Study author R. Edward Hendrick, PhD, clinical professor of radiology at the University of Colorado Denver School of Medicine in Aurora, CO, concluded that BSGI or PEM carries a lifetime risk of inducing fatal cancer greater than or comparable to a lifetime of annual screening mammography starting at age 40.

Hendrick reviewed recent studies on radiation dose from radiologic procedures and organ doses from nuclear medicine procedures, along with Biologic Effects of Ionizing Radiation (BEIR) VII age-dependent risk data, to estimate the lifetime risk of radiation-induced cancer incidence and death from breast imaging exams using ionizing radiation.

Receiving a single two-view digital mammography or film-screen mammography exam was associated with an average lifetime risk of fatal breast cancer of 1.3 and 1.7 cases, respectively, per 100,000 women age 40 years at exposure, and less than one case per 1 million among women age 80 years at exposure.

Annual screening by digital or film-screen mammography performed in women from age 40 to age 80 is associated with an aggregate lifetime risk of fatal breast cancer of 20 to 25 cases in 100,000.

In comparison, a single BSGI exam was estimated to involve a lifetime risk of fatal cancer 20 to 30 times that of digital mammography in women 40 years of age, while the lifetime risk of a single PEM study was 23 times greater than that of digital mammography.

In addition, while mammography only slightly increases a woman’s risk for breast cancer, the study found that BSGI and PEM may increase the risk of cancers in other organs as well, including the intestines, kidneys, bladder, gallbladder, uterus, ovaries, and colon.

Hendrick recommended that women younger than 40 who are known to be at higher risk of breast cancer should consider being screened with breast ultrasound or breast MRI, both of which deliver no ionizing radiation and have sensitivities to breast cancer that are unaffected by higher breast density.

By Wayne Forrest
AuntMinnie.com staff writer
August 24, 2010

During the minimally invasive TAVI (transcatheter aortic valve implantation) intervention, an artificial aortic valve is inserted via the femoral artery or through the apex of the heart. A new image processing software from provides the physician automated 3D guidance for the procedure: Syngo Aortic ValveGuide segments the aortic root in three-dimensional mode from Syngo DynaCT Cardiac images. With the aid of anatomical landmarks in the 3D representation of the vessel, Syngo Aortic ValveGuide calculates the exact perpendicular view on the aortic root. The C-arm adjusts to the corresponding angulations for live fluoroscopy. That way, it provides the proper perspective that the physician requires to exactly position the new valve. Consequently, as soon as the software overlays the 3D image of the aorta with the two-dimensional live fluoroscopy, the cardiologist in the cath lab or, respectively, the heart surgeon in the hybrid room, can start the intervention. Since Syngo Aortic ValveGuide only requires a short fluoroscopy time prior to the procedure, the patient’s exposure to radiation and contrast agent can be reduced considerably.

The Heart Center in Leipzig, one of the leading facilities in Germany to perform TAVI-procedures, had previously performed several of these interventions with the Syngo DynaCT Cardiac from Siemens. This software processes CT-like images of the heart from images acquired with the angiography system. However, to overlay live fluoroscopy images with these 3D images and find the correct angulation for the C-arm, the physician had to leave the sterile operating area and perform manual angulation calculations at a workstation or make medical staff available solely for this purpose. “With Syngo Aortic ValveGuide, we can now find the optimal angulation with a perpendicular view on the aortic root easier and faster than before, because the software automates so many work steps,” says Dr. Jörg Kempfert, heart surgeon at the Heart Center Leipzig.

The product mentioned herein is not commercially available. Due to regulatory reasons its future availability cannot be guaranteed.

The outcomes achieved by the Siemens customers described herein were achieved in the customer’s unique setting. Since there is no “typical” hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that others will achieve the same results.

The Heart Center of the University Leipzig has a cooperation contract with Siemens Healthcare.

Source: Siemens

Pediatric gastroenterologists and radiologists at Wilhelmina Children’s Hospital in Utrecht, the Netherlands, conducted a study to determine the accuracy and intra- and interobserver agreement of the Starreveld scoring method in the diagnosis of functional constipation among pediatric patients (Pediatric Radiology, July 1, 2010).

The physicians wanted to determine if the Starreveld scoring system, designed for scoring radiographs of constipated adult patients, might be useful for pediatric patients as well. During this exercise, they also compared the performance of the Starreveld method with the Barr scoring method, the oldest method for evaluating constipation of pediatric patients on plain abdominal radiographs.

