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Digital Mammography More Accurate in Young Women, Women With Dense Breasts
A new study has found that the overall diagnostic accuracy of digital mammography is similar to that of traditional film mammography but that digital mammography is more accurate in women younger than 50 years, pre- and perimenopausal women, and women with dense breasts.
Nearly 50,000 women in the United States and Canada underwent both digital and film mammography in a study led by Etta D. Pisano, M.D., of the Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill. The results of the study were published online September 16 in the Early Release section of the New England Journal of Medicine.
Although the overall accuracy of breast cancer detection was similar in both methods, digital mammography was more accurate in detecting breast cancer in women younger than 50 years, women with dense breasts, and pre- and perimenopausal women. The authors note, however, that the cost of digital mammography—1.5 to 4 times greater than film mammography—may be a barrier to its widespread adoption. The study did not address the effect of digital mammography on breast cancer mortality.
Study Finds Decrease in U.S. Death Rate, Smaller Decrease in Cancer Deaths
A new study has found that the age-standardized rate of death in the United States declined by 32% between 1970 and 2002 and that the rate of death from cancer declined by 2.7%.
Ahmedin Jemal, D.V.M., Ph.D., of the American Cancer Society, and colleagues analyzed vital-statistics data on U.S. mortality between 1970 and 2002 for the six leading causes of death: accidents, cancer, chronic obstructive pulmonary disease, diabetes mellitus, heart disease, and stroke.
There were large decreases in the age-standardized rates of death from stroke (63%), heart disease (52%), and accidents (41%). However, the rate of death from chronic obstructive pulmonary disease doubled over the study period, and the rate of death from diabetes rose by 45% since 1987. The death rate from cancer increased between 1970 and 1990 but then fell through 2002, for a net overall decrease of 2.7%. The authors also found that the absolute number of deaths from all of these conditions continues to increase and that these deaths occur at higher ages.
ASCO Issues Guidelines on Use of Sentinel Lymph Node Biopsy in Breast Cancer Patients
The American Society of Clinical Oncology has issued new guidelines for the use of sentinel lymph node biopsy (SNB) in patients with early-stage breast cancer, concluding that the procedure is an "appropriate initial alternative" to the more invasive axillary lymph node dissection (ALND).
ALND has been the long-time standard method of assessing disease progression and determining the appropriate treatment for patients with early-stage breast cancer. However, serious complications can occur, including nerve injury, shoulder dysfunction, and lymphedema.
In SNB, the sentinel nodes (i.e., the first node on the lymphatic drainage pathway from the tumor) are identified through the use of a weak radioactive agent and/or dye injected into the breast and are then removed and examined for cancer. Only if there is evidence of cancer is a complete dissection of the lymph nodes in the armpit performed. Although few trials have examined clinical outcomes associated with the use of SNB, the practice is common in the United States, Europe, and Australia.
A panel led by Gary H. Lyman, M.D., of the University of Rochester Medical Center in New York, conducted a literature review to determine the appropriate use of SNB in early-stage breast cancer. They concluded that SNB is a safe alternative to ALND and that SNB is associated with less morbidity. However, they did not find enough evidence to compare the effects of the two procedures on tumor recurrence or patient survival. The guidelines were published online September 12 by the Journal of Clinical Oncology and will appear in the October 20 issue.
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