"The American Association for Cancer Research (AACR), a scientific organization consisting of 13,000 cancer researchers, recognizes the evolving nature of scientific knowledge in the area of breast cancer screening and the good-faith efforts of the NIH Consensus Development Conference on mammography to determine the relative benefits of screening for women aged 40-49. The AACR does not believe that a single all-inclusive yes or no recommendation for mammography screening was intended to be generated by the Consensus Development Conference, nor would a single recommendation be in the best interest of women who fall into the 40 to 49 age group."
"Although the AACR has not had the opportunity to review either the scientific data or the full draft report from this Consensus Development Conference, we are strongly in favor of clearly defining the risks and benefits for each patient, rather than generalizing about specific ages at which women should seek mammograms. It is especially critical in the informed consent process that each patient understand her personal risk factor(s) for breast cancer, the risks of the mammogram itself, and the potential for false negatives and positives as well as the potential benefits of the procedure."
Complexity of Issues Stressed
"The complexity of the question being addressed has increased as data from recent studies performed in Sweden show a statistically significant benefit of mammography screening in this age group in terms of a reduction in breast cancer mortality. These findings suggest that follow-up investigations in the United States should be pursued to consider differences in both the technology and the mammography reading process that may explain the differences in findings. It is particularly important to address the problem of false positives and negatives in such studies. The AACR would support the meticulous scientific analysis of such studies prior to the release of any final comprehensive recommendations on screening mammograms for this age group. In addition, any recommendations from this or any future group must give careful consideration to the issue of differential risks within this age group, since younger women's mammograms are more difficult to read and younger women generally tend to develop more aggressive cancers."
Process for Disclosing Findings Criticized
"Finally, the AACR is compelled to comment on the process employed for the analysis and disclosure of findings from this Consensus Development Conference. Any process in which scientists are charged with reviewing an evolving body of scientific data and making recommendations that may have a far-reaching effect on policy decisions, public perception, insurance coverage, and in this case, breast cancer mortality, must involve rigor in terms of scientific review, the evaluation of the report, and the appropriate process of communication. It is unacceptable to announce findings and recommendations to the press before appropriate members of the scientific community, health care providers, consumers, and other interested parties have had an opportunity for review and comment. The premature release of controversial recommendations based on inconsistent data can only serve to slow scientific progress and create additional confusion and insecurity both in this group of women and the general public."
"In summary, we recommend that critical research issues such as quality assurance in the interpretation of mammograms, breast cancer risk factors, and the overall economic impact of early detection in this population become the focus of the recommendations from this Consensus Development Conference. The goal of this process should be to provide a rational and understandable basis for patients, physicians, hospitals, clinics, and public health departments that offer mammography on which to weigh the benefits and risks in each specific case so that the individual patient may make a personal choice about mammography based on truly informed consent."
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
