies, therefore Ignore improved detection technology Pre MQSA Act Many contain 1 view mammogram

  14. Consider Basic Facts III Digital versus Analogue Mammography Pisano 2005

  15. Consider Basic Facts IV In USA, as of August 1, 2009: # of mammography sites 8711 Digital units 54% New analogue unit purchases <5%

  16. Consider Basic Facts V USPSTF considered anxiety related to false positive mammograms in younger women Anxiety related to interval / advanced cancers in unscreened population is not discussed

  17. Consider Basic Facts VI USPSTF studies have 15% mortality reduction in favor of screening in women aged 39-49 years The comparisons are made between “invited to screen vs. not invited” and NOT between “screened and un-screened”

  18. The Answer - AMA Women 40 years or older yearly mammogram Women younger than 40 yearly mammogram starting 10 years younger than the youngest first degree relative with breast cancer

  19. Cancers caught early with screening… … 9 out of 10 are curable (like it never happened) Cancer Death Life Stage IV Stage III Stage II Stage I

  20. Situation Analysis • Cancer picked up by screening mammogram prolongs life • Less than 1 in 4 women > 40 years old had mammograms in 2009 • Less than 1 in 3 doctors recommended appropriate breast screening

  21. Who’s Job Is It? • Primary Care Physician or Gynecologist orders the mammograms (no physician order needed in Texas) • If they miss you should request

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