Three radiologists and a medical student independently evaluated the abdominal radiographs of 34 children who presented at the outpatient clinic of Rijnstate Hospital in Arnhem with symptoms of constipation. Thirty-four children with symptoms of nonretentive fecal incontinence and functional abdominal pain who also had abdominal radiographs served as the control group. All children were between 7 and 12 years of age, and they received treatment at the clinic between September 2001 and April 2004.

All participants were blinded to the patients’ diagnoses and to each other’s scoring. One month later, the three radiologists repeated the evaluation.

Both the Starreveld score and the Barr score quantify the amount of feces in the ascending colon, the transverse colon, and the descending colon. The Starreveld score also assesses the rectosigmoid, whereas the Barr score also assesses the rectum.

Using the Starreveld score, 67% of the constipated children were correctly identified; with the Barr score, this percentage was 41%. With the Starreveld and Barr scores, 41% and 59%, respectively, of the control group were incorrectly identified as being constipated.

The mean confidence interval score from all reviewers was 0.54 for the Starreveld score and 0.38 for the Barr score. There was no correlation between accuracy and experience, lead author Fredericus Kokke, MD, a pediatric gastroenterologist, and colleagues reported.

Because the analysis showed a diagnostic accuracy that was only marginally above results that can be obtained by chance, the authors do not recommend that abdominal x-ray exams be part of the routine workup of childhood constipation.

By Cynthia E. Keen
AuntMinnie.com staff writer
August 4, 2010

In its comprehensive examination of different diagnostic and treatment approaches to patients with suspected coronary artery disease, the study hypothesized that the low cost of ETT and the paucity of disease in low-risk populations combined to push initial treadmill testing to the forefront, despite its very modest sensitivity and frequently equivocal results.

The specter of fast-rising healthcare costs — which currently consume 17% of the U.S. gross domestic product and are rising fast — has focused a lot of attention on the high cost of attending to patients with suspected coronary artery disease, said Dr. James Min from Weill Cornell Medical College in New York City.

The cost of chest-pain evaluation alone has been tagged at more than $8 billion a year in the U.S.

“CT has been looked at in a number of prior studies to evaluate its cost-effectiveness in patients with suspected coronary artery disease,” Min said in a presentation at the International Society for Computed Tomography (ISCT) meeting in San Francisco.

But those studies were all limited either by their small cohorts or their retrospective design, he said. Other efforts employed high-quality decision models, but simply didn’t account for the full spectrum of imaging modalities and available treatment options.

The new study attempts to do it all by using a decision analytic model to evaluate the cost-effectiveness of coronary artery disease diagnostic strategies, as measured by incremental cost-effectiveness ratio (ICER) adjusted by life years, Min said.

“We tried to use the totality of commonly available and commonly utilized testing modalities including ETT, stress echocardiography, myocardial perfusion SPECT imaging [SPECT MPI] and CT angiography, and invasive coronary angiography,” he said.

Using the option of applying successive noninvasive exams until a diagnosis is reached leaves 12 reasonable alternatives, all of which were modeled in the analysis:

1. ETT followed by invasive coronary angiography (ICA) for equivocal or positive ETT (ETT-ICA)
2. ETT followed by echocardiography for equivocal ETT and ICA for positive ETT (ETT-ECHO-ICA)
3. ETT followed by myocardial perfusion scintigraphy (MPS) for equivocal ETT and ICA for positive MPS (ETT-MPS-ICA)
4. ETT followed by coronary CTA for equivocal ETT and ICA for positive ETT (ETT-CCTA-ICA)
5. Echocardiography followed by ICA for equivocal or positive echocardiography (ECHO-ICA)
6. Echocardiography followed by coronary CTA for equivocal echocardiography and ICA for positive echocardiography (ECHO-CCTA-ICA)
7. MPS followed by ICA for equivocal or positive MPS (MPS-ICA)
8. MPS followed by coronary CTA for equivocal MPS or ICA for positive MPS (MPS-CCTA-ICA)
9. Coronary CTA followed by ICA for equivocal or positive coronary CTA (CCTA-ICA)
10. Coronary CTA followed by echocardiography for equivocal coronary CTA or ICA for positive coronary CTA (CCTA-ECHO-ICA)
11. Coronary CTA followed by MPS for equivocal coronary CTA or ICA for positive coronary CTA (CCTA-MPS-ICA)
12. Direct ICA

To model the postdiagnosis period, Min used a Markov model based on one-year cycles to account for outcomes and treatment costs for patients correctly diagnosed with coronary artery disease, the diagnosis of false negatives, and clinical events such as revascularization, all modeled from a payor perspective, he said.

