Mammography Screening

'This book gives plenty of examples of ad hominem attacks, intimidation, slander, threats of litigation, deception, dishonesty, lies and other violations of good scientific practice. For some years I kept a folder labeled Dishonesty in breast cancer screening on top of my filing cabinet, storing articles and letters to the editor that contained statements I knew were dishonest. Eventually I gave up on the idea of writing a paper about this collection, as the number of examples quickly exceeded what could be contained in a single article.' From the Introduction The most effective way to decrease women's risk of becoming a breast cancer patient is to avoid attending screening. Mammography screening is one of the greatest controversies in healthcare, and the extent to which some scientists have sacrificed sound scientific principles in order to arrive at politically acceptable results in their research is extraordinary. In contrast, neutral observers increasingly find that the benefit has been much oversold and that the harms are much greater than previously believed. This groundbreaking book takes an evidence-based, critical look at the scientific disputes and the information provided to women by governments and cancer charities. It also explains why mammography screening is unlikely to be effective today. All health professionals and members of the public will find these revelations disturbingly illuminating. It will radically transform the way healthcare policy makers view mammography screening in the future. 'If Peter Gotzsche did not exist, there would be a need to invent him ...It may still take time for the limitations and harms of screening to be properly acknowledged and for women to be enabled to make adequately informed decisions. When this happens, it will be almost entirely due to the intellectual rigour and determination of Peter Gotzsche.' From the Foreword by Iona Heath, President, RCGP 'If you care about breast cancer, and we all should, you must read this book. Breast cancer is complex and we cannot afford to rely on the popular media, or on information from marketing campaigns from those who are invested in screening. We need to question and to understand. The story that Peter tells matters very much.' From the Foreword by Fran Visco, President, National Breast Cancer Coalition

The enormous expansion seen over the last decade in the mammo graphic detection of breast cancer lesions, especially the use of screen ing procedures for the early detection of clinically unsuspected tumors, has made it necessary to summarize the experience made by various centers in the world. The 2nd International Copenhagen Symposium on Detection of Breast Cancer afforded an opportunity of gathering scientists from all over the world to discuss the various problems of early breast cancer detection with special reference to screening procedures. This book forms a synthesis of the information presented by leading scientists from many of the world's mammo graphic centers, particularly those in Sweden and the USA. Hence, the reader will have the opportunity to study the outstanding work carried out by various institutes and centers of breast cancer screening. It is our sincere hope that a study of this volume will encourage other scientists to join in the work on screening procedures. S. Brunner B. Langfeldt P. E. Andersen Contents S. A. Feig: 1 Hypothetical Breast Cancer Risk from Mammography S. A. Feig: Benefits and Risks of Mammography 11 R. L. Egan and M. B. McSweeney: Multicentric Breast Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . 28 M. B. McSweeney and R. L. Egan: Breast Cancer in the Younger Patient: A Preliminary Report 36 M. B. McSweeney and R. L. Egan: Bilateral Breast Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . ' 41 N. Bjurstam: The Radiographic Appearance of Normal and Metastatic Axillary Lymph Nodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 M. Moskowitz, S. A. Feig, C. Cole-Beuglet, S. H.

The outlook for women with breast cancer has improved in recent years. Due to the combination of improved treatments and the benefits of mammography screening, breast cancer mortality has decreased steadily since 1989. Yet breast cancer remains a major problem, second only to lung cancer as a leading cause of death from cancer for women. To date, no means to prevent breast cancer has been discovered and experience has shown that treatments are most effective when a cancer is detected early, before it has spread to other tissues. These two facts suggest that the most effective way to continue reducing the death toll from breast cancer is improved early detection and diagnosis. Building on the 2001 report Mammography and Beyond, this new book not only examines ways to improve implementation and use of new and current breast cancer detection technologies but also evaluates the need to develop tools that identify women who would benefit most from early detection screening. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis encourages more research that integrates the development, validation, and analysis of the types of technologies in clinical practice that promote improved risk identification techniques. In this way, methods and technologies that improve detection and diagnosis can be more effectively developed and implemented.

