Breast Cancer Screening Controversy Research Articles

Controversies in Breast Cancer Screening Strategies.

A panel discussion on controversies in breast cancer screening held recently at the NCCN 21st Annual Conference included only a few controversies. Representatives of the U.S. Preventive Services Task Force, American Cancer Society, and NCCN disagreed primarily on 2 main areas: when to start screening (ages 40, 45, or 50 years) and frequency of screening (annual vs biennial). Panelists from these organizations presented the rationales for their respective recommendations.

Breast cancer screening controversy: too much or not enough?

The Cochrane analysis exploring the risk/benefit ratio of breast cancer screening resulted in a controversy worldwide spread by the mass media. Our survey sought to assess the impact of this controversy in terms of breast cancer screening awareness and attendance. A nationwide observational study, recorded in the EDIFICE iterative surveys, with a representative sample of 451 women aged 40-75 years, living in France, was carried out in the 3 months after the start of the controversy in January 2013. Of the 405 women with no personal history of cancer, 69 (17%) declared having heard of the controversy (aware group). Women remembering the controversy were more likely to belong to higher socioprofessional categories and to have a higher level of education. The most frequently remembered issues were overdiagnosis (38%), unreliability (16%) and radiation risk (9%). Compared with women who were unaware of the controversy, the aware group knew more about the limits of breast cancer screening (undiagnosed cancers, 20 vs. 7%, P<0.05 and risk of false positives, 20 vs. 2%, P<0.05) and were more likely to change their opinion for the worse over the mass media debate (8.7 vs. 1.2%, P<0.05). Nevertheless, only 1% of the aware-group declared their intention to subsequently undergo screening less frequently. The low impact of the controversy on the behaviour of women with respect to screening suggests that it should not be seen as a threat to screening attendance rates, but more as an opportunity to improve awareness.

Breast Cancer Screening Controversy: Impact on Other Cancer Screening Programs

ABSTRACT Aim: The breast cancer screening (BCS) controversy following the Cochrane meta-analysis has affected women's perception and understanding of BCS. We speculated that this controversy may influence cancer screening for other locations. This analysis looks at the potential collateral effect of the BCS controversy on the population's perception of and intention to participate in colorectal and cervical cancer screening programs. Methods: A nationwide, observational study, recorded in the EDIFICE iterative surveys, on a representative sample of 451 women (age 40-75 years) living in France, was conducted in January 2013, using the method of quotas. The survey questionnaire was administered via the computer-assisted telephone interviewing technique 3 months after the start of the controversy. Attitudes toward different cancer location screening were studied. Results: Of the 405 women with no history of cancer, 69 (17%) were aware of the controversy. Among this latter group, 8% declared their intention to undergo mammograms less frequently and 9%, that the controversy would have an impact on their participation in other cancer screening programs. The concept of BCS being “more reassuring than worrying” was significantly less prevalent among women in the “aware of the controversy” group than in the group without awareness (57% vs.77%, P Conclusions: Few women were aware of the controversy, and its impact on the intention to undergo screening in the overall population of our sample is very low (1%). However, for women who are mindful of the controversy, we observed a deterioration in the level of confidence in cancer screening, and this effect was not limited to BCS but also extended to colorectal and cervical cancer screening. Disclosure: X. Pivot: Board honorarium from Roche; F. Eisinger: Board honorarium from Roche; J. Morere: Board honorarium from Roche. All other authors have declared no conflicts of interest.

Breast cancer screening controversy: Impact on other cancer screening programs.

e12507 Background: The breast cancer screening (BCS) controversy following the Cochrane meta-analysis has affected women’s perception and understanding of BCS. We speculated that this controversy may influence cancer screening for other locations. This analysis looks at the potential collateral effect of the BCS controversy on the population’s perception of and intention to participate in colorectal and cervical cancer screening programs. Methods: A nationwide, observational study, recorded in the EDIFICE iterative surveys, on a representative sample of 451 women (age 40-75 years) living in France, was conducted in January 2013, using the method of quotas. The survey questionnaire was administered via the computer-assisted telephone interviewing technique 3 months after the start of the controversy. Attitudes toward different cancer location screening were studied. Results: Of the 405 women with no history of cancer, 69 (17%) were aware of the controversy. Among this latter group, 8% declared their intent...