“We looked at an economic model developed over a lifetime horizon,” Min said. “We used … test sensitivity and specificity, the rates of equivocal tests, and coronary artery disease prevalence in order to classify patients as true positives, false positives, true negatives, false negatives, or equivocal for obstructive coronary artery disease.”

The model referred all positive results to invasive coronary angiography, which was assumed to have perfect sensitivity and specificity. Alternatively, patients could proceed to additional noninvasive testing, Min said.

Costs and quality-adjusted life years (QALYs) were calculated for all 12 diagnostic strategies, which were ranked by cost. Some strategies were eliminated by simple dominance (i.e., they were less effective and more costly than other strategies) and others were eliminated by extended dominance (i.e., the strategies were less effective than others and had a higher ICER).

The disease severity component of the model compared degrees of abnormality (none, mild, moderate, and severe) and functional measurements, as well as treatment implications, Min said.

Angiographic CAD (coronary artery disease) was defined for ICA and coronary CTA as absent, mild (1%-69% luminal narrowing), moderate (? 70% in one or two vessels, not including the left main artery), or severe (? 50% stenosis in the left main artery or ? 70% stenosis in three major epicardial coronary artery vessels). Post-test myocardial infarction patients were also deemed to have severe CAD.

Functional imaging CAD was applied to echocardiography and MPS. No CAD meant a lack of wall motion abnormalities or perfusion abnormalities. For mild, moderate, and severe disease, functional test results were deemed equivalent to angiographic severity, Min said.

ETT results for no CAD, moderate CAD, or severe CAD and equivocal results tied to exercise-induced ST-segment changes — or the lack thereof. Patients ineligible for ETT (those with pacemakers, pre-excitation, 1 mm resting ST segment depression, etc.) were considered to have skipped the test, along with many patients in other groups who are unable to perform ETT.

Post-treatment approaches, following the results and recommendations of the recently published COURAGE and SYNTAX trials, included optimal medical therapy (OMT) alone for patients with mild CAD. They also included percutaneous coronary intervention plus medical therapy for 50% of patients with severe CAD, along with OMT alone for the other 50% of patients with severe CAD, Min said. Additional analyses were then performed for intermediate and conservative treatments.

“We used a base case model of a 55-year-old man with stable chest pain syndrome and no prior history of CAD with a 20% risk of obstructive CAD, and we employed a common threshold standard of a $50,000 willingness to pay for discrimination of cost-effectiveness strategies,” Min explained.

For this individual, treadmill test followed by coronary CTA when results were equivocal and ICA for a positive treadmill test “demonstrated a favorable ICER of $49,021 at 50% risk of obstructive CAD, ETT-CCTA-ICA cost $63,294 per QALY gained compared to the least expensive ETT-ECHO-ICA,” Min said.

In low-risk patients with a 20% likelihood (LK) of disease, exercise treadmill testing, followed by coronary CT angiography, followed by invasive coronary angiography was the most cost-effective strategy, demonstrating an incremental cost-effectiveness ratio of $49,021. All data courtesy of Dr. James Min.

“When we moved the pretest probability up to 50%,” Min said, “you can see the red disappears because the cheapest strategy is the most cost-effective strategy, and that was treadmill testing, followed by stress echocardiography, followed by ICA.”

In higher-risk patients with a 50% likelihood of disease, exercise treadmill testing, followed by echocardiography, followed by coronary angiography was the dominant strategy.

“When we moved it up to 80% pretest likelihood, the cheapest strategy is treadmill testing, followed by nuclear testing, followed by cath, whereas the most cost-effective strategy is treadmill testing, followed by echo, followed by cath,” Min said. At 80% risk, the ETT-ECHO-ICA strategy cost $38,234 per QALY, as compared to the least expensive ETT-MPS-ICA strategy.

In the highest-risk patients with suspected coronary artery disease (80% risk), exercise treadmill testing, followed by echocardiography, followed by invasive angiography cost $38,234 per quality-adjusted life year, whereas the cheapest diagnostic strategy was treadmill testing, followed by myocardial perfusion scintigraphy, followed by invasive coronary angiography.

Beyond the initial diagnosis, different post-test treatment strategies also have a big impact on the effectiveness of postdiagnostic testing, Min said.

