Effectiveness of Breast Cancer Screening: Systematic Review and Meta-analysis to Update the 2009 U.S. Preventive Services Task Force Recommendation

Nelson, Heidi D; Fu, Rochelle; Cantor, Amy; Pappas, Miranda; Daeges, Monica; Humphrey, Linda L.

doi:10.7326/m15-0969

Cited by 466 publications

(413 citation statements)

References 88 publications

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“…Evidence from the RCTs and observational data have shown similar relative benefits associated with invitation and exposure to screening among women in their 40s and 50s, 29,62–64 and rates of recall and biopsy among women screened with screen-film and digital mammography were similar. 37,65 However, judgments about the absolute benefit of mammography in 10-year age groups, or for women in their 40s compared to women ages 50–74, have defined modern debates about when to begin screening. While the 5-year absolute risk of breast cancer has increased steadily during this period, the 5-year risk among women ages 45–49 (0.9%) and women ages 50–54 (1.1%) was similar, and greater than that for women ages 40–44 (0.6%) (Table 3).…”

Section: Results (Recommendations)mentioning

confidence: 99%

“…Based upon all-digital, non-prevalent (first screening exam excluded) screening mammography, there was an inverse relationship between age and false-positive findings per 1000 screening exams among women ages 40–89, although the differences between 10 year age groups are modest. 65 For example, false positive findings per 1000 exams for women ages 40–49 (121.2) vs. 50–59 (93.2) differed by only 28 exams per 1000 women, and recommendations for biopsy per 1,000 women differed by less than 1 per 1000 (16.4 vs. 15.9, respectively).…”

Section: Results (Recommendations)mentioning

confidence: 99%

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Breast Cancer Screening for Women at Average Risk

Oeffinger

Fontham

Etzioni

et al. 2015

JAMA

1,439

906

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Importance Breast cancer is a leading cause of premature mortality among U.S. women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality. This report updates the American Cancer Society (ACS) 2003 breast cancer screening guideline for women at average risk for breast cancer. Process The ACS commissioned a systematic evidence review of the breast cancer screening literature to inform the update, and a supplemental analysis of mammography registry data to address questions related to the screening interval. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. Evidence Synthesis Mammography screening in women aged 40–69 years is associated with a reduction in breast cancer deaths across a range of study designs, and inferential evidence supports breast cancer screening in women who are age 70 years and older and are in good health. Estimates of the cumulative lifetime risk of false positive exams are greater if screening begins at younger ages due to the greater number of mammograms, as well as the higher recall rate in younger women. The quality of the evidence for overdiagnosis is not sufficient to estimate a lifetime risk with confidence. Analysis examining the screening interval demonstrates more favorable tumor characteristics when premenopausal women are screened annually vs. biennially. Evidence does not support routine clinical breast examination as a screening method for average risk women. Recommendations The ACS recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation). Women who are ages 45 to 54 years should be screened annually (qualified recommendation). Women who are age 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation). Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation). Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or more (qualified recommendation). The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).

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Section: Results (Recommendations)mentioning

confidence: 99%

Section: Results (Recommendations)mentioning

confidence: 99%

Breast Cancer Screening for Women at Average Risk

Oeffinger

Fontham

Etzioni

et al. 2015

JAMA

1,439

906

View full text Add to dashboard Cite

show abstract

“…In the short term, mammography screening is associated with increased breast cancer incidence (through (1) earlier diagnosis of pre-symptomatic cancers and (2) overdiagnosis of indolent breast cancer tumors that would have never progressed (Bleyer & Welch, 2012; Marcus, Prorok, Miller, DeVoto, & Kramer, 2015)), although this relationship is dynamic over time and generally reaches a steady state after screening has disseminated in the population (Feuer & Wun, 1992). In the long term, mammography screening is associated with decreased breast cancer mortality (Das, Feuer, & Mariotto, 2005; Nelson et al, 2016). In contrast, Pap screening is associated with reduced cervical cancer incidence ((1) through earlier detection of pre-symptomatic cancers and (2) by allowing the removal of cervical lesions before they develop into cancer) (Smith, Cokkinides, Brooks, Saslow, & Brawley, 2010).…”