Controversies in breast cancer screening for women aged 40-49 years.

Mammography is the only method of breast cancer screening that has established evidence of a mortality reduction. However, mammography does not achieve sufficient accuracy in the high-density breasts of patients<50 years of age. In 2009, the US Preventive Services Task Force revised its recommendation for breast cancer screening in women aged 40-49 years from Grade B to C because the net benefit was relatively small for this age bracket. The net benefit of screening is the sum of benefits and harm and should always be monitored especially in population screening. A high recall rate, an inefficient number needed to invite for screening to prevent one breast cancer death, a high false-positive rate and unnecessary additional imaging for women aged 40-49 years are great concerns of mammography screening. Overdiagnosis is also a detriment of mammography screening; however, it may have a limited effect on women aged 40-49 years. Establishment of new evidence for breast cancer screening, such as ultrasonography screening, is needed in order to create a more effective screening system.

Real and artificial controversies in breast cancer screening

SUMMARY We review the apparent disparities between different reviews of the effects of mammographic screening on mortality from breast cancer and overdiagnosis. When results of each review are expressed with respect to a common population and a common baseline, all find a substantial mortality benefit and variation among estimates is minor. There are genuine disagreements about overdiagnosis, but methods that take account of lead time and underlying incidence trends yield estimates of overdiagnosis that are modest and are outweighed by the mortality benefit. There is potential for individualized screening regimens, particularly with respect to breast density.

Sorting through the recent controversies in breast cancer screening

Despite the new US recommendations, we continue to recommend yearly mammograms for most women, starting at age 40.

The most recent breast cancer screening controversy about whether mammographic screening benefits women at any age: nonsense and nonscience.

The most recent breast cancer screening controversy about whether mammographic screening benefits women at any age: nonsense and nonscience.

An overview of the breast cancer screening controversy.

Randomized controlled studies show that screening mammograms are as important for women aged 40-49 as for women 50 years old and above. It was the improper use of retrospective, unplanned, sub-group analysis to advise women and their physicians that caused the controversy over mammograms for women under 50. Furthermore, arbitrarily grouping women into two groups leads to the incorrect conclusion that the age of 50 is a significant break point when it is not. The data demonstrates that none of the parameters of screening change abruptly at age 50. The recall rates (an abnormal mammogram) and the rate at which biopsies are recommended are virtually the same, regardless of age. Breast cancer is not a trivial problem for women in their forties. More than 30% of the years of life lost to breast cancer are from women diagnosed while in their forties. Because of changing demographics, in 1995 and 1996, there were actually more women diagnosed with breast cancer in their forties than for women in their fifties. The data clearly show that screening women for breast cancer, on an annual basis, beginning by age 40, can reduce the death rate by approximately 24%. It is important to separate medical and scientific analyses from the economic considerations. "Society" may decide that it is too expensive to screen women for breast cancer, but women should be provided with the scientific and medical information so that they can participate in the discussion of whether screening is "worthwhile" and decide whether or not to avail themselves of its benefit. The economics should not be used to influence the scientific and medical analysis of benefit.

Controversies in breast cancer screening

Because breast cancer is the most common cancer occurring in women in the United States, early detection of breast cancer through screening mammography, physician clinical examination, and breast self-examination has been recommended. However, despite admonitions to physicians and patients to be aggressive in their screening efforts, there has been continued controversy regarding appropriate guidelines for screening. In December 1993, the National Cancer Institute announced that it could no longer recommend routine mammographic screening for women age 40-49 years, which it had previously supported along with other medical organizations. This change in policy, along with data from the Canadian National Breast Screening Study showing an increased mortality rate for screened women, created confusion for physicians and patients alike. The controversy about screening guidelines has created many practical concerns for the physicians involved in the primary health care of women. In the current paper, the author discussed the development of screening guidelines and the current recommendations of various medical organizations and reviewed the data from studies supporting and challenging the current guidelines, with a focus on screening guidelines for women age 40-49 and the elderly. Recommendations are made for physicians on how to communicate with patients regarding screening controversies.

