Thursday, July 21, 2011

The Breast Cancer News Update: July 21

Today in breast cancer news, we'll look at the latest recommendations on screening mammography and two new studies on sentinel lymph node biopsy recurrence rates.

ACOG weighs in on the screening mammography debate

Another influential group, the American College of Obstetrics and Gynecology (ACOG), has weighed in on the debate over when to start and how often to have screening mammography. Reuters, US News and World Report and The Boston Globe covered the story.

In 2009, the US Preventative Services Task Force stirred up controversy when it noted that the benefit of screening mammography before age 50 was very small compared to the risk of false positives and unnecessary biopsies. Even after age 50, the Task Force recommended screening every two years. By contrast, the American Cancer Society and the National Comprehensive Cancer Network recommend annual screening mammography starting at age 40. The National Cancer Institute recommends screening every one or two years starting at age 40. The public has been vocal on both sides of the issue.

This week, the ACOG recommended that doctors offer annual screenings starting at age 40. Media coverage of the new guidelines varied in emphasis. The Reuters story highlighted the offering of a choice. Reuters quoted Dr. Jennifer Griffin, one of the authors of the new recommendation as saying, "We believe it is our job to help women make the best health decision for themselves. We believe that many women will choose to have a screening mammogram every year, (and) of course there are women that will choose not to." By contrast, the US News and World Report coverage highlighted the incidence of breast cancer among women in their 40s and also quoted Dr. Griffin,

"I think the main point we considered was that about 40,000 women every year in their 40s are diagnosed with breast cancer, and about 20 percent of them will die from it," said Griffin, an assistant professor of OB/GYN at the University of Nebraska Medical Center. "Screening mammograms reduce the risk of dying by 15 percent" in this population.

The ACOG guidelines only apply to women with average risk of breast cancer.

Sentinel lymph node biopsies for node negative and micrometastatic nodes

A sentinel lymph node biopsy (SLNB) is generally preferred over complete axillary lymph node dissection (ALND) due to the less severe side effects and better quality of life associated with SLNB. Back in February, a Journal of the American Medical Association study concluded that for women with one or two positive sentinel lymph nodes, the use of SLNB instead of ALND did not result in inferior overall survival.

This month, two studies evaluated the recurrence rates associated with SLNB without complete axillary dissection for women with negative or micrometastatic nodes.

A July 1 study in The Breast Journal assessed the incidence of recurrence in 481 patients from a hospital in Belgium who were treated with SLNB. In this study, the sentinel nodes were either negative or contained micrometastases. At a median follow-up of 4 years, only one patient (from the node negative group) experienced axillary relapse. The authors concluded, "This study confirms that the axillary recurrence rate after long-term follow-up of patients with a negative sentinel lymph node is very rare, provided that the selection criteria are judicious."

A July 9 study from China in Breast Cancer Research and Treatment reviewed recurrence and survival rates from 8 randomized controlled trials of SLNB and ALND. The authors concluded that "SLNB can be recommended as preferred care for SLN-negative patients and selected patients with SLN-micrometastasis."

Please check back tomorrow for more breast cancer news from

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