Screening for breast cancer

An update for the U.S. Preventive Services Task Force

Heidi Nelson, Kari Tyne, Arpana Naik, Christina Bougatsos, Benjamin K. Chan, Linda Humphrey

Research output: Contribution to journalArticle

854 Citations (Scopus)

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. Primary Funding Source: Agency for Healthcare Research and Quality.

Original languageEnglish (US)
Pages (from-to)727-737
Number of pages11
JournalAnnals of Internal Medicine
Volume151
Issue number10
DOIs
StatePublished - Nov 17 2009

Fingerprint

Advisory Committees
Mammography