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Screening for breast cancer: an update for the U.S. Preventive Services Task Force

Review

. 2009 Nov 17;151(10):727-37, W237-42. doi: 10.7326/0003-4819-151-10-200911170-00009. Screening for breast cancer: an update for the U.S. Preventive Services Task Force

Affiliations

Affiliation

¹ Oregon Health & Science University, Veterans Affairs Medical Center, Portland, OR 97239-3098, USA. nelsonh@ohsu.edu

PMID: 19920273
PMCID: PMC2972726
DOI: 10.7326/0003-4819-151-10-200911170-00009

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Review

Screening for breast cancer: an update for the U.S. Preventive Services Task Force

Heidi D Nelson et al. Ann Intern Med. 2009.

. 2009 Nov 17;151(10):727-37, W237-42. doi: 10.7326/0003-4819-151-10-200911170-00009. Affiliation

¹ Oregon Health & Science University, Veterans Affairs Medical Center, Portland, OR 97239-3098, USA. nelsonh@ohsu.edu

PMID: 19920273
PMCID: PMC2972726
DOI: 10.7326/0003-4819-151-10-200911170-00009

Item in Clipboard

Abstract

Background: This systematic review is an update of evidence since the 2002 U.S. Preventive Services Task Force recommendation on breast cancer screening.

Purpose: To determine the effectiveness of mammography screening in decreasing breast cancer mortality among average-risk women aged 40 to 49 years and 70 years or older, the effectiveness of clinical breast examination and breast self-examination, and the harms of screening.

Data sources: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2008), MEDLINE (January 2001 to December 2008), reference lists, and Web of Science searches for published studies and Breast Cancer Surveillance Consortium for screening mammography data.

Study selection: Randomized, controlled trials with breast cancer mortality outcomes for screening effectiveness, and studies of various designs and multiple data sources for harms.

Data extraction: Relevant data were abstracted, and study quality was rated by using established criteria.

Data synthesis: Mammography screening reduces breast cancer mortality by 15% for women aged 39 to 49 years (relative risk, 0.85 [95% credible interval, 0.75 to 0.96]; 8 trials). Data are lacking for women aged 70 years or older. Radiation exposure from mammography is low. Patient adverse experiences are common and transient and do not affect screening practices. Estimates of overdiagnosis vary from 1% to 10%. Younger women have more false-positive mammography results and additional imaging but fewer biopsies than older women. Trials of clinical breast examination are ongoing; trials for breast self-examination showed no reductions in mortality but increases in benign biopsy results.

Limitation: Studies of older women, digital mammography, and magnetic resonance imaging are lacking.

Conclusion: Mammography screening reduces breast cancer mortality for women aged 39 to 69 years; data are insufficient for older women. False-positive mammography results and additional imaging are common. No benefit has been shown for clinical breast examination or breast self-examination.

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Figures
Figure. Pooled Relative Risk for Breast Cancer…

Figure. Pooled Relative Risk for Breast Cancer Mortality from Trials of Mammography Screening Compared to…
Figure. Pooled Relative Risk for Breast Cancer Mortality from Trials of Mammography Screening Compared to Control for Women Age 39 to 49 Years

*Swedish Two-County Trial. Abbreviations: Cl = confidence interval for individual trial results and credible interval for meta-analysis results, HIP = Health Insurance Plan of New York, CNBSS-1 = Canadian National Breast Screening Study-1.

Comment in

The background review for the USPSTF recommendation on screening for breast cancer.
Jørgensen KJ, Gøtzsche PC. Jørgensen KJ, et al. Ann Intern Med. 2010 Apr 20;152(8):538; author reply 538-9. doi: 10.7326/0003-4819-152-8-201004200-00198. Epub 2010 Feb 15. Ann Intern Med. 2010. PMID: 20157097 No abstract available.
The background review for the USPSTF recommendation on screening for breast cancer.
Dickersin K, Tovey D, Wilcken N, Ghersi D. Dickersin K, et al. Ann Intern Med. 2010 Apr 20;152(8):537; author reply 538-9. doi: 10.7326/0003-4819-152-8-201004200-00196. Epub 2010 Feb 15. Ann Intern Med. 2010. PMID: 20157109 No abstract available.
The background review for the USPSTF recommendation on screening for breast cancer.
DeFrank JT, Brewer NT. DeFrank JT, et al. Ann Intern Med. 2010 Apr 20;152(8):537-8; author reply 538-9. doi: 10.7326/0003-4819-152-8-201004200-00197. Epub 2010 Feb 15. Ann Intern Med. 2010. PMID: 20157111 No abstract available.
ACP Journal Club. Review: In women 39 to 69 years of age, screening with mammography reduces breast cancer mortality.
Willett LR. Willett LR. Ann Intern Med. 2010 Feb 16;152(4):JC-27. doi: 10.7326/0003-4819-152-4-201002160-02007. Ann Intern Med. 2010. PMID: 20157131 No abstract available.
Systematic review: Mammography reduces breast cancer mortality in women aged 39-69 years; but harms may outweigh benefits in women under 50.
Jørgensen KJ. Jørgensen KJ. Evid Based Med. 2010 Apr;15(2):62-3. doi: 10.1136/ebm1045. Evid Based Med. 2010. PMID: 20436133 No abstract available.
Screening for breast cancer.
Kumiko S, Hiroshi S, Noriaki O, Tomotaka S. Kumiko S, et al. Ann Intern Med. 2010 Nov 2;153(9):618-9; author reply 619. doi: 10.7326/0003-4819-153-9-201011020-00016. Ann Intern Med. 2010. PMID: 21041585 No abstract available.