Breast Cancer In Average-Risk Women Research Articles

Breast cancer screening in average-risk women: towards personalized screening.

Breast cancer screening is widely recognized for reducing breast cancer mortality. The objective in screening is to diagnose asymptomatic early stage disease, thereby improving treatment efficacy. Screening recommendations have been widely debated over the past years and controversies remain regarding the optimal screening frequency, age to start screening, and age to end screening. While there are no new trials, follow-up information of randomized controlled trials has become available. The American College of Physicians recently issued a new guidance statement on screening for breast cancer in average-risk women, with similar recommendations to the U.S. Preventive Services Task Force and to European guidelines. However, these guidelines differ from those ofother American specialty societies. The variations reflect differences in the organizations' values, the metrics used to evaluate screening results, and the differences in healthcare organization (individualized or state-organized healthcare). False-positive rates and overdiagnosis of biologically insignificant cancer are perceived as the most important potential harms associated with mammographic screening; however, there is limited evidence on their actual consequences. Most specialty societies agree that physicians should offer mammographic screening at age 40 years for average-risk women and discuss its benefits and potential harms to achieve a personalized screening strategy through a shared decision-making process.

Screening for Breast Cancer in Average-Risk Women

Screening for Breast Cancer in Average-Risk Women

Screening for Breast Cancer in Average-Risk Women

Letters17 September 2019Screening for Breast Cancer in Average-Risk WomenKelly W. Biggs, MDKelly W. Biggs, MDTyrone Hospital, Tyrone, Pennsylvania (K.W.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0470 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The American College of Physicians (ACP) guidance statement on screening for breast cancer in average-risk women (1) concludes that “the potential harms of screening for breast cancer with mammography before age 50 years outweigh the benefits in most women.” Among the chief harms of screening that ACP cites are “distress, anxiety, and worry.” Women should know that these “harms” must be measured against evidence accrued over decades that proves that mammography saves lives in women aged 40 to 49 years. Randomized controlled trials show a reduction in breast cancer deaths for women in this age group who ...

Screening for Breast Cancer in Average-Risk Women

Screening for Breast Cancer in Average-Risk Women

Annals for Educators - 16 April 2019.

Annals for Educators - 16 April 2019.

Screening for Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians.

The purpose of this guidance statement is to provide advice to clinicians on breast cancer screening in average-risk women based on a review of existing guidelines and the evidence they include. This guidance statement is derived from an appraisal of selected guidelines from around the world that address breast cancer screening, as well as their included evidence. All national guidelines published in English between 1 January 2013 and 15 November 2017 in the National Guideline Clearinghouse or Guidelines International Network library were included. In addition, the authors selected other guidelines commonly used in clinical practice. Web sites associated with all selected guidelines were checked for updates on 10 December 2018. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to evaluate the quality of guidelines. The target audience is all clinicians, and the target patient population is all asymptomatic women with average risk for breast cancer. In average-risk women aged 40 to 49 years, clinicians should discuss whether to screen for breast cancer with mammography before age 50 years. Discussion should include the potential benefits and harms and a woman's preferences. The potential harms outweigh the benefits in most women aged 40 to 49 years. In average-risk women aged 50 to 74 years, clinicians should offer screening for breast cancer with biennial mammography. In average-risk women aged 75 years or older or in women with a life expectancy of 10 years or less, clinicians should discontinue screening for breast cancer. In average-risk women of all ages, clinicians should not use clinical breast examination to screen for breast cancer.

How Effective Is Mammography as a Screening Tool?

Screening mammography has been shown to be an effective tool in the early diagnosis of breast cancer in average-risk women. Because the results of mortality reduction take time to become evident, the effectiveness of screening requires monitoring of quality indicators to determine the functioning of a population-based screening program. It is important to understand the goals of a population-based screening program to balance the risks and benefits of screening mammography and to determine the effectiveness of the program. In Canada, breast cancer screening has been shown to be highly effective at reducing breast cancer mortality by 40%. Using the Canadian screening program as an example of population-based screening, quality indicators of screening mammography and recent performance will be reviewed to assess overall effectiveness of the program. Screening mammography as a population-based program is an effective tool in the early diagnosis of breast cancer in average-risk women, showing a 40% reduction in breast cancer mortality.

Time to Douse the Firestorm Around Breast Cancer Screening.

This issue includes recommendations from the USPSTF on screening for breast cancer in average-risk women. The editorialists discuss the recommendation as well as the firestorm after the 2009 recomm...