American Women Prefer Annual Mammograms

The US Preventive ServicesTask Force (USPSTF) reaffirmed its recommendations to screen women ages 50-74 for breast cancer every two years stating that the harms of annual screening outweighed the benefits.  It also says the decision on frequency of screening should be individualized for women ages 40-49 based on risk.  The USPSTF found insufficient evidence to recommend for or against screening for women 75 or older.

Several professional societies like the American College of Radiology and Society of Breast Imaging advocate annual screening mammography starting at age 40.

A survey of 731 women indicated that 71% of the women who were 59 years old on average said they’d prefer a screening mammogram every year. Only 17% of participants felt having biennial screening would cause less anxiety. Of the patients who reported a prior abnormal mammogram, 13% believe biennial screening would cause less anxiety

The study was presented at the 103th annual meeting of the Radiological Society of North America.

Carotid endarterectomy versus stenting, 1999-2014

Lichtman et al in their article published in JAMA address the issue of carotid endarterectomy and stenting outcomes in the U.S. in the years 1999 to 2014.

In their study that included Medicare beneficiaries, the national annualized rate of carotid endarterectomy per 100 000 beneficiary-years decreased from 298 in 1999-2000 to 128 in 2013-2014, whereas the rate of carotid artery stenting initially 40 in 1999-2000 increased to 75 in 2005-2006 followed by a decline to 38 in 2013-2014.

During the study, 937 111 unique patients underwent carotid endarterectomy (mean age, 75.8 years) and 231 077 underwent carotid artery stenting (mean age, 75.4 years).

Outcomes improved over time despite increases in vascular risk factors such as hypertension prevalence that increased from 67% to 81% among patients who underwent endarterectomy and from 61% to 70% among patients who underwent stenting.  The adjusted annual decreases in 30-day ischemic stroke or death of 2.90% among patients who underwent endarterectomy and 1.13% among patients who underwent stenting.  The 1-year ischemic stroke decreased to 3.5% after endarterectomy and 1.6% after stenting. Additional improvements were noted for in-hospital mortality, 30-day stroke, myocardial infarction, or death, and 30-day all-cause mortality.

Carotid endarterectomies declined from 1999 to 2014, whereas carotid artery stenting increased until 2006 and then declined from 2007 to 2014. Outcomes improved despite increases in vascular risk factors.

Coronary Artery Calcium on Chest CTs and Mortality Risk.

A study by Hughes-Austin et al published in the Journalof the American College of Cardiology: Cardiovascular Imaging reported on the correlation between coronary artery calcium (CAC) scores on 3 mm electrocardiography (ECG)-gated computed tomography (CT) scans and standard 6 mm chest CT scans, and compared their associations of CAC on each scan type with mortality risk.

The investigators analyzed CT studies of 4,544 patients (mean age 68), who had standard 6mm CT that were followed with 3mm EKG gated CTs.  The Agatston method quantified CAC on both scans.  The median CAC scores were lower on 6 mm CTs compared to 3 mm CTs (22 vs.104 Agatston units, p < 0.001).

During the study period 157 deaths were recorded.  Adjusted for traditional CVD risk factors, when CAC scores were evaluated as a continuous variable each standard deviation higher CAC score on both 6 mm and 3 mm CTs was associated with 1.5-fold or 50% higher odds of mortality. 

The authors concluded that CAC scores on standard 6 mm chest CTs correlate well with 3 mm ECG-gated CTs and can predict mortality risk similarly in patients whose CTs were performed for other clinical indications without additional radiation exposure or expense.

Head CT does not increase the risk for meningioma

A paper by Nordenskjold et al published in Radiology found that exposure to radiation from computed tomography of the head does not increase the risk of developing a meningioma.

The authors collected data from a cohort of 26 370 subjects from a radiology archive of CT examinations of the head performed from 1973 through 1992. For comparison, an age- and sex-matched cohort of 96 940 subjects who were not exposed to CT (unexposed cohort) was gathered.

Comparison of exposed and unexposed cohorts no statistically significant increase in the risk of meningioma was found among patients who were exposed to ionizing radiation from CT of the head compared to the unexposed control individuals.

Stroke patients may be treated as late as 24 hours after Ictus

A study presented at the European Stroke Organization conference in Prague showed that treatment for severe-stroke patients as late as 24 hours after a stroke can restore brain function.

The study employed a clot-retrieval device from Stryker Corp and was conducted on 206 patients with serious strokes at 32 hospitals in the U.S., Spain, France and Australia.

The researchers suggested that 40% of patients with severe stroke fit in this new window of opportunity. They were able to lower by 73% the risk that a patient would become dependent on another person or health care providers for help in their daily activities.

For the past two decades, the clot dissolving drug tPA was the primary treatment for ischemic stroke. But the drug was useful only until about 4 ½ hours after a stroke. Clot-retrieval devices widened that window to about 6 hours, but brain tissue was considered irreparably damaged after that.

As the results of this study are promising a larger trial should be conducted as initiating treatment in the first 6 hours after ictus is difficult even in the most well organized centers.  As clot retrievers are used approximately in 25,000 cases in the U.S. every year the issue of the length of opportunity to intervene should be settled.  Another issue that should be looked at is the role an intact and complete circle of Willis plays on how patients respond to treatment.  

Breast MRI is the study of choice for women at high risk for breast cancer.

According to a study published in Radiology Lo et al reviewed the outcomes of 3,934 screening breast studies (MRI and mammograms) performed on 1,249 high-risk women. A total of 45 cancers (33 invasive and 12 ductal carcinomas in situ) were diagnosed, 43 were seen with MR imaging and 14 with both mammography and MR imaging.   The cancer detection rate for MR imaging was 21.8 cancers per 1000 examinations and that for mammography was 7.2 cancers per 1000 examinations. Sensitivity and specificity of MR imaging were 96% and 78% respectively, and those of mammography were 31% and 89%, respectively (P < .001).  The researchers reported that all cancers found at screening mammography were also detected on breast MRI.  

The researchers concluded that annual screening mammography adds no value to women that are at high risk for breast cancer especially since they are screened each year with breast MRI.