BackgroundEarlier studies of breast cancer, screening mammography, and mortality reduction may have inflated lifetime and long-term risk estimates for invasive breast cancer due to limitations in their data collection methods and interpretation.ObjectiveTo estimate the percentage of asymptomatic peri/postmenopausal women who will be diagnosed with a first invasive breast cancer over their next 25 years of life.MethodsA systematic review identified peer-reviewed published studies that: 1) enrolled no study participants with a history of invasive breast cancer; 2) specified the number of women enrolled; 3) reported the number of women diagnosed with a first invasive breast cancer; 4) did not overcount [count a woman multiple times]; and, 5) defined the length of follow-up. Data sources included PubMed, Cochrane Library, and an annotated library of 4,409 full-text menopause-related papers collected and reviewed by the first author from 1974 through 2008. Linear regression predicted incidence of first invasive breast cancer, based on follow-up duration in all studies that met the our inclusion criteria, and in a subset of these studies that included only women who were 1) at least 50 years old and 2) either at least 50 or less than 50 but surgically menopausal at enrollment.ResultsNineteen studies met the inclusion criteria. They included a total of 2,305,427 peri/postmenopasual women. The mean cumulative incidence rate of first invasive breast cancer increased by 0.20% for each year of age (95% CI: 0.17, 0.23; p < 0.01; R2 = 0.90). Over 25 years of follow-up, an estimated 94.55% of women will remain breast cancer-free (95% CI: 93.97, 95.13). In the 12 studies (n = 1,711,178) that enrolled only postmenopausal women, an estimated 0.23% of women will be diagnosed with a first invasive breast cancer each year (95% CI: 0.18, 0.28; p < 0.01, R2 = 0.88).ConclusionThe vast majority (99.75%) of screened asymptomatic peri/postmenopasual women will not be diagnosed with invasive breast cancer each year. Approximately 95% will not be diagnosed with invasive breast cancer during 25 years of follow-up. Women who receive clinical examinations, but do not have mammograms, will have higher cancer-free rates because innocuous positives (comprising 30-50% of mammography diagnoses) will remain undetected. Informed consent to asymptomatic women should include these results and consideration of the benefits of avoiding mammograms.

For over 20 years, medical authorities have urged asymptomatic peri/postmenopausal women to undergo frequent mammography. In a recent paper, the authors tested whether early detection reduced the incidence of previously undetected late-stage cancer and saved lives. They compared data from 1976-1978 (pre- mammography) to 2006-2008 US data. Annualized age-adjusted cancer data per 100,000 women ≥ 40 years old showed that early-stage cancer detection cases increased, from 105 to 178 cases of localized disease and from seven to 56 cases of ductal carcinoma in situ; regional invasive late-stage cancer diminished slightly, from 85 to 78 cases; distant late-stage cancer showed no decline, with 17 cases in both 1976-1978 and 2006-2008; breast cancer mortality declined by 20 per 100,000 women, from 71 to 51 cases. Since mammogram detection produced no decline in late-stage distant cancer presentations (with high mortality rates), and an extremely modest reduction in invasive regional disease (with low mortality rates), improved treatment, not early detection, is the likely engine for the lives saved. Overdiagnosis--estimated at about 70,000 US women per year--inflicts terror, and triggers biopsies followed by unnecessary medical treatments that are painful, potentially harmful, may impair immune responsiveness and increase the risks for other cancers. Given the availability of annual clinical exams, routine mammography screening should now be seriously questioned.

Forty-two experienced clinicians who work with consumers diagnosed with schizophrenia were surveyed in order to assess the feasibility of using mobile applications as an adjunct to conventional treatment. Clinicians reported that over two-thirds of their consumers could safely make use of this technology. In addition, a majority of consumers were seen as likely to benefit from all but one of the fifteen functions performed by the investigational app (TherAPPist).

No abstract

Background Invasive Breast Cancer (IBC) risk estimates continue to be based on data collated from cancer registries, i.e., retrospective research that excludes disease-free women. For women without a prior diagnosis, these estimates inflate both risk and screening frequency recommendations and inadvertently increase recently recognized harms from overdiagnosis and overtreatment. Objective To estimate the likelihood that pre or postmenopausal women with no prior diagnosis will remain free of IBC in order to enable evidence-based screening recommendations. Methods Prospective data from 21 studies of 2,402,672 women were analyzed, updating our previously published systematic search of 19 studies. This second systematic search included PubMed and The Cochrane Library from 2012 through April 2019. Inclusion criteria: only studies reporting the number of women enrolled, length of follow-up, and number of women diagnosed with IBC. Linear regression was used to estimate the percentage of women expected to remain free from an IBC diagnosis based on follow-up duration. To minimize non-response bias and selective outcome bias, only studies reporting outcomes for all enrolled women followed for similar, specific lengths of time were included. Sensitivity analyses confirm that the overall findings were unchanged by age at enrollment, menopausal status, screened women, variation in sample size, duration of follow-up, and heteroskedasticity.