US women endure twice the surgical biopsies as British for same cancer detection rate

Although the rate of breast cancer detection is similar in the two countries, US doctors perform two to three times more open surgical biopsies than British doctors. In addition, American women are recalled, or referred for further testing, twice as often as British women, according to a study by UCSF radiologist Rebecca Smith-Bindman, MD.

Women in both countries who are recalled undergo additional tests such as ultrasound, diagnostic mammography and biopsy.

The study, published in the October 22 issue of the Journal of the American Medical Association, compared screening mammography performance in the US and UK among similar aged women by examining three large-scale registries, analyzing 5.5 million mammograms.

Recall rates in the UK are substantially lower than in the US, yet there is no substantial reduction in cancer detection. Projections made by the researchers show that over ten years of screening about 40-50 percent of US women will have at least one false-positive scare, while in England only 15 percent of women will. Still, very similar numbers of cancers are detected in both countries. "The anxiety and costs associated with these false-positives can be enormous," said Smith-Bindman, a UCSF assistant professor of radiology and epidemiology and biostatistics.

"We need to find ways to improve the accuracy of mammography and training for mammographers," she added. "The goal of any cancer screening effort is to obtain high cancer detection rates while avoiding unnecessary diagnostic evaluation following false positive results. Perhaps we can learn from the UK, where half as many women without breast cancer undergo open surgical biopsies as in the US."

The National Health Service Breast Cancer Screening Program of the UK provided the researchers with records for 3.94 million mammograms. In the US, the Breast Cancer Surveillance Consortium provided 978,591 records and National Breast and Cervical Cancer Early Detection Pr

Contact: Eve Harris
University of California - San Francisco

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