Breast cancer is the most commonly diagnosed malignancy in women and the second leading cause of cancer-related deaths in American women. Although cardiovascular-related deaths significantly outnumber breast cancer deaths, breast cancer is arguably the most feared diagnosis among American women. Great strides have been made to heighten public awareness of breast cancer, with particular emphasis on early detection with mammography. Breast radiologists regularly witness the extreme anxiety that just the thought of being diagnosed with breast cancer can cause a patient. This anxious anticipation is often heightened by a lack of knowledge about what to expect from the process of breast imaging evaluation, which is frustrating for both patient and practitioner and can negatively affect the experience. Physicians often encounter patients who have little or no understanding of the reasoning behind the examination or procedure about to be performed-sometimes even up to the day of their breast cancer surgery. Furthermore, most women who undergo breast evaluations will not be diagnosed with cancer. The incidence of breast cancer is only 125.3 per 100,000 women (or 3-6 in every 1,000 screenings), however, symptoms of benign breast abnormalities are quite common and impact many more lives. Accurately diagnosing these non-cancerous conditions can alleviate much anxiety, in addition to helping patients towards a correct treatment plan. The Breast Test Book is a straightforward guide to the process of radiologic breast evaluations. Based on the most current scientific research and best standards of clinical practice, it will help debunk myths, shed light on misinformation, and provide clear facts about what women should expect from these screenings. This improved understanding will ultimately allow patients to play more active roles in their own care and, in the event that a diagnosis is made, give them confidence in their treatment.

X-ray mammography screening is the current mainstay for early breast cancer detection. It has been proven to detect breast cancer at an earlier stage and to reduce the number of women dying from the disease. However, it has a number of limitations. These current limitations in early breast cancer detection technology are driving a surge of new technological developments, from modifications of x-ray mammography such as computer programs that can indicate suspicious areas, to newer methods of detection such as magnetic resonance imaging (MRI) or biochemical tests on breast fluids. To explore the merits and drawbacks of these new breast cancer detection techniques, the Institute of Medicine of the National Academy of Sciences convened a committee of experts. During its year of operation, the committee examined the peer-reviewed literature, consulted with other experts in the field, and held two public workshops. In addition to identifying promising new technologies for early detection, the committee explored potential barriers that might prevent the development of new detection methods and their common usage. Such barriers could include lack of funding from agencies that support research and lack of investment in the commercial sector; complicated, inconsistent, or unpredictable federal regulations; inadequate insurance reimbursement; and limited access to or unacceptability of breast cancer detection technology for women and their doctors. Based on the findings of their study, the committee prepared a report entitled Mammography and Beyond: Developing Technology for Early Detection of Breast Cancer, which was published in the spring of 2001. This is a non-technical summary of that report.

The use of tomosynthesis in breast imaging is growing rapidly due to its superior ability to identify and characterize normal findings, benign lesions, and breast cancer, as well as its optimal performance with dense breast tissue. Providing unparalleled coverage of this breakthrough breast imaging modality, Breast Tomosynthesis explains how this new modality can lead to enhanced interpretation and better patient outcomes. This new reference is an indispensable guide for today's practitioner looking to keep abreast of the latest developments with correlative findings, practical interpretation tips, physics, and information on how tomosynthesis differs from conventional 2D FFDM mammography. Over 900 high-quality images offer visual guidance to effectively reading and interpreting this key imaging modality. Includes over 900 high-quality tomosynthesis and mammography images representing the spectrum of breast imaging. Features the latest Breast Imaging Reporting and Data System (or BI-RADS) standards updated in February 2014. Highlights practical tips to interpreting this new modality and how it differs from 2D mammography. Details how integration of tomosynthesis drastically changes lesion work-up and overall workflow in the department. "Tomo Tips" boxes offer tips and pitfalls for expert clinical guidance.

This book offers a single publication to be utilised comprehensively as a reference manual within current mammographic clinical practice for use by assistant practitioners and practitioners as well as trainees in radiography and related disciplines. In recent years mammographic clinical practice and technology have evolved rapidly and become increasingly sophisticated, this book will cover these issues. The public feel increasingly empowered to ‘have a say’ in their care and expectations of their mammography experience is high. Consequently a well-trained, well-informed practitioner is of paramount importance in clinical practice today. This book addresses patient/client-related issues in the form of psychological and emotional support they may require. This will enable the reader to gain insight into the patient/client perspective and thereby assist in meeting their needs.

Breast cancer is the leading site of new cancer cases in women. Breast cancer detection is currently primarily based on physical examination by health care professionals, chance findings by women, breast self-examination and mammography used for diagnosis or for routine screening. Early enough detection through mass screening with mammography has been introduced in many countries in the hope that early intervention would lead to reduced mortality and less aggressive treatment. The aim of this publication is to provide an independent, authoritative review of the evidence of the efficacy and effectiveness of breast cancer screening. This will be of value to governments, public health officials and others concerned with policy recommendations for cancer control.