Despite Katie Couric’s advice, doctors say ultrasound breast exams aren’t necessary | Rare Techy


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

“Please get your annual mammogram,” she wrote on her website in September. “But importantly, find out if you need additional screening.”

Couric, 65, explained in the article that in addition to mammograms, she gets an ultrasound test when screening for breast cancer because she has dense breast tissue. A breast ultrasound, sometimes called a sonogram, uses sound waves to take pictures of breast tissue. It can sometimes detect malignancies that are difficult to detect on a mammogram in women whose breasts are dense – meaning they have a high ratio of fibrous tissue and glands versus fatty tissue.

Couric, who underwent a colonoscopy on live television after her first husband died of colon cancer and lost her sister to pancreatic cancer, has long pushed for cancer screening and better detection options.

Breast cancer experts have praised Couric for drawing attention to breast density as a risk factor for cancer. But some weren’t so comfortable with her advocacy for supplemental screening.

“We don’t have evidence that adjunctive screening reduces breast cancer mortality or improves quality of life,” said UCLA professor of medicine and public health Dr. Carol Mangione said. Recommendations are made for preventative services after weighing their pros and cons.

Couric’s office did not respond to requests for comment.

In addition to annual mammograms, some women with dense breasts get a breast ultrasound, or MRI, to help identify cancer cells that mammograms miss. Dense fibrous tissue appears white on mammograms and makes it difficult to see cancers, which appear white. Fatty breast tissue that appears dark on a mammogram does not mask breast malignancies.

As digital breast tomosynthesis, or 3D mammography, becomes more widely available, more women are having the screening test than standard 2D mammography. 3D mammography reduces the number of false-positive results and detects more cancers in some women with dense breasts, although the impact on mortality is unknown.

The task force gives an “I” rating to supplemental screening for women with dense breasts whose mammogram results do not indicate a problem. That is, current evidence is “insufficient” to assess whether the benefits outweigh the harms of additional screening. (Task force updates recommendation for breast cancer screening, including supplemental screening for women with intact breasts.)

A major disadvantage that researchers are concerned about is the possibility of a false-positive result, in addition to the possible additional cost. Supplemental imaging in women who are not at high risk for breast cancer may identify potential problem areas and lead to further testing, such as a breast biopsy. But research has found that these results often turn out to be false alarms.

Studies show that if 1,000 women with dense breasts get an ultrasound after a negative mammogram, the ultrasound will identify two to three cancers. But additional imaging can identify up to 117 potential problems that lead to recalls and tests but are ultimately determined to be false positives.

“On the one hand, we want to do everything we can to improve detection,” said Dr. Sharon Maas said. . But on the other hand, there is a lot of cost and emotional distress associated with false positive results.

The professional group does not recommend supplemental screening for women with dense breasts who have no additional risk factors for cancer.

Many other professional groups take a similar position.

“We recommend having a conversation with a health care provider and asking patients to find out if their breasts are dense,” Maas said. “But we don’t recommend testing everyone.”

In particular, for the roughly 8% of women with very dense breasts, it’s worth having a conversation with a doctor about additional screening, Maas said.

Similarly, for women with dense breasts who have more risk factors for breast cancer, a family history of the disease or a personal history of breast biopsies to check for suspected cancers, supplemental screening may make sense, she said.

Dense breasts are relatively common. In the United States, it is estimated that 43% of women age 40 and older have dense or very dense breasts. In addition to making mammograms difficult to interpret, research shows that women with dense breasts are more than twice as likely to develop breast cancer as women with breasts of average density.

Studies have shown that mammograms reduce breast cancer mortality. While it may seem intuitive that more screenings would improve one’s chances of beating cancer, research has not found that women are less likely to die from breast cancer if they get a follow-up ultrasound or MRI after a negative mammogram result.

A few studies have found that women with dense or very dense breasts who received a mammogram and an ultrasound or MRI had fewer cancers during the intervals between routine screening mammograms. But it’s unclear whether those results have any effect on their risk of dying from breast cancer.

“Not every little abnormality is going to lead to something that needs treatment,” Mangione said.

Thirty-eight states and the District of Columbia have laws requiring patients to be notified of breast density after a mammogram, although some require only general notification rather than informing individual women of their own condition. Some states require insurance to cover supplemental testing, but others do not.

In 2019, the FDA proposed that letters patients receive after mammograms include information about breast density. That rule has not yet been finalized, but the agency told lawmakers it expects to issue the rule as early as next year.

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

Another factor to consider is the cost of additional testing. Because the Preventive Services Task Force recommends that women get regular screening mammograms, health plans usually require people to do so without charging anything out of pocket. Not so with supplemental screening for women with dense breasts, which is not recommended by the task force. Some states require insurance coverage for those tests, but those laws don’t apply to many plans in which employers “self-fund” workers’ compensation benefits rather than purchasing state-mandated insurance coverage.

Supplemental imaging can be expensive if your health plan doesn’t cover it. A screening ultrasound costs $250 out-of-pocket, and a breast MRI costs $1,084, according to the Bream Foundation to Fight Breast Cancer.

Rep. Rosa DiLoro (D-Conn.) recently tweeted Works on a bill There are no out-of-pocket costs with Coric, which covers MRIs and ultrasounds for women with dense breasts.

Some doctors recommend other measures that may be more effective than additional screening for women with dense breasts who want to reduce their risk of breast cancer.

“If you want to help yourself, lose weight,” says Dr. Carla Kerlikowski said she has worked with other researchers to develop calculators to help providers evaluate patients. ‘Risk of breast cancer. “Moderate your alcohol intake and avoid long-term hormone replacement. Those are things you can control. “

KHN (Kaiser Health News) is a national newsroom that provides in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides information on health issues to the nation.

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