JAMA: 2009-10-21, Vol. 302, No. 15, Author in the Room™ Audio Interview

Interview with Laura Esserman, MD, MBA, author of Rethinking Screening for Breast Cancer and Prostate Cancer. Summary Points: 1. The effectiveness of screening depends on the underlying biology of cancer. Routine mammographic screening works best for slow to moderate growth tumors, most common in women 50-74 and explains why the Preventive Services guidelines actually make sense. 2. There are ways that we can improve screening today. Trained mammographers find the most cancers and have the fewest false positives. Offering follow-up as an option for low risk mammographic lesions will decrease false positives. Screening the populations who benefit most will also avoid false positives and overdiagnosis in those who benefit less from screening. The prostate cancer risk calculator is a good tool to use to determine whether to do a biopsy. 3. We can and must do better. Mammography and PSA testing can detect very low risk cancers, and these cancers can be less aggressively treated. Tools are available to distinguish these low risk cancers. The most aggressive cancers often present between normal screens, so women with new masses, regardless of a recent normal mammogram should be evaluated. Men and women at high risk to develop breast and prostate cancer should consider prevention interventions. Future screening should be developed to reduce mortality from the highest risk cancers.