For intermediate-risk patients, the cost-effective strategy was treadmill testing, followed by CT when ETT was equivocal or couldn’t be performed, followed by ICA. An aggressive post-test treatment strategy would favor treadmill testing, followed by echocardiography, followed by ICA, whereas extremely conservative management would favor coronary CTA first, followed by echocardiography for equivocal CT, followed by ICA, he said.

“In individuals with stable chest pain syndrome and suspected CAD, initial testing by ETT followed by imaging … is more cost-effective than any strategy that employed initial testing by imaging alone,” Min concluded. At lower and moderate risks of obstructive CAD, coronary CTA following ETT demonstrated favorable ICERs, while echo following ETT demonstrated favorable ICERs for higher-risk individuals,” Min said.

Moreover, the post-test treatment strategy significantly affects the cost-effectiveness of diagnostic testing, he said.

Asked to suggest possible reasons for ETT’s dominance among noninvasive tests, Min said that above all, ETT is inexpensive. Second, disease prevalence is so low in the low-risk cohort that it may be that even if ETT misses some disease, there are few poor outcomes to diminish its ranking.

By Eric Barnes
AuntMinnie.com staff writer
June 7, 2010

Related Reading

Coronary CTA best next test for positive stress patients, April 23, 2010

Zero calcium score enough to send chest pain patients home, February 10, 2010

Analysis favors coronary CTA over stress MPS for chest pain, January 15, 2010

ACCURACY trial compares coronary CTA to angiography, January 18, 2008

Coronary CTA results correlate with all-cause mortality, June 19, 2007

Copyright © 2010 AuntMinnie.com

Last updated np 6/7/2010 10:20:57 AM

Instead of referring patients for ultrasound-guided biopsies, physicians may now be able to rely on certain conventional ultrasound characteristics to determine the pathology of some thyroid nodules,

Ultrasound imaging is non-invasive and involves exposing part of the body to high-frequency ultrasound waves to produce pictures of inside the body.

Barry Sacks, MD said, From more than 50 percent population affect by thyroid nodules more than 85 percent of them are incidental and benign statistically.
It means millions of patients are undergoing unnecessary biopsies as doctors are finding a very low number of cancers.This is an enormous cost burden and provokes a lot of unnecessary anxiety for patients.

For more information about this study do visit

http://www.medicalnewstoday.com/articles/187540.php

Dr. Valeria Dominelli from the University of Rome “La Sapienza” and colleagues tracked 164 women with biopsy-proven breast cancer, analyzing how breast MRI influenced their surgical management.

Mammography plus ultrasound found 175 suspicious lesions in the cohort of women included in the study. Contrast-enhanced MRI found all of these, as well as an additional 51 suspicious lesions, which were confirmed by histology, in 34 patients (21%).

Breast MRI also changed the therapy that had been proposed (based on mammography and ultrasound imaging) for 32 out of the 164 patients:

• Seven patients with multifocal disease detected with MRI had a partial mastectomy instead of a planned lumpectomy.
• Three patients underwent mastectomy for multicentric disease.
• 12 patients with contralateral lesions had additional surgery on the contralateral breast.
• Two patients underwent neoadjuvant chemotherapy because the cancer had invaded the chest muscles, and this had been identified only by MRI.
• Four patients had a partial mastectomy because of a larger tumor size.

Dominelli’s team found that contrast-enhanced MRI rated higher in sensitivity, accuracy, and positive predictive value (PPV) for malignant lesion detection and identification when compared to mammography and ultrasound together:

The team concluded that contrast-enhanced breast MRI helps doctors make better cancer treatment decisions, and it should be recommended for mapping tumor extent in patients with newly diagnosed breast cancer.

Breast MRI reduces local recurrence rates

In another study also presented by Dominelli, results indicate that use of preoperative breast MRI before breast cancer surgery may reduce the number of local cancer recurrences at follow-up.

This study included 49 patients with a local recurrence that had been found seven to 47 months after surgical treatment of the primary cancer. Ten patients had contrast-enhanced breast MRI before surgery, while the remaining 39 patients did not.

The team found significantly more cancers in the opposite breast and more local recurrence in patients who did not have the MRI exam prior to surgery compared to those who did: 88% and 85%, respectively, versus 12% and 14%, respectively (p < 0.001).

The findings suggest that preoperative breast MRI staging would reduce the number of local cancer recurrences at follow-up, Dominelli said.

