My colleagues in Technology Insights just reported on yet another conflicting study on mammography that I wanted to share:
A new study published in the British Medical Journal is reigniting the debate over mammography as a screening tool. Lead author Dr. Phillipe Autier looked at historical data from 1980 to 2006 to determine the impact of screening mammography on breast cancer-related mortality in six European countries. The greatest decrease in mortality over this 26 year period was seen in women ages 40 to 49. However, there was not a correlation between decreases in mortality and the availability of screening mammography in these countries. Accordingly, the authors have concluded that there is no impact on breast cancer mortality as a result of screening mammography. Rather, the authors infer that improved treatments for breast cancer and efficiencies in healthcare are more likely responsible for this decrease.
This and other studies published on the efficacy of screening mammography seem at odds with new recommendations from the American College of Obstetrics and Gynecology (ACOG). This week, ACOG released updated guidelines recommending screening mammography annually for all women over 40. ACOG revised its earlier recommendations of annual screening at 50 due to new evidence that more aggressive tumors have shorter sojourn times (time from detection to symptoms) in women under 50, and that reductions in mortality due to screening are similar for women in their 40s and 50s. ACOG emphasizes the importance of communicating the risk of false positives to women receiving screening mammography as this risk increases with more frequent imaging. This high false positive rate is also referenced in the widely-discussed USPSTF guidelines from 2009 that recommend biennial screening at age 50.
New Studies Conflict with Established Guidelines Over Effectiveness of Screening Mammography
Recently we've received a few questions from members about the potential for ASTRO's PAAROT (Performance Assessment for the Advancement of Radiation Oncology Treatment) program to serve as a national, wide-scale quality improvement platform in oncology - one that could potentially parallel ASCO's QOPI (Quality in Oncology Practice Initiative) program. When first asked this, we didn't know much about PAAROT, so we did some research. I wanted to share what we learned as well as solicit input. Are any of you participating in PAAROT? What are your views? Please post your comments to the blog, or feel free to email me directly with your thoughts.
PAAROT in Brief
At a high level, PAAROT
is quite similar to QOPI. It was developed by ASTRO in 2008 and involves periodic chart review (10 charts) and reporting of metrics, which are compared to peers, expert consensus and evidence-based guidelines. Once this analysis has taken place, an area in need of improvement is identified and the physician is asked to make that an area of focus for a quality improvement project. They must then conduct the project and then be remeasured. And everything is managed online. Pretty straightforward. Notably, PAAROT has been approved by the American Board of Radiology as a Type 2 PQI project, which means it counts as part of their certification process, specifically in partial fulfillment of the ABR Maintenance of Certification Program
PAAROT as a Platform for Radiation Oncology QI?