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Physicians: .25 AMA PRA Category I CreditsTM
Family Physicians: .25 Prescribed credits
Nurse Practitioners: .25 Contact hours

Release Date: July 15, 2015
Expiration Date: July 15, 2016

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon above.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:

1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD
Assistant Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Executive Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP
Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company


Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This enduring material activity, DynaMed EBM Focus Volume 10+, has been reviewed and is acceptable for up to 13.25 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins April 29, 2015. Term of approval is for one year from this date. Each weekly update is approved for .25 Prescribed credits. Credit may be claimed for one year from the date of each update. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 13.0 contact hour(s) of continuing education by the American Association of Nurse Practitioners. Program ID 1504207. This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.

DynaMed Careers

The DynaMed editorial team is seeking specialist editors in the following fields: Gastroenterology, Nephrology, Oncology (especially Breast cancer and Pancreatic cancer), Ophthalmology, and Pediatric Neurology.

If interested, please send a recent copy of your CV to Rachel Brady at rbrady@ebsco.com.

DynaMed Contribution Opportunities

Become a DynaMed Resident Focus Reviewer
Education for Clinicians in Training

Last week 572 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 120 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to inform clinical practice," one article was selected by the DynaMed Editorial Team.

Higher Rates of Mammography Screening Associated with Higher Rates of Breast Cancers, but Not Associated with Decreased Breast Cancer Mortality

Reference: JAMA Intern Med 2015 Jul 6 early online (level 2 [mid-level] evidence)

Routine mammography for breast cancer screening is recommended beginning as early as age 40 for women with an average risk of breast cancer (CA Cancer J Clin 2012 Mar-Apr;62(2):129, USPSTF Screening for Breast Cancer 2009 Nov). As the rate of mammography increases, however, so does the potential for overdiagnosis and overtreatment. Overdiagnosis occurs if screening leads to diagnosis of cancers that would never have affected the patients' health or longevity. Mammography has been associated with an increase in the detection of early stage breast cancer, but only a small reduction in the incidence of late-stage breast cancer (N Engl J Med 2012 Nov 22;367(21):1998). Furthermore, results on the benefit of mammography for the prevention of breast cancer-associated mortality have been mixed and the extent of overdiagnosis remains unclear (Cochrane Database Syst Rev 2013 Jun 4;(6):CD001877, BMJ 2014 Feb 11;348:g366). A recent retrospective cohort study evaluated 16,120,349 women ≥ 40 years old having screening mammography in the year 2000 in one of 547 United States counties reporting to Surveillance, Epidemiology, and End Results (SEER) database.

Of the > 16 million women screened, 55,809 (0.35%) were diagnosed with breast cancer and 10 years of follow-up data was available for 95.3%. The rate of screening, defined as the percentage of women ≥ 40 years old in each county having mammography in past 2 years, was determined for each county to examine the effect of different screening rates on breast cancer diagnosis and mortality. The median rate of screening was 62.2%, with a range of 39.1% to 77.8%. In the county-based analysis, each 10% increase in the rate of breast cancer screening was associated with an increase in breast cancer incidence (relative risk [RR] 1.16, 95% CI 1.13-1.19) without any decrease in 10-year breast cancer mortality. Further analysis of tumor size found each 10% increase in screening was associated with an increase in the incidence of small (≤ 2 cm) cancers (RR 1.25, 95% CI 1.18-1.32) as well as a smaller increase in the incidence of large (> 2 cm) cancers (RR 1.07, 95% CI 1.02-1.12). The incidence of stage 0-II breast cancer was also increased with screening, but there was no decrease in the incidence of stage III-IV breast cancer.

The goal of breast cancer screening is to identify cancers at an earlier stage by identifying asymptomatic lesions. Higher rates of mammography would be expected to increase the diagnosis of small breast tumors, and decrease the incidence of larger and later stage tumors. Finding and treating tumors earlier would be expected to result in a decrease in breast cancer-specific mortality. This retrospective cohort study did indeed find that higher rates of mammography were associated with the expected increase in the diagnosis of small breast tumors. However, it also found an increase in the incidence of large breast tumors with higher screening rates, contrary to expectations. Additionally, while higher screening rates increased the incidence of early stage (0-II) cancer, they did not decrease the incidence of late stage (III-IV) breast cancer. The lack of change in the incidence of late stage cancers may in part explain why screening did not decrease the 10-year breast cancer-specific mortality. Instead of preventing breast-cancer specific deaths, this large study suggests increased rates of mammography may be leading to an overdiagnosis of small, indolent tumors. Finding these tumors may lead to increased patient anxiety and distress along with potentially unnecessary treatment. For example, as was noted in last week’s EBM Focus, surgical management of women with low grade DCIS lesions detected by screening mammography may not improve survival compared to conservative management. Further studies are required to determine an optimal schedule for routine mammography screening and how best to manage women with small incidental tumors found by such screening.

For more information see the Mammography for breast cancer screening topic in DynaMed.

EBSCO Health’s New DynaMed Plus Delivers Trusted, Evidence-Based Content to Physicians on Any Platform

EBSCO Health recently launched DynaMed Plus, a cross-platform, evidence-based clinical decision support tool that provides clinicians with the ideal blend of evidence and expertise to help them determine optimal patient care paths.

DynaMed Plus helps medical professionals quickly find evidence-based answers to make the best treatment decisions in any location. With DynaMed Plus, clinicians (and their patients) will benefit from:

  • Quickest time-to-answer—Including intelligent auto-suggest, direct-to-section search results, exact match summary display, dynamic linking and quick access to relevant calculators.
  • Concise, accurate overviews and recommendations—For the most common conditions as well as evidence-based recommendations for action.
  • Comprehensive image library—Over 4,000 full-color medical graphics and images to help clinicians make the best decisions.
  • Rigorous editorial process—Subject-specific experts review topics on a daily basis using the DynaMed Plus proprietary evidence-based methodology and quality assurance process.
  • Access to specialty content—Clinicians can view thousands of topics covering emergency medicine, cardiology, oncology, infectious disease, pediatrics, obstetrics and gynecology, and much more.
  • Anywhere, anytime accessDynaMed Plus can be used on iOS and Android mobile devices, making access fast and easy, and providing clinicians with an intuitive and elegant mobile experience.

To read the press release and for more information on DynaMed Plus, click here. For free trial information, click here.