Radiation risk of mammography related to benefit in screening programmes: a favourable balance?

Beemsterboer, Petra M. M.; Warmerdam, Peter G.; Boer, R. de; Koning, Harry J. de

doi:10.1136/jms.5.2.81

Cited by 51 publications

(31 citation statements)

References 19 publications

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“…Feig and Hendrick (1997) estimated the risks from screening women aged 40 -49 years and, assuming mortality reductions of between 24 and 36% for screened women, concluded that the radiation risks would be small compared to the mortality benefits. Beemsterboer et al (1998) and Mattsson et al (2000) focused on the question of whether to start screening all women at age 40 years rather than at age 50 years. Both conclude that this strategy would reduce the net reduction in breast cancer mortality.…”

Section: Discussionmentioning

confidence: 99%

Mammographic screening before age 50 years in the UK: comparison of the radiation risks with the mortality benefits

González

Reeves

2005

Br J Cancer

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Mammographic screening before age 50 years is less effective than at older ages and the associated radiation risks are higher. We estimated how many breast cancer deaths could be caused and how many could be prevented by a decade of annual two-view mammographic screening starting at ages 20, 30 and 40 years, respectively, in the UK; for all women, and for women with first-degree relatives affected with breast cancer. We extrapolated from a radiation risk model to estimate the number of radiation-induced breast cancer deaths, and used results from randomised trials, which suggest a reduction in breast cancer mortality of 10 -20% in women invited to screening before age 50 years, to estimate the number of deaths that could be prevented. The net change in breast cancer deaths was defined as the number of radiation-induced deaths minus the number of prevented deaths. For all women, assuming a reduction in mortality from screening of 20%, a decade of annual screening was estimated to induce more deaths than it prevents if started at age 20 years and at age 30 years (net increase ¼ 0.86 and 0.37 breast cancer deaths, respectively, per 1000 women screened). The corresponding estimate for screening starting at age 40 years was a net decrease of 0.46 deaths/1000 women screened and a zero net change assuming a 10% mortality reduction. Results for women with first-degree relatives with breast cancer were generally in the same direction but, because their background incidence rates are higher, the net increases or decreases were greater. In conclusion, our estimates suggest that a decade of annual two-view mammographic screening before age 40 years would result in a net increase in breast cancer deaths, and that starting at age 40 years could result in a material net decrease only if breast cancer mortality is reduced by about 20% or more in women screened. Although these calculations were based on a number of uncertain parameters, in general, the conclusions were not altered when these parameters were varied within a feasible range. The National Health Service Breast Screening Programme currently invites women in the UK aged 50 -70 years for mammographic screening once every 3 years. Whether screening should be offered to women younger than age 50 years, particularly to those thought to be at a higher than average risk of the disease because of a family history of breast cancer, is a question that is frequently raised. However, mammographic screening before age 50 years is less effective than at older ages possibly because premenopausal women have denser breasts and because the tumours grow more rapidly (Buist et al, 2004). Preliminary results from the UK Age Trial suggest that the reduction in breast cancer mortality associated with offering annual mammographic screening from age 40 to 47/48 years may be 10% (Moss et al, 2005), which is considerably lower than the 25% reduction achieved in randomised trials offering regular screening to women aged 50 -69 years (IARC, 2002).Exposure to mammographic X-rays confers a risk of...

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Section: Discussionmentioning

confidence: 99%

Mammographic screening before age 50 years in the UK: comparison of the radiation risks with the mortality benefits

González

Reeves

2005

Br J Cancer

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“…The risk of radiation exposure was calculated by modeling and this predicted the incidence and mortality of radiation-induced cancer (45)(46)(47)(48)(49)(50)(51)(52).…”

Section: Harms Of Mammographic Screeningmentioning

confidence: 99%

The Japanese Guidelines for Breast Cancer Screening

Hamashima¹,

C²,

Hattori³

et al. 2016

Jpn. J. Clin. Oncol.

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Objective: The incidence of breast cancer has progressively increased, making it the leading cause of cancer deaths in Japan. Breast cancer accounts for 20.4% of all new cancers with a reported agestandardized rate of 63.6 per 100 000 women. Methods: The Japanese Guidelines for Breast Cancer Screening were developed based on a previously established method. The efficacies of mammography with and without clinical breast examination, clinical breast examination and ultrasonography with and without mammography were evaluated. Based on the balance of the benefits and harms, recommendations for populationbased and opportunistic screenings were formulated. Results: Five randomized controlled trials of mammographic screening without clinical breast examination were identified for mortality reduction from breast cancer. The overall relative risk for women aged 40-74 years was 0.75 (95% CI: 0.67-0.83). Three randomized controlled trials of mammographic screening with clinical breast examination served as eligible evidence for mortality reduction from breast cancer. The overall relative risk for women aged 40-64 years was 0.87 (95% confidence interval: 0.77-0.98). The major harms of mammographic screening were radiation exposure, false-positive cases and overdiagnosis. Although two case-control studies evaluating mortality reduction from breast cancer were found for clinical breast examination, there was no study assessing the effectiveness of ultrasonography for breast cancer screening. Conclusions: Mammographic screening without clinical breast examination for women aged 40-74 years and with clinical breast examination for women aged 40-64 years is recommended for population-based and opportunistic screenings. Clinical breast examination and ultrasonography are not recommended for population-based screening because of insufficient evidence regarding their effectiveness.

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“…We have no evidence of cancers directly induced by radiation exposure within the mammographic range. However, some extrapolation from high doses has been published [93,94]. A mantle-field irradiation (typically for treatment of lymphoma) before 30 years of age is associated with a 12-fold increased risk of breast cancer [95,96], and the atomic bomb radiation at Hiroshima and Nagasaki determined an excess of breast cancer in direct proportion with the dose and in inverse proportion with the age of exposed females [97].…”

Section: The Technical Development Of Mr Imaging Of Breast Tumorsmentioning

confidence: 99%

Breast MR imaging in women at high-risk of breast cancer. Is something changing in early breast cancer detection?

2006

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In the last few years, several papers have addressed the introduction of contrast-enhanced MR imaging for screening women at high risk for breast cancer. Taking in consideration five prospective studies, on 3,571 screened women with hereditary predisposition to the disease and 9,652 rounds, we found that 168 patients were diagnosed with breast cancer (155 screen-detected, eight interval, and five cancers excluded from analysis) with a detection rate per year of 1.7%. These cancers were small (49% equal to or less than 10 mm in diameter) but aggressive, 82% being invasive and 49% with histologic grade 3; however, only 19% of these invasive cancers were associated with nodal involvement. The pooled sensitivity was 16% for clinical breast examination, 40% for mammography, 43% for ultrasound, and 81% for MR. The positive predictive value (calculated on the basis of the number of invasive diagnostic procedures due to false positives) was 33%, 47%, 18%, and 53%, respectively. Aim of the present article is to present the historical development of MR imaging of breast tumors that made this application theoretically and technically possible, to explain what strategic problems we face in the presence of a hereditary predisposition to the disease, to review the main results of the published studies, and to outline open problems and future perspectives.

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Radiation risk of mammography related to benefit in screening programmes: a favourable balance?

Cited by 51 publications

References 19 publications

Mammographic screening before age 50 years in the UK: comparison of the radiation risks with the mortality benefits

Mammographic screening before age 50 years in the UK: comparison of the radiation risks with the mortality benefits

The Japanese Guidelines for Breast Cancer Screening

Breast MR imaging in women at high-risk of breast cancer. Is something changing in early breast cancer detection?

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