Section: Urban/rural Differences In Breast and Cervical Cancer Incidementioning

confidence: 99%

Urban/Rural Differences in Breast and Cervical Cancer Incidence: The Mediating Roles of Socioeconomic Status and Provider Density

Moss

Liu

Feuer

2017

Women's Health Issues

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Background Breast and cervical cancer incidence vary by urbanicity, and several ecological factors could contribute to these patterns. In particular, cancer screening or other sociodemographic and healthcare system variables could explain geographic disparities in cancer incidence. Methods Governmental and research sources provided data on 612 counties in the Surveillance, Epidemiology, and End Results program for rural-urban continuum code, socioeconomic status (SES) quintile, percent non-Hispanic white residents, density of primary care physicians, cancer screening, and breast and cervical cancer incidence rates (2009–2013). Ecological mediation analyses used weighted least squares regression to examine whether candidate mediators explained the relationship between urbanicity and cancer incidence. Results As urbanicity increased, so did breast cancer incidence (β̂=0.23, p<.001). SES quintile and density of primary care physicians mediated this relationship, while percent non-Hispanic white suppressed it (all p<.05); county-level mammography levels did not contribute to the relationship. After controlling for these variables, urbanicity and breast cancer incidence were no longer associated (β̂=0.11, p>.05). In contrast, as urbanicity increased, cervical cancer incidence decreased (β̂=−0.33, p<.001). SES quintile and density of primary care physicians mediated this relationship (both p<.05); percent non-Hispanic white and Pap screening levels did not contribute to the relationship. After controlling for these variables, the relationship between urbanicity and cervical cancer incidence was still statistically significant (β̂=−0.13, p<.05). Conclusions County-level SES and density of primary care physicians explained the relationships between urbanicity and breast and cervical cancer incidence. Improving these factors in more rural counties could ameliorate geographic disparities in breast and cervical cancer incidence.

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“…Breast screening programs provide an opportunity for early breast cancer detection and contribute to increased survivorship and reduced breast cancer mortality [3,4]. While controversy exists regarding the effectiveness of mammography [5,6], women need to be adequately informed about the benefits of screening alongside the potential harm of false positive results and unnecessary treatment when deciding to participate in breast screening [7,8].…”

Section: Introductionmentioning

confidence: 99%

Barriers to Breast Cancer Screening among Diverse Cultural Groups in Melbourne, Australia

O’Hara

McPhee

Dodson

et al. 2018

IJERPH

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This study explored the association between health literacy, barriers to breast cancer screening, and breast screening participation for women from culturally and linguistically diverse (CALD) backgrounds. English-, Arabic- and Italian-speaking women (n = 317) between the ages of 50 to 74 in North West Melbourne, Australia were recruited to complete a survey exploring health literacy, barriers to breast cancer screening, and self-reported screening participation. A total of 219 women (69%) reported having a breast screen within the past two years. Results revealed that health literacy was not associated with screening participation. Instead, emotional barriers were a significant factor in the self-reported uptake of screening. Three health literacy domains were related to lower emotional breast screening barriers, feeling understood and supported by healthcare providers, social support for health and understanding health information well enough to know what to do. Compared with English- and Italian-speaking women, Arabic-speaking women reported more emotional barriers to screening and greater challenges in understanding health information well enough to know what to do. Interventions that can improve breast screening participation rates should aim to reduce emotional barriers to breast screening, particularly for Arabic-speaking women.

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Effectiveness of Breast Cancer Screening: Systematic Review and Meta-analysis to Update the 2009 U.S. Preventive Services Task Force Recommendation

Abstract: Agency for Healthcare Research and Quality.

Cited by 466 publications

References 88 publications

Breast Cancer Screening for Women at Average Risk

Breast Cancer Screening for Women at Average Risk

Urban/Rural Differences in Breast and Cervical Cancer Incidence: The Mediating Roles of Socioeconomic Status and Provider Density

Barriers to Breast Cancer Screening among Diverse Cultural Groups in Melbourne, Australia

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