SAVING WOMEN’S LIVES

Strategies for Improving Breast Cancer Detection and Diagnosis

A Breast Cancer Research Foundation and Institute of Medicine Symposium

Committee on New Approaches to Early Detection and Diagnosis of Breast Cancer

National Cancer Policy Board

Roger Herdman and Larry Norton, Editors

INSTITUTE OF MEDICINE AND NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu



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Saving Woman’s Lives: Strategies for Improving Breast Cancer Detection and Diagnosis SAVING WOMEN’S LIVES Strategies for Improving Breast Cancer Detection and Diagnosis A Breast Cancer Research Foundation and Institute of Medicine Symposium Committee on New Approaches to Early Detection and Diagnosis of Breast Cancer National Cancer Policy Board Roger Herdman and Larry Norton, Editors INSTITUTE OF MEDICINE AND NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Saving Woman’s Lives: Strategies for Improving Breast Cancer Detection and Diagnosis THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. Support for this project was provided by the Apex Foundation, The Breast Cancer Research Foundation, the Broad Reach Foundation, the Carl J.Herzog Foundation, Mr. Corbin Gwaltney, Mr. John Castle, the Josiah Macy Jr. Foundation, the Kansas Health Foundation, and the National Cancer Institute. This study was supported, in part, by Contract No. N01-OD-4–2139, TO #110 between the National Academy of Sciences and the National Cancer Institute. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number: 0-309-09438-0 (Pbk) International Standard Book Number: 0-309-54631-1 (PDF) Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624–6242 or (202) 334–3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2005 by the National Academy of Sciences. All rights reserved. Printed in the United States of America.

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Saving Woman’s Lives: Strategies for Improving Breast Cancer Detection and Diagnosis THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M.Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm.A.Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V.Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M.Alberts and Dr. Wm.A.Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Saving Woman’s Lives: Strategies for Improving Breast Cancer Detection and Diagnosis COMMITTEE ON NEW APPROACHES TO EARLY DETECTION AND DIAGNOSIS OF BREAST CANCER EDWARD E.PENHOET (Chair), Director, Science and Higher Education Programs, Gordon and Betty Moore Foundation, San Francisco, CA DIANA B.PETITTI (Vice Chair), Senior Scientific Advisor Health Policy and Medicine, Kaiser Permanente Southern California, Pasadena, CA MARTIN D.ABELOFF, Director, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD COLIN B.BEGG, Chairman, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center M.KATHLEEN BEHRENS, General Partner, RS & Co. Venture Partners IV, L.P.RS Investments, San Francisco, CA RICHARD BOHMER, Assistant Professor, Harvard Business School, Boston, MA CHRISTINE BRUNSWICK, Vice President, National Breast Cancer Coalition, Washington, DC SANJIV S.GAMBHIR, Director, Molecular Imaging Program at Stanford, Stanford University, Palo Alto, CA ROBERT A.GREENES, Professor, Radiology and Health Sciences & Technology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA JEFFREY R.MARKS, Associate Professor, Department of Surgery, Duke University Medical Center, Durham, NC BARBARA J.McNEIL, Ridley Watts Professor and Head, Department of Health Care Policy, Harvard Medical School, Boston, MA; Professor of Radiology, Brigham and Women’s Hospital, Boston, MA DAVID C.MOWERY, Professor, Walter A. Haas School of Business, University of California, Berkeley, CA ETTA D.PISANO, Chief of Breast Imaging, Department of Radiology, University of North Carolina Hospitals, Chapel Hill, NC GLENN D.STEELE, President and CEO, Geisinger Health System, Danville, PA KIRBY G.VOSBURGH, Associate Director, Center for Integration of Medicine and Innovative Technologies (CIMIT), Cambridge, MA WILLIAM C.WOOD, Chief of Surgery, Emory University Hospital, Atlanta, GA

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Saving Woman’s Lives: Strategies for Improving Breast Cancer Detection and Diagnosis Consultants LAURA J.ESSERMAN, Director, Carol Franc Buck Breast Care Center, University of California, San Francisco, CA LANCE A.LIOTTA, Chief, Laboratory of Pathology, National Cancer Institute, Bethesda, MD LARRY NORTON, Deputy Physician-in-Chief and Director of Breast Cancer Programs, Memorial Sloan-Kettering Cancer Center, New York, NY Study Staff ROGER C.HERDMAN, Director, National Cancer Policy Board ELIZABETH J.BROWN, Research Assistant MARY ANN F.PRYOR, Project Assistant ANIKE L.JOHNSON, Administrative Assistant LARRY NORTON, Chair, Medical Advisory Board, The Breast Cancer Research Foundation

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Saving Woman’s Lives: Strategies for Improving Breast Cancer Detection and Diagnosis NATIONAL CANCER POLICY BOARD JOSEPH SIMONE (Chair), Simone Consulting, Dunwoody, GA BRUCE W.STILLMAN (Vice Chair), Director, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY ELLEN STOVALL (Vice Chair), Executive Director, National Coalition for Cancer Survivorship, Silver Spring, MD JILL BARGONETTI, Associate Professor, Department of Biological Sciences, Hunter College, New York, NY TIMOTHY EBERLEIN, Bixby Professor and Chairman, Department of Surgery, Washington University School of Medicine, St. Louis, MO KATHY GIUSTI, President, Multiple Myeloma Research Foundation, New Canaan, CT KAREN HERSEY, Senior Counsel, Massachusetts Institute of Technology, Cambridge, MA JIMMIE C.HOLLAND, Chair, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY WILLIAM KAELIN, Professor, Harvard Medical School, Boston, MA WILLIAM McGUIRE, Chief Executive Officer, UnitedHealth Group, Minnetonka, MN JOHN MENDELSOHN, President, M. D. Anderson Cancer Center, University of Texas, Houston, TX KATHLEEN HARDIN MOONEY, Professor, University of Utah College of Nursing, Salt Lake City, UT PATRICIA NOLAN, Director, Rhode Island Department of Health, Providence, RI DAVID PARKINSON, Oncology Therapeutic Area Head, Amgen, Inc., Thousand Oaks, CA JOHN POTTER, Senior Vice President and Director, Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA LOUISE RUSSELL, Professor, Rutgers University, New Brunswick, NJ THOMAS J.SMITH, Professor, Virginia Commonwealth University, Richmond, VA ROBERT C.YOUNG, Past-President, American Cancer Society and President, Fox Chase Cancer Center, Philadelphia, PA

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Saving Woman’s Lives: Strategies for Improving Breast Cancer Detection and Diagnosis Contents     ABSTRACT   1     INTRODUCTION   3     PLENARY SESSION   6     SIMULTANEOUS GROUP DISCUSSIONS WITH INVITED SPEAKERS   68     WRAP-UP SESSION   118     REFERENCES   126     APPENDIX: SYMPOSIUM AGENDA   131

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