A doctor holds a linear ultrasonic diagnostic probe.

Despite Katie Couric’s advice, doctors say breast ultrasounds may not be necessary

When Katie Couric Share the news Regarding her breast cancer diagnosis, the former co-host of NBC’s “Today” said she considers this new health challenge a teachable moment to encourage people to get needed cancer screenings.

“Please get your annual mammogram done,” she wrote on her website in September. “But just as important, please see if you need additional examination.”

In the article, Couric, 65, explains that as she tends to have dense breast tissue, she undergoes ultrasound testing in addition to mammograms when screening for breast cancer. a Ultrasound of the breastSometimes called an ultrasound, it uses sound waves to take pictures of breast tissue. Malignant tumors that are difficult to detect on a mammogram can sometimes be identified in women whose breasts are dense – that is, they have a higher ratio of fibrous and glandular tissue versus fatty tissue.

Couric, who underwent a colonoscopy live after her first husband died of colon cancer and lost her sister to pancreatic cancer, has always pushed for cancer screening and better screening options.

Breast cancer experts praised Couric for drawing attention to breast density as a cancer risk factor. But some were less comfortable with her advocacy of supplemental screening.

“We have no evidence that additional screening reduces breast cancer deaths or improves quality of life,” he said. Dr. Carol Mangionnia professor of medicine and public health at the University of California, Los Angeles who heads the US Preventive Services Task Force, a group of medical experts that make recommendations about preventive services after weighing their benefits and harms.

Couric’s office did not respond to requests for comment.

In addition to annual mammograms, some women with dense breasts get a mammogram or an MRI to help identify cancer cells missed on the mammogram. Dense fibrous tissue appears white on a mammogram and makes it difficult to see cancers that also appear white. Fatty breast tissue, which appears dark on a mammogram, does not mask malignant breast tumors.

As digital mammography, or 3D mammography, becomes more widely available, an increasing number of women are getting this screening test in place of a standard 2D mammogram. 3D mammography has been found to reduce the number of false positives and identify more cancers in some women with denser breasts, although the effect on mortality is unknown.

Gives the staff rating “I” For supplemental screening for women with dense breasts whose mammogram results don’t indicate a problem. This means that the current evidence is “insufficient” to assess whether the benefits outweigh the harms of additional screening. (The task force is updating its recommendation for breast cancer screening, including supplemental screening for women with high-density breasts.)

One of the main disadvantages researchers are concerned about, besides the potential additional cost, is the chance of getting a false positive result. Complementary imaging in women who are not at risk for breast cancer may identify potential problem points, which can lead to follow-up tests such as invasive breast biopsies and raise concerns for many patients that they may develop cancer. But research has found that these findings are often false alarms.

If 1,000 women with dense breasts get an ultrasound after a negative mammogram, Ultrasound will determine Studies show that there are two to three cancers. But additional imaging will also identify as many as 117 potential problems that lead to recall visits and tests, but were ultimately identified as a false positive.

“On the one hand, we want to do everything we can to improve discovery,” said Dr. Sharon Maas, an obstetrician-gynecologist in Morristown, New Jersey, and past president of the American College of Obstetricians and Gynecologists of New Jersey. . “But on the other hand, there are a lot of costs and emotional distress” associated with false positive results.

professional group Supplementary examination is not recommended For women with dense breasts and no additional risk factors for cancer.

many Other professional groups take a similar position.

“We recommend having a conversation with a healthcare provider, and for patients to understand if their breasts are dense,” Maas said. “But we don’t recommend everyone get tested.”

In particular, for the roughly 8% of women who have very dense breasts, it’s worth having a conversation with a doctor about additional screening, Maas said.

Likewise, for women with dense breasts who have additional risk factors for breast cancer, such as a family history of the disease or a personal history of breast biopsies to check for suspected cancers, supplemental screening may make sense, she says.

Dense breasts are relatively common. In the United States, it is estimated that 43% of women age 40 or older have breasts that are considered to be dense or very dense. In addition to making mammograms more difficult to interpret, women with dense breasts reach this Double the probability For breast cancer risk in women with medium-density breasts, research shows.

Studies have shown that mammograms reduce breast cancer mortality. But although it seems counterintuitive that more testing would improve someone’s odds of developing cancer, research has not found that women are less likely to die from breast cancer if they get a complementary ultrasound or MRI after a negative imaging result. Mammogram.

Some studies have found that women with dense or very dense breasts who have had an ultrasound or an MRI in addition to a mammogram Had fewer purported separating cancers Between mammograms. But it is not clear whether these results no effect on the risk of death from breast cancer.

“Not every small abnormality will lead to something that needs treatment,” Mangionni said.

There are laws in 38 states and the District of Columbia Require patient notification About breast density after mammography, although some require only general notice rather than obligating women to inform them of their situation. Some states require insurance companies to cover supplemental exams, but others do not.

In 2019, the US Food and Drug Administration (FDA) suggested this information about breast density to merge into letters Patients receive after mammography. This rule has not yet been finalized, but the agency has told lawmakers that it expects to issue the rule No later than early next general.

“The FDA is committed to improving patient mammography services and working diligently to finalize the rule to amend existing mammography regulations,” FDA spokeswoman Carly Kempler told KHN.

The cost of additional tests is another factor to consider. Because the Preventive Services Task Force recommends that women get regular mammograms, health plans are generally required to cover them without charging people out of pocket. This is not the case with supplemental screening for women with dense breasts, which the staff does not recommend. Some states require insurance coverage for these tests, but these laws do not apply to many plans in which employers fund workers’ benefits instead of purchasing state-regulated insurance coverage.

Complementary Photography can be the price If your health plan doesn’t cover it. An ultrasound can cost $250 out of pocket while a breast MRI can cost $1,084, according to the Brem Breast Cancer Foundation.

Rep. Rosa DeLoro (D) recently tweeted that she is. Work on an invoice With COREK that will cover MRI and ultrasound for women with dense breasts without any out-of-pocket costs.

Some doctors recommend other steps that may be more effective than additional screening for women with dense breasts who want to reduce their breast cancer risk.

He said “If you really want to help yourself, lose weight” Dr. Karla Kirlikowskiprofessor of medicine and epidemiology/biostatistics at the University of California, San Francisco, who has worked with other researchers to develop calculators that help providers Breast cancer risk assessment for patients. “Moderate alcohol and avoid long-term hormone replacement. These are things that you can control.”

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