By Kate Madden Yee
AuntMinnie.com staff writer
May 3, 2010

Skeletal PET bone imaging fell into disuse in the 1970s after SPECT imaging with technetium sodium chloride was introduced, said Dr. Frederick Grant of the division of nuclear medicine at Children’s Hospital Boston. But tight supplies of technetium, caused by the ongoing global shortage of molybdenum, have many nuclear imaging specialists re-examining the technology.

Children’s Hospital Boston began to use F-18 NaF scintigraphy routinely in 2005 and has had very positive experiences, Grant said. In his SPR presentation, he reported results from a retrospective study of 484 patients between infancy and 19 years of age who had the procedure between April 2005 and March 2010, with skeletal scintigraphy showing positive findings for 57%.

In the study, 87% of patients had the exam due to back pain — often due to sports injuries — and, of these, 186 of 350 young athletes had positive exam findings. Other indications included back pain after trauma (13 patients with 54% positive findings), persistent back pain after spinal fusion surgery (33 patients with 61% positive findings), and metastatic disease. In most cases, images were of higher resolution than with conventional SPECT, Grant said.

A total of 46 children younger than 2 who had indications of nonaccidental trauma had positive findings 89% of the time. Grant attributed this to selection bias, as these were patients suspected of being victims of child abuse. Because of their very young age, these children required sedation for the procedure.

For all patients, PET was performed 30 minutes after administration of 21 MBq per kg (with a maximum of 148 MGq) F-18 NaF. Grant recommended that patients be well hydrated. The imaging procedure took 30 minutes or less, compared to 60 to 90 minutes for a technetium bone SPECT exam, requiring an update period of up to three hours.

“The shorter procedure time has improved department workflow, and it enables us to obtain a higher utilization rate for the PET scanner,” Grant said. “By educating medical doctors of large health insurance companies, we also get reimbursement for this. The only payor we haven’t had any success with is the Centers for Medicare and Medicaid Services, because Medicare rules strictly apply to Medicaid patients.”

By Cynthia E. Keen
AuntMinnie.com staff writer
April 15, 2010

Regular screening for breast cancer is a must in these women, and “further research is required to better define the harms and benefits of lifelong surveillance,” senior author Dr. Kevin C. Oeffinger, from Memorial Sloan-Kettering Cancer Center, New York, and colleagues note.

The researchers analyzed results from two dozen studies. They found that in women treated with chest radiation at a young age, the rate of breast cancer by age 40 to 45 years was as high as 20%.

Once diagnosed, according to the studies, breast cancers among those women were similar to those of women in the general population.

The researchers also found that mammograms can be used to detect breast cancer among women who had chest radiation as children or adolescents.

The investigators note that along with more information on the pros and cons of lifelong surveillance, research is needed to assess “how estimates of risk and outcome might change, given use of lower radiation doses in contemporary treatment.”

The study was funded by the National Cancer Institute.

Source: Annals of Intern Medicine, April 5, 2010.

Researchers from the Children’s Hospital at Vanderbilt in Nashville, TN, reached this conclusion after retrospectively evaluating the records of 235 children admitted to the hospital’s level I trauma center between September 2006 and March 2008. The children all had a chest CT in conjunction with an abdominal and pelvic CT. More than half also had a chest radiograph within 24 hours of the CT exams (Pediatric Radiology, February 24, 2010).

The objective of the study was to assess the clinical impact of the chest CT exam compared with chest x-rays in managing pediatric trauma. Lead author Dr. Rina Patel, of the Vanderbilt University School of Medicine, and colleagues determined that chest CT scans showed more positive findings, with 63.8% of CT exams showing at least one positive finding, compared with 38.3% of chest radiographs.

During their evaluation, the researchers determined that the majority of thoracic vertebral fractures and all pneumothoracies requiring chest tube placement could be identified in the abdominopelvic CT scan. If the images from this CT scan had been reviewed prior to ordering a chest CT scan for hemodynamically stable patients, only 24% of the patients in this cohort would have needed the exam.

The authors pointed out that although a chest CT exam is the preferred study to evaluate traumatic aortic injury, this is a rare injury for children. In fact, none of the patients being studied were diagnosed with this injury.

The most common findings identified from the chest CT exams included pulmonary consolidations, pneumothorax/hemothorax, and rib fractures. The only abnormal finding demonstrated exclusively by a chest CT exam was vertebral injury. Its greatest utility was in detecting occult thoracic spine fractures.

Pediatric CT chest scans should be reserved for patients in whom the mechanism of injury or cardiovascular status suggests spinal or vascular injury, according to the authors.

