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Reuters Health editor Ivan Oransky is welcoming everyone to the call
On the call today is Heidi Nelson, who led the review
Also Daniel B. Kopans, professor of radiology at Harvard Medical School and director of breast imaging at the Massachusetts General Hospital.
Maggie Fox, Reuters editor for health & science, is also on the call
Ivan: What do these new guidelines say?
Nelson: The big change is the age. What we're talking about here is the mammograms for women who have no symptoms or findings. That's different from someone coming to physician with findings.
What has changed is the understanding of when to start that routine of screening.
The language has changed to a discussion of the benefits and harms
Kopans says guidelines are more emphatic: don't get screening
Kopans: There was no-one on taskforce that has any direct experience of screening. I would point out that the taskforce said no screening for women in their 40s.
What I would like to know is what are they advising women in their 40s? It sounds like they're saying wait until they have a cancer they can no longer ignore.
Nelson: I'm not on the taskforce, I'm trying to help you read what they've written. Regarding clinical breast exam, that a clinician does on a routine basis, they gave that rating an "i". That's not a yes or a no, but a placeholder.
Oransky: Tell us about the taskforce and how what you do feeds into what they do.
Nelson: They're not a government panel. They rotate every three years. They systematically review the evidence looking at the effectiveness of different ...
Nelson: We lay out the evidence and then step back. I have nothing to do with actual recommendations..
The evidence I hope isn't too controversial
Kopans: You can show me no trial to show that something changes at age 50
The task force actually stated that there is a clear benefit for screening women in their 40s. I can find nowhere that they looked at evidence from Netherlands and Sweden that when you introduce screening there are clear data that the death rate goes down
The task force doesn't even mention that data. They use computer modeling. There are other models that disagree with the models they use.
Fox suggesting this is getting too technical. Let's discuss how we got to the recommendations.
Fox: Does anything change at 50? Why 50?
Nelson: We force the data into those decade groups and those for the 40s are the same for the 50s. We get a 15 pct reduction in mortality for women in 40s and 50s.
So we do see strong effect across all ages
Kopans: the conservative estimate you've used is the lowest of the lows. randomized control trials underestimate benefits of screening. women in control group can only be invited to be screened.
such trials give you lowest estimate of benefit of screening. what happens when you go outside the trials? where it has been introduced into the general population, the death rate has dropped dramatically.
Death rate in US down 30 percent. Task force admits in its paper that death rate has declined highest among women in their 40s.
Nelson: I think randomized control trials strengthen the finding.
The task force went on to commission modelling studies.
The reason for taking it on to a model is because a lot of questions weren't answered in the trials
Kopans: We still haven't had an answer on why use computer models not studies showing benefits when introduced in general population?
Oransky: last guidelines were 2002. We're getting to some meaty questions of evidence. We need for our users to ask is there something that has changed since then? Is it a regular review?
Nelson: This is an update of that work. They wanted to focus on fuzzy issues of when to stop and when to start. New trial in UK on women in their 40s.
Kopans: Age trial in UK was shown to be nonsense. Author has repudiated it.
It missed 25 pct of breast cancers.
They basically missed a huge number of cancers. The age trial adds nothing.
Nothing has actually changed since 1997 when National Cancer Institute recognized the data clearly showed a benefit for women in their 40s.
Now we're going back to 1993 with the same arguments.
Fox: What should women in their 40s be doing?