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Dr. Paula Gordon
@DrPaulaGordon
, 3 tweets, 2 min read Read on Twitter
The probability of mammograms causing cancers is negligible in women over 40. These cancer were missed in dense tissue, which is why women should be told their breast density. Just like you tell them their blood pressure (don't you?)
They should do BSE, and consider supplementary screening with US/MRI to find those cancers. US can find 3-4 cancers per thousand women screened, and the vast majority are small, invasive (not DCIS) and node-negative.
Women who have mammograms are 40-60% less likely to die of breast cancer than women who don't
Coldman A et al. ncbi.nlm.nih.gov/pubmed/25274578
Tabar L et al. ncbi.nlm.nih.gov/pubmed/30411328

(But stats are not as good in the UK, because NHS screens only every 3 years)
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Dr. Paula Gordon
@DrPaulaGordon
Connecticut has been doing screening US for all women with C and D density with no other risk factors since 2009, and finding 3-4 cancers per thousand women screened, essentially doubling the cancer detection rate over mammo alone.
The vast majority are small, invasive (not DCIS) and node negative, with PPV low at first but improving over time. That would be my first choice. If forced to ration, perhaps screening US for all category Ds and for category C with another risk factor, like + family history, but
you risk missing cancers in the Cs. Any woman considering US screening (or any screening for that matter) should be aware of the likelihood of false alarms, especially the first time she has the test. We find complicated cysts, fibroadenomas, etc.
Read 5 tweets
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Dr. Paula Gordon
@DrPaulaGordon
Important reading for @cantaskforce , and based on a RCT, no less ;- ). Thanks for the references, Murray. Thanks for the lifetime of work @MdTabar to save women's lives.
…ast-cancer-research.biomedcentral.com/articles/10.11… gives a possible explanation of why increased mortality is less obvious. Both the Tabar and old BIRADS density categories are based on overall breast density. BIRADS 2014 is based on the densest part of the breast and the probability of masking.
It shows that localized mammographic density (category D by BIRADS 2014) is associated with interval cancer and large breast cancer, both surrogates for increased mortality. Perhaps the 2010 study should be repeated using BIRADS 2014 categories.
Read 3 tweets
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Dr. Paula Gordon
@DrPaulaGordon
Thanks @colinmcphail for your coverage cbc.ca/news/canada/ne… Not sure Moore is correct that "breast density is not associated with an increased risk of dying from breast cancer."
No registry records the breast density of women who have died of breast cancer. But women with dense breasts certainly have a higher incidence of interval cancers, and interval cancers have a worse prognosis than screen-detected cancer.
Besides, mortality reduction is only one of the benefits of early detection, but the only one considered by @cantaskforce . They gave no value to women being able to have less aggressive surgery and avoid chemotherapy when cancers are found early. Those are important to women.
Read 3 tweets

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