By Cynthia E. Keen
AuntMinnie.com staff writer
April 12, 2010

Almost any woman who had a cancerous tumor detected in her breast during a regular screening appointment would probably think the scan — and subsequent surgery, radiotherapy, or chemotherapy treatment to remove the cancer — saved her life.

But that is not always true and an increasingly heated international debate is raging about whether women are getting the right information on the merits, and risks, of mammograms.

The fear is that overdiagnosis — when screening picks up tumors that would never have presented a problem — may mean many women are undergoing unnecessary radical treatment, suffering the physical and psychological impact of a breast cancer diagnosis that would otherwise not have come up.

While some scientists are locked in battle, slinging accusations at each other of misleading data and conflicts of interest, others say the row itself is a signal that it’s time for a new and more refined approach to breast cancer screening.

“What really bothers me … is the poor women who are the subjects of this debate, who must be utterly confused and not know what the hell is going on or what to do,” Michael Baum, the doctor who introduced Britain’s first breast screening program more than 20 years ago, told Reuters.

“To carry on regardless is no longer acceptable. I’m trying to find a way out of this mess.”

Row erupts

Low level argument over the merits of mammograms has bubbled for some years, but a political storm blew up in the United States last year when public health officials questioned whether screening for women in their 40s actually save lives and proposed upping the regular screening age to 50.

Now, in Europe, two recent scientific studies have brought the issue to a head, pitting convinced breast cancer screening supporters against those who say the numbers just don’t add up.

A team of Danish scientists published a study showing that breast cancer screening programs of the type run by health services in Europe, the United States, and other rich nations do nothing to reduce death rates from the disease.

A week later, a British team published a study showing a “substantial and significant reduction in breast cancer deaths” due to screening.

The lead researchers on each paper, Stephen Duffy of Queen Mary, University of London, who led the British study, and Peter Gotzsche of the Nordic Cochrane Center, who led the Danish team, told Reuters they suspected the other of having long-held biases on breast cancer screening that skewed their work.

At the heart of the matter is the issue of overdiagnosis. This is when a mammogram picks up something called ductal carcinoma in situ (DCIS), which are cells — often described as “precancerous” or noninvasive — that may progress into life-threatening cancer if left untreated.

The problem is there is also the chance they would never progress or cause a problem, but instead leave the woman to live in blissful ignorance and die years later — but not of breast cancer.

The fear is that regular populationwide screening programs are causing overtreatment of such cancers, ruining women’s lives with unnecessary mastectomies or chemotherapy.

Gotzsche’s evidence suggests that for every 2,000 women who are screened over 10 years, only one stands to have her life saved by the mammogram program, whereas the risk of getting an unnecessary breast cancer diagnosis is 10 times that.

Duffy’s study, meanwhile, found that screening saves two women’s lives for everyone who is given unnecessary treatment.

“I have never in science seen such a huge discrepancy, and Stephen Duffy’s estimates are simply blatantly wrong,” Gotzsche told Reuters when asked about the difference.

For his part, Duffy accuses Gotzsche’s team of spending years pursuing research that finds against the merits of breast cancer screening, yet has failed to change opinion.

“Most of the people who work in breast cancer … are actually pretty happy with screening. That’s why we get paper after paper from the Danish Cochrane team, and yet the screening program stays,” he said.

When the evidence changes

Yet other experts say the ongoing row exposes the failings of applying a “one-size-fits-all” policy to a complex area of medicine, and the time has come for change.

Baum, an early pioneer of breast screening said he became so sickened by the refusal of health officials to update patient information leaflets with data on potential benefits and harms that he resigned from the program after 10 years.

He now has a proposal for a solution:

“What I’m advocating is that instead of one-size-fits-all, we should think of it in the same way we think of other screening approaches — we should identify the high-risk groups first.”

Baum favors a “triage” system to divide women into high-, middle-, and low-risk groups based on family history and lifestyle factors like alcohol consumption, weight, diet, and exercise.

He says high-risk women — those with a long family history of breast cancer — should be offered genetic testing to find out if they have a gene mutation which predisposes them to the disease, while low-risk women should get advice on healthy eating, avoiding alcohol, and minimizing other risk factors.

Screening would then be reserved for those in the middle, where he thinks the benefit-risk balance makes most sense.

“At the beginning I was convinced enough (about breast cancer screening) to actively involve myself in setting it up, but as the numbers change, the mind has to change,” said Baum. “This is the whole point of science. As the evidence changes, you must change your mind.

By Kate Kelland