Benefits and Harms of Breast Cancer Screening

Myers, Evan R.; Moorman, Patricia G.; Gierisch, Jennifer M.; Havrilesky, Laura J.; Grimm, Lars J.; Ghate, Sujata V.; Davidson, Brittany; Mongtomery, Ranee Chatterjee; Crowley, Matthew J; McCrory, Douglas C; Kendrick, Amy; Sanders, Gillian D

doi:10.1001/jama.2015.13183

Cited by 535 publications

(386 citation statements)

References 128 publications

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“…The harms of such overdiagnosis have to be balanced against the benefits of a reduction in breast cancer mortality of about 20% in those women invited for screening (1). The other major harm of screening come from false positive results.…”

Section: Overdiagnosis In Mammographic Screeningmentioning

confidence: 99%

Overdiagnosis in breast imaging

Evans

Vinnicombe

2017

The Breast

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The main harm of overdiagnosis is overtreatment. However a form of overdiagnosis also occurs when foci of cancer are found by imaging in addition to the symptomatic lesion when this leads to additional treatment which does not benefit the patient. Even if overtreatment is avoided, knowledge of the diagnosis can still cause psychological harm.Overdiagnosis is an inevitable effect of mammographic screening as the benefit comes from diagnosing breast cancer prior to clinical detectability. Estimates of the rate of overdiagnosis at screening are around 10%. DCIS represents 20% of cancers detected by screening and is the main focus in the overdiagnosis debate. Detection and treatment of low grade DCIS and invasive tubular cancer would appear to represent overdiagnosis in most cases. Supplementary screening with tomosynthesis or US are both likely to increase overdiagnosis as both modalities detect predominantly low grade invasive cancers. MRI causes overdiagnosis because it is so sensitive that it detects real tumour foci which after radiotherapy and systemic therapy do not, in many cases go on and cause local recurrence if the women had had no MRI and undergone breast conservation and adjuvant therapy with these small foci left in situ.

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Section: Overdiagnosis In Mammographic Screeningmentioning

confidence: 99%

Overdiagnosis in breast imaging

Evans

Vinnicombe

2017

The Breast

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“…1 A review by Myers et al, confirmed the findings of several published studies that screening mammography in women aged 40-79 reduces breast cancer mortality rates by 20%-50%, with extent of benefit varying by age, as well as study design (RCT vs. observational). 2 However, mammography has a population-based sensitivity of only approximately 80% 1 which is further corroborated by the findings of Carney et al, that showed that with increasing breast density, the sensitivity of mammography decreases to 62% in women with dense breasts. 3 Breast density refers to the proportion of glandular and fibrous breast tissue to the amount of fatty tissues in a woman's breast.…”

Section: Introductionmentioning

confidence: 80%

Contrast-Enhanced Spectral Mammography: A Radiologic-Pathologic Perspective of a Novel Functional Imaging Modality for Breast Cancer

Buenaflor¹,

Moria²

2017

PJP

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Contrast-enhanced Spectral Mammography (CESM) is an emerging and promising functional imaging modality that tries to address the paucity of physiologic-based tumor imaging for the detection of breast cancer.This article describes two cases of women with non-dense and dense breasts presenting with clinically palpable breast masses and the depiction of breast cancer utilizing Contrast-enhanced Spectral Mammography.

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“…Breast self-examination is not advocated by INCA and other organizations as there is no evidence of this measure's benefits in terms of reducing mortality. 19,20 Clinical examination of the breast is recommended because it is a part of medical semiology. However, it has substantially less diagnostic accuracy than mammography for early breast cancer investigation, and no impact on the reduction of mortality.…”

Section: Discussionmentioning

confidence: 99%

Factors related to non-adherence to mammography in a city of the Brazilian Amazonian area: A population-based study

Souza

Araújo

Teles

et al. 2017

Rev. Assoc. Med. Bras.

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Objective: To assess the prevalence of mammography use and factors related to non-adherence in Boa Vista, capital of Roraima, Brazil. Method: A cross sectional study, quantitative analysis, based on household survey was performed between June and August 2013, using a face-to-face interview with a pre-tested form. Target population was women between 40 and 69 years. The sample size target was 240 participants, and the sampling method was random cluster sampling. The study was approved by the Institutional Review Board of Federal University of Roraima. Results: 241 women were included without refusals. The prevalence of non-use of mammography in the past two years was 55.6% (95CI 49.1-61.9). In univariate analysis, the risk factors for non-adherence to mammography were having low educational level, family income below three minimum wages, receiving government assistance, not having consulted with a doctor and no health insurance. In multivariate analysis, only low educational level and receiving government assistance remained as risk factors. Medical consultation or health worker visiting were protective factors. Conclusion: Adherence to mammography is unsatisfactory in Boa Vista, Roraima, and has a predominantly opportunistic character. Low educational level is confirmed as an independent risk factor, but belonging to a family that receives government assistance can be interpreted as a social marker of families and/or areas lacking of government intervention to increase access to breast cancer control programs.

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Benefits and Harms of Breast Cancer Screening

Cited by 535 publications

References 128 publications

Overdiagnosis in breast imaging

Overdiagnosis in breast imaging

Contrast-Enhanced Spectral Mammography: A Radiologic-Pathologic Perspective of a Novel Functional Imaging Modality for Breast Cancer

Factors related to non-adherence to mammography in a city of the Brazilian Amazonian area: A population-based study

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