Screening for Breast Cancer: An Update for the U.S. Preventive Services Task Force

Abstract

Background This systematic review is an update of evidence since the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation on breast cancer screening. Purpose To determine the effectiveness of mammography screening in decreasing breast cancer mortality among average-risk women age 40 to 49 and 70 and older; the effectiveness of clinical breast examination (CBE) and breast self examination (BSE); and harms of screening. Data Sources Cochrane Controlled Trials Registry and Database of Systematic Reviews (4th Quarter 2008), MEDLINE® (January 2001 to December 2008), reference lists, and Web of Science® for published studies; Breast Cancer Surveillance Consortium for screening mammography data. Study Selection Randomized controlled trials with breast cancer mortality outcomes for screening effectiveness; multiple study designs and data sources for harms. Data Extraction Investigators abstracted relevant data and rated study quality using established criteria. Data Synthesis Mammography screening reduces breast cancer mortality by 15% for women age 39 to 49 (relative risk 0.85; 95% CrI 0.75 to 0.96; 8 trials); data are lacking for age ≥70. Radiation exposure from mammography is low. Patient adverse experiences are common, transient, and do not impact screening practices. Estimates of overdiagnosis vary from 1% to 10%. Younger women have more false positive mammograms and additional imaging, but fewer biopsies than older women. Trials of CBE are ongoing; for BSE, trials showed no reductions in mortality but increased benign biopsies. Limitations Studies of older women, digital mammography, and MRI are lacking. Conclusions Mammography screening reduces breast cancer mortality for women age 39 to 69; data are insufficient for older women. False positive mammograms and additional imaging are common. No benefit has been shown for CBE or BSE.

Primary care providers’ cancer genetic testing-related knowledge, attitudes, and communication behaviors: A systematic review and research agenda

“…Although screening tests including mammography, colonoscopy, and sigmoidoscopy have established populationlevel health benefits, [9][10][11][12] these tests also carry risks; as such, there is a desire to identify individuals who will derive the greatest benefit and least harm. Genetic testing for cancer susceptibility may have utility for risk stratification, thereby allowing for a more focused application of screening tests to those at greatest disease risk.…”

Cost‐effectiveness of digital mammography screening before the age of 50 in The Netherlands

“…Although the UK Age Trial showed a non-significant 17% reduction in breast cancer mortality, 9 a statistically significant breast cancer mortality reduction of 15% to 18% associated with screening for women aged 39 to 49 or 40 to 49 at entry was demonstrated by several meta-analyses of randomised controlled trials. [10][11][12][13] In addition, a recent Swedish observational study that compared breast cancer mortality rates between women aged 40 and 49 who were invited to screening and women who were not invited to screening demonstrated a 26% statistically significant breast cancer mortality reduction. 14 Younger women may benefit less from mammography screening because of factors associated with younger age, including a lower breast cancer incidence 1 and a lower test sensitivity of mammography due to higher breast density and, possibly, faster growing tumours.…”

Mammography Use Among Women Ages 40–49 After the 2009 U.S. Preventive Services Task Force Recommendation

“…1,2 Evidence behind this decision included a meta-analysis that revealed that while mammography does reduce mortality in this age group, there are more false positives than in older women and the number needed to treat is higher due to lower incidence. 3 Therefore, screening mammography in this younger age group could lead to costly and anxiety-provoking workups, which are associated with their own health risks, as well as to potential over-diagnosis. 4 The new guidelines led to resistance among the media, patients, providers, and medical organizations.…”