Kopans: They should continue to get mammographic screening. Death rate in US has continued to come down because of screening.
Fox: Programs in UK and Netherlands don't invite women until they are 50
Kopans: that's because they're saving money
Fox: Is this to save money or is there harm done to women from screening in 40s?
Nelson: task force doesn't consider cost
Kopans disputes that, citing figures from report
Oransky: isn't it potentially also harm? what is the potential harm? are there false positives that don't turn out to be lethal?
Nelson: looked at consequences of false positives. We looked at regular screeners. Able to get numbers by decade, although there's no magic at the decade number.
Women in their 40s have a lot more false positives. You would have to screen 556 to find 1 with a breast cancer. Maybe that was okay.
Of those, 47 come back for additional image.
What was surprising and reassuring was that of those 47, 5 have biopsy. Radiologists have got very good at determining who needs biopsy.
So false positives is mainly around follow-up mammography.
Kopans: We've already talked about downside of screening. Most of false positives are dealt with by extra mammographic view. That doesn't seem to me to correlate with dying from breast cancer.
Kopans: Task force is said we're making the decision for you, you can't have mammograms in your 40s.
Oransky: American Cancer Society said they would recommend disregarding guidelines
What does this really mean in terms of change in practice, change in reimbursement?
Kopans: American Cancer Society is continuing because scientific evidence supports it
People who can't afford it will be denied access and lives will be lost
Fox: Are women going to die because of these guidelines?
Nelson: Less screening could result in that way but you'll also have less issues around overdiagnosis. It's hard to put societal perspective
Kopans: There will be more deaths. if you stop screening, death rate will go back up. Task force admits that but think it's not worth anxiety of false positives.
Overtreatment has nothing to do with screening. They're working out how to tailor treatment. That doesn't mean you tell women who can have their lives saved that they can't because of overtreatment
Fox: Are there other costs? Can women die from cancer surgery?
Kopans: No. Every woman I know who had benign biopsy was relieved.
Decreasing breast cancer rates by 30 percent is a major advance while we wait for cure. This is an important health issue for women in their 40s.
Oransky: reader asks, are there other tests younger women can get?
Nelson: There really haven't been very many randomized trials of clinical breast exam or self exam. We don't have a good study in the US.
For clinical breast exams. So the test was given a placeholder rating until we have comprehensive data.
Most clinical exams right now are not done properly anyway. So the jury's out on that.
Kopans disputes lack of studies, cites two
I'm not out to defend clinical breast exam
It's the same for self examination.
It used to be that 90 percent of cancers were discovered by women themselves. What are American women in their 40s supposed to do about their breasts?
Nelson: I can't answer for task force.
Fox: what would you tell your patients?
Nelson: we need to do a better job of educating them. Should we spend a lot of time in clinical setting teaching breast self-exam, I don't think that's good use of time.
Kopans: It's too late once you find change
Fox: Is it too late? Some evidence shows improvement in treatment responsible for lower death rates.
Kopans: Only evidence from computer model. Models are interesting but silly for making recommendations. There's direct data from Sweden and Netherlands shows majority of decrease of deaths is from screening.
Fox: What effect has reduction in HRT had on lower deaths?
Kopans citing research on hormone replacement therapy and reduced breast cancer death rates and incidents.
The hormone business is totally unlinked to breast cancer in the US
Nelson: It's pretty complicated to sort out each factor. We need to re-examine the data often. We owe it to women to really lay out the best data for them.
(Discussion around different imaging technologies ongoing)
Kopans citing issues with MRI screening.
Kopans: We find a lot of breast cancers early enough to save lives and that begins at 40
Recommendations are not based on science
Fox: Is the task force saying women can't deal with consequences of false positives?
Kopans: the only discussion they recommend is high-risk women. None of the controlled trials were based on risk.
They're not saying talk it over with your doctor, they're saying we don't support it. That suggests insurance companies won't be far behind.
Nelson: the task force says the decision to start screening before 50 should be an individual one
Fox: what are you going to say to your patient?
Nelson: at any age we should have discussion about the harms that are going on as well. I don't think my practices will be changing a whole lot.
Nelson: this may be a big shift for some practices but it's good to think through everything we do. that piece of advice is pretty wise, don't think we're being controversial. payment issue is concerning, perhaps.
Kopans: there's no new data on screening, task force relied on computer models. i think these guidelines will result in increase in deaths that could be avoided
Nelson: there are lot of holes and deficiencies in trials. it's a changing world and we're never done. there are big holes in the research that we need to fill.
Oransky thanking everyone for participating and listening
Thanks for following the live blog. We'll be posting a recording of the call later.