The National Cancer Institute and guideline development: lessons from the breast cancer screening controversy.

The National Cancer Institute and guideline development: lessons from the breast cancer screening controversy.

The Breast Cancer Screening Controversy Continues

Letters1 May 1993The Breast Cancer Screening Controversy ContinuesAnthony B. Miller, MDAnthony B. Miller, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-118-9-199305010-00024 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Dr. Miller responds: Dr. Kopans and Dr. Logan-Young and her colleagues make several erroneous statements. Centers were chosen for the National Breast Screening Study for their expertise in mammography. Expertise in screening was not available because there was no screening program in operation in Canada at the time. Thus, the radiologists, radiographers, and nurse-examiners learned to deal with the problems of screening on the job. We simply did not have the resources to send radiologists and technologists to Rochester, New York, or indeed anywhere else for training. We documented good sensitivity and specificity of both screening modalities [1, 2] and ...

The Breast Cancer Screening Controversy Continues

Letters1 May 1993The Breast Cancer Screening Controversy ContinuesJonathan M. Ross, MD and Paul Gerber, MDJonathan M. Ross, MDSearch for more papers by this author and Paul Gerber, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-118-9-199305010-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Two recent articles [1, 2] and your editorial in Annals help bring into focus a central issue in clinical care todaynamely, the balance between individual care and population-based care. Naylor and colleagues [1] note that the way that results of randomized, controlled trials are presented can affect clinicians' perceptions of therapeutic effectiveness. Presenting data in terms of relative risk reduction impressed clinicians more than using either absolute risk reduction or the number needed to be treated to avoid one adverse outcome. Coleman and colleagues [2] report that the use of mammography in older women increased dramatically in ...

The Breast Cancer Screening Controversy Continues

The Breast Cancer Screening Controversy Continues

The Breast Cancer Screening Controversy Continues

The Breast Cancer Screening Controversy Continues

Breast Carcinoma: The Radiologist's Expanded Role

A major controversy now rages concerning the carcinogenic effects of radiation at doses ordinarily employed in diagnostic mammography. Although a clear-cut answer will not be forthcoming in the immediate future, the radiologist must exert every effort to obtain a good diagnostic image with the lowest possible radiation exposure. This conference presents the current thinking regarding mammographic image production and radiation reduction. Of the 5 parts, in the book, the first discusses radiation as it relates to cancer induction, benefit-risk ratio in mammography, and a perspective of breast cancer screening controversy. The contributors believe that radiation is indeed carcinogenic, but that estimations of carcinogenesis are at best tenuous. At least in selected patients who are at higher-thannormal risk, breast screening by mammography is desirable. In part 2 physicists discuss in depth the physical factors affecting mammographic images. These include the effects of scattered radiation on contrast, geometric unsharpness and its related

Special lecture: the breast cancer screening controversy: a perspective

Analysis of the data of the Health Insurance Plan of New York Breast Cancer Screening Study indicates that in patients whose cancers were found by screening, the case fatality rate at all ages is almost half the case fatality rate of controls. The data also strongly suggest that maximal benefit in young women resides in the detection of in situ cancers. Due to relatively low yield of these early lesions, projected 20 year survival in that study may be little different for all women screened compared to controls. We have shown that the yield of these early lesions can be increased by aggressive screening and liberal use of biopsy. Furthermore, where J.C. Bailar has indicated a net gain (or loss) of -4 to +8 lives per 20,000 women using the HIP data, using his method and our data we find a savings of 25-27 lives/20,000 women by 3 year screening to date. These are lives that have been saved by mammography alone.