Health

Despite Katie Couric’s advice, doctors say breast ultrasound may not be needed


When Katie Couric shared the news about her breast cancer diagnosis, the former co-host of NBC’s “Today” said she sees this new health challenge as a teachable time to encourage people to get the necessary cancer screenings. .

“Please have your annual mammogram,” she wrote on her website in September. “But just as importantly, please find out if you need further screening.”

In the essay, Couric, 65, explains that because she tends to have dense breast tissue, she gets an ultrasound exam along with a mammogram when screening for breast cancer. One breast ultrasound, sometimes called an ultrasound, uses sound waves to take pictures of breast tissue. It can sometimes identify malignancies that are difficult to detect on mammograms in women with dense breasts – that is, with a high ratio of fibrous and glandular tissue to fatty tissue.

Couric, who famously underwent a colonoscopy on live television after her first husband died of colon cancer and who lost his sister to pancreatic cancer, has long promoted the cancer control and better detection options.

Breast cancer experts applaud Couric for drawing attention to breast density as a risk factor for cancer. But some don’t feel more comfortable with her advocacy for additional screening.

“We have no evidence that adjuvant screening reduces breast cancer mortality or improves quality of life,” said Dr. Carol Mangionea professor of medicine and public health at UCLA who chairs the US Preventive Services Task Force, a group of health professionals that make recommendations about preventive services after weighing the benefits and their effects.

Couric’s office did not respond to a request for comment.

In addition to yearly mammograms, some women with thick breasts get a breast ultrasound or MRI to help identify cancer cells missed by mammograms. Dense fibrous tissue appears white on a mammogram and makes it harder to see cancerous masses, which are also white. Fatty breast tissue, which appears dark on mammograms, does not obscure breast malignancies.

As digital breast fusion, or 3D mammography, has become more widely available, more and more women are accepting that screening test instead of the standard 2D mammogram. 3D mammography has been found to reduce the number of false-positive results and identify more cancers in some women with dense breasts, although the impact on mortality is unknown.

Task Force for rating “me” for additional screening of women with dense breasts whose mammograms do not show a problem. That means the current evidence is “insufficient” to assess whether the benefits outweigh the harms of further screening. (The task force is updating its recommendations for breast cancer screening, including additional screening for women with dense breasts.)

A major harm the researchers fear, besides the possible added cost, is the potential for false-positive results. Additional imaging in women who are not at high risk for breast cancer can identify potential trouble spots, which can lead to further testing such as an invasive breast biopsy and cause fear. cancer in many patients. But research has found that very often these results turn out to be false alarms.

If 1,000 women with thick breasts had an ultrasound after a negative mammogram, Ultrasound will determine two to three cancers, studies show. But additional imaging will also identify up to 117 potential problems that led to visits and recall tests but were ultimately identified as false positives.

“On the one hand, we wanted to do everything we could to improve detection,” said Dr. Sharon Mass, an obstetrician and gynecologist in Morristown, New Jersey and former president of the American College of Obstetricians and Gynecologists. United in New Jersey said . “But on the other hand, there is a lot of cost and emotional distress” associated with false positives.

Professional group No additional screening is recommended for women with thick breasts who don’t have any additional cancer risk factors.

Much other professional groups hold a similar position.

“We recommend talking to a healthcare provider and letting the patient understand if their breasts are thickened,” says Mass. “But we don’t recommend everyone get tested.”

In particular, for about 8% of women with overly dense breasts, it’s a good idea to talk to your doctor about additional testing, Mass says.

Similarly, for women with thick 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 cancers. in doubt, additional screening may make sense.

Dense breasts are relatively common. In the United States, an estimated 43% of women age 40 and older have breasts that are considered thick or extremely dense. In addition to the difficulty of interpreting mammograms, women with thick breasts may also double Studies show breast cancer development when women have average breast density.

Studies have shown that mammograms reduce breast cancer mortality. But while it may seem intuitive that getting more screening will improve someone’s chances of beating cancer, research hasn’t found that women are less likely to die from breast cancer. if they received additional ultrasound or MRI after a negative mammogram.

Some studies have found that women with thick or very dense breasts get an ultrasound or an MRI in addition to a mammogram. there are less so-called gap cancers between regular screening mammograms. But it is not clear whether those results are does it have any effect? about their risk of dying from breast cancer.

“Not every minor abnormality will lead to something that needs to be treated,” says Mangione.

Thirty-eight states and the District of Columbia have laws require the patient to be informed about breast density after a mammogram, although some require only a general notice rather than requiring individual women to be informed of their own condition. Some states require insurance companies to cover additional testing, but others do not.

In 2019, the FDA proposed that breast density information incorporated into the letters patient received after mammogram. That rule has yet to be finalized, but the agency told lawmakers it hopes to enact the rule. no later than the beginning of the next day five.

In a statement to KHN, FDA spokeswoman Carly Kempler said, “The FDA is committed to improving mammography services for patients and is working hard to finalize the rule that amends existing regulations regarding mammography. Mammography”.

Additional testing costs are another factor to consider. Because the preventive services task force recommends that women get regular mammograms, health plans are often required to cover them at no cost to everyone. That’s not the case for additional testing for women with thick breasts, which the task force discourages. Some states require coverage for those inspections, but those laws don’t apply to many plans in which employers “pay for themselves” workers’ benefits instead of purchasing insurance. state-mandated insurance.

Additional images can be expensive if your health plan does not cover it. According to the Brem Foundation to Beat Breast Cancer, a screening ultrasound can cost $250 while a breast MRI can cost $1,084, according to the Brem Foundation to Beat Breast Cancer.

Representative Rosa DeLauro (D-Conn.) Recently tweeted that she is work on an invoice with Couric will cover MRIs and ultrasounds for women with thick breasts at no additional cost.

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

“If you really want to help yourself, lose weight,” says Dr. Karla Kerlikowskeprofessor of medicine and epidemiology/biostatistics at the University of California-San Francisco who has worked with other researchers to develop computers that help providers Assess the patient’s risk of breast cancer. “Moderate your alcohol intake and avoid hormone replacement in the long run. Those are the things you can control.”

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