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NAP's Skim View of: Mammography and Beyond: (2001) Executive Summary, pages 1-14 Top key sentences from significant pages are presented; key terms are presented in bold grey. Content may derive from OCRed text; please use individual pages as the more authoritative version. |
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page 1 |
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Clinical data show that women diagnosed with
early-stage breast cancers are less likely to die of the disease than
those diagnosed with more advanced stages of breast cancer. A thorough
annual physical breast examination and monthly breast self-examination
can often detect tumors that are smaller than those found in the
absence of such examinations, but data on the ability of physical
examinations alone to reduce breast cancer mortality are limited.
... |
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page 2 |
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The benefit of screening mammography for women over
age 70 is more difficult to assess because of a lack of data for this
age group from randomized clinical trials. Screening mammography cannot
eliminate all deaths from breast cancer because it does not detect all
cancers, including some that are detected by physical examination.
... |
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page 3 |
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TECHNOLOGIES IN DEVELOPMENT Most of the progress
thus far in the field of breast cancer detection has resulted in
incremental improvements in traditional imaging technologies. These
technical advances have likely led to more consistent detection of
early lesions, but clinical trials have not been undertaken to
determine whether their use has also resulted in a greater reduction in
breast cancer mortality compared with that of older technologies.
... |
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page 4 |
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Ideal detection performance may ultimately depend
on TABLE 1 Current Status of Imaging and Related Technologies Under
Development for Breast Cancer Detection Current Status Technology
Film-screen mammography (FSM) Full-field digital mammography (FFDM)
... |
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page 5 |
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Furthermore, improved imaging technologies that
allow detection of more lesions at an earlier, precancer stage may or
may not lead to reduced breast cancer mortality and may lead to more
overtreatment of women. The dilemma of overtreatment could potentially
be overcome by coupling imaging technologies with biologically based
technologies, such as functional imaging, that can determine which
lesions are likely to become lethal.
... |
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page 8 |
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Moreover, in addition to the developers of new
technologies, many groups participate in the process, including FDA,
health care insurers and managed care organizations, and other
technology assessment institutions. These public and private
organizations and policy makers play a role in evaluating medical
technologies at various points along the way, making decisions about
FDA approval, insurance coverage, and reimbursement that ultimately
determine whether new technologies will be adopted and disseminated.
... |
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page 9 |
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. TECHNOLOGY DISSEMINATION After the hurdles of FDA
approval, insurance coverage, and reimbursement have been cleared, the
adoption and dissemination of new breast cancer detection technologies
will ultimately depend on whether women and their health care providers
find them acceptable.
... |
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page 10 |
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The program has grown considerably since it was
launched 10 years ago, but it still only reaches about 12 to 15 percent
of eligible women nationwide. New federal legislation that would allow
Medicaid coverage for treatment of breast cancer detected through the
program was recently passed, but adoption of this program by the states
.
... |
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page 11 |
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· Health care professionals and breast cancer
advocacy groups should educate women about the importance of building
tumor banks and encourage women to provide consent for research on
patient samples. · Stronger protective legislation should be enacted at
the national level to prevent genetic discrimination and ensure the
confidentiality of genetic test results.
... |
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page 12 |
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This pursuit should be streamlined by coordinating
oversight and support from all relevant participants (FDA, NCI, HCFA,
private insurers, and breast cancer advocacy organizations) at a very
early stage in the process.
... |
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page 13 |
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However, given the length of time required to
assess that end point and the fact that early detection by screening
mammography has already been proven to reduce breast cancer mortality,
a surrogate end point for breast cancer detection is appropriate in
some cases. As a general rule, a screening technology that consistently
detects early invasive breast cancer could be presumed efficacious for
the purposes of FDA approval.
... |
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page 14 |
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10. The National Cancer Institute, through the
American College of Radiology Imaging Network or the Breast Cancer
Surveillance Consortium, should sponsor further studies to define more
accurately the benefits and risks of screening mammography in women
over age 70.
... |
