ACR slams JAMA mammography study, editorial over ‘outrageous and insulting’ claims

The American College of Radiology slammed new JAMA research and a corresponding editorial on Monday over “outrageous and insulting” claims related to breast imaging.

In a research letter published March 15, Weill Cornell Medicine scientists estimated that 87% of specialized breast cancer centers in the U.S. provide screening recommendations that differ from national societies. That included an average start date of 40 years, with 81% of centers advising annual screening.

Only about 12% of breast cancer centers highlighted the importance of shared decision-making between a woman and her primary care doc. In a corresponding editorial University of California, San Francisco, experts criticized these findings and breast imaging providers for operating based on “nonevidence-based” guidelines.

“The recommendation for annual mammography in women younger than 50 years is, at best, confusing for patients and is likely to conflict with advice from their primary care physicians, which can create tension,” Anand Habib, MD, a resident physician in internal medicine at UCSF, and colleagues wrote March 15. “This recommendation can also produce unnecessary testing, invasive procedures, overdiagnosis and anxiety among women who receive screening. Breast cancer centers with clear financial benefits from increased mammography rates may wish to reconsider offering recommendations that create greater referral volume but conflict with unbiased evidence-based USPSTF guidelines and have the potential to increase harms among women,” he and co-authors added.

ACR shared its own response to the editorial and research on Monday, condemning the new JAMA content. The college believes the original research letter was based on “serious omissions of fact.”

“The claim that facilities offering mammograms to women ages 40 and older are operating counter to recommendations of ‘national societies’ is misleading at best,” ACR said. “Also, to assert that financial incentives may be driving local site screening recommendations—with no evidence to back the claim—is outrageous and insulting to the medical professionals working to save lives from the nation’s second leading cancer killer in women.”

The college further noted that it, alongside the Society of Breast Imaging and American Society of Breast Surgeons, all recommend that women start receiving annual mammograms at age 40. And the American College of Obstetricians and Gynecologists recommends women also begin at 40 and get tested every 1-2 years.

United States imaging providers “largely do not support” delayed or less frequent screening, as called for by the U.S. Preventive Services Task Force and American Cancer Society, the college added.

In the original research letter, Weill Cornell’s Neal Patel and co-authors noted that most countries recommend that women receive breast cancer screening every two years between ages 50-69. And in 2016, the influential USPSTF updated its recommendations to advise women to receive screening every two years between ages 50-74. The decision to be screened earlier, meanwhile, should be based on each individuals’ evaluation of risks and benefits.

For their research, Patel et al. reviewed recommendations for starting age and interval of screening mammography on the public websites of 606 breast cancer centers between December 2019 and July 2020. Among them, 431 centers (88.5%) specified a starting age for screening. Of those, 87.2% provided guidance “different from those of national societies,” recommending screening start at 40. About 8.1% of centers recommended age 45, while 4.6% of centers used age 50 as the starting date.

You can read the entire research letter in JAMA Internal Medicine here and the corresponding editorial here.

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