A Systematic Assessment of Benefits and Risks to Guide Breast Cancer Screening Decisions

Abstract

To maximize the benefit of mammography screening, decisions should be individualized based on patients' risk profiles and preferences. Risk models and decision aids are useful tools, but more research is needed to optimize these and to further quantify overdiagnosis. Research should also explore other breast cancer screening strategies.

Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial

“…6 Decision aids have the potential to address this need by communicating evidence-based harm and benefit information to women in a consumer-friendly manner. 8 In January 2014 the Cochrane Collaboration published an updated systematic review of randomised trials evaluating decision aids in people making health treatment or screening decisions. 15 The search (in June 2012) included Medline, Embase, and PsycINFO databases, trial registries, reference lists of included trials, and the Decision Aid Inventory (http://decisionaid.ohri.ca).…”

“…6 Momentum is shifting from "uninformative persuasion" approaches to screening communication 7 towards clear, balanced information giving people the opportunity to make informed choices based on their assessment of the trade-offs between potential outcomes. 8,9 It is argued that a person-centred health system should facilitate decision making that incorporates individual values and preferences, regardless whether the eventual choice is to screen or not. 10 In turn, key performance indicators for screening should reflect informed choice rather than participation.…”

“…6 While there are diverse overdetection estimates using various data and methods, randomised trials provide the best evidence regarding the extent of overdetection. 6,8 Our resources were designed to support women to make informed choices, not to influence them towards or away from screening. 7 Decision aids are provided where there is no obviously right or wrong option, so the focus in evaluating them should not be on the option selected 19 but rather on decision quality defined in terms of knowledge and values-choice agreement.…”

Risk factors of breast cancer and knowledge about the disease: an integrative revision of Latin American studies

“…Both represent well-known harms of mammography and clinical breast examination 61,62 . Furthermore, in their interviews, the authors of these 16 studies did not ask women if screening techniques may serve to prevent or alternatively to early detect the breast tumour.…”

Understanding Patient Options, Utilization Patterns, and Burdens Associated with Breast Cancer Screening

“…4 Overall, the sensitivity of mammography (i.e., likelihood that the test will detect existing disease) is 70%-90%; however, for women with denser breast tissue the sensitivity is lower (30%-48%). 5 The benefit of mammography in terms of early detection of cancer is balanced by certain limitations or ''harms.''…”