Breast cancer deaths down 40% since 1990, thanks to mammography

A new report from the National Cancer Institute reaffirms the efficacy of regular mammography screening, finding breast cancer deaths have dropped nearly 40 percent since 1990. This reduction represents over 274,000 lives saved, according to the American College of Radiology (ACR).

Breast cancer mortality rates had remained mostly stable until the introduction of screening mammography in the early 1980s. However, it wasn’t until Congress passed and enacted the Mammography Quality Standards Act (MQSA) in 1992 that mammography really took off.

“Regular mammography screening and improved therapies are undoubtedly responsible for the decline in breast cancer deaths,” the ACR said in a statement. “Mammography can detect cancer early when it’s most treatable and can be treated less invasively. This also helps preserve quality of life.”

According to the Government Accountability Office, the MQSA’s uniform set of standards provided a valuable benchmark for lagging mammography practices to strive for, causing many facilities to improve their services in order to become fully certified. This is visible in mortality data: In 1990, 73.8 out of 100,000 women died of breast cancer; the 2014 data showed that number had dropped to 45.9 out of 100,000. Nonetheless, there’s plenty of room for improvement, according to a study published in Radiology.

A group of researchers affiliated with the National Institutes of Health’s Breast Cancer Surveillance Consortium used national statistics to paint an updated picture on the state of mammography in the U.S. When compared to screen-film mammography, digital mammography showed increases in abnormal interpretation and cancer detection rates, but a decrease in positive predictive value.

“Overall, our results suggest that radiologists in the United States excel at detecting cancers but are often not meeting expert-based goals for reducing false-positive biopsy recommendations,” the authors wrote. “The substantial degree of variation in performance metrics across radiologists suggests that ongoing quality improvement efforts are needed in diagnostic mammography.”

Such efforts include the push for increased use of digital breast tomosynthesis (DBT) in regular screening. DBT was given a CMS current procedural terminology (CPT) code in 2015, opening the door for clinical implementation of the more accurate modality. According to a study published in the Journal of the American College of Radiology, an average state-wide Medicaid program could avoid 1,200 unnecessary follow-up appointments per year by using DBT, saving $200,000 annually.

The researchers found other benefits too: the added sensitivity and specificity of DBT can improve patient throughput and reducing follow-ups curtails the stress and anxiety felt by women who are recalled for a follow-up appointment. Five states have introduced legislation requiring insurers to cover DBT, but the passage of the bills may come down to the legislative climate of those individual states, according to Eugenia Brandt, Director of State Affairs for the
ACR.

Countless studies tout the most efficient modality or workflow for mammography, but simply increasing the amount of women who receive these screenings is another prominent issue.

A study published in Cancer found 70 percent of women dying of breast cancer at Massachusetts General Hospital were among the 20 percent of women not undergoing recommended screening, representing an opportunity to improve outreach and education about the benefits of mammography, the authors said.

“Our study emphasizes that palpable breast cancers remain the major challenge to efforts to reduce breast cancer mortality,” they wrote. “Programs to achieve regular screening in all appropriately aged women should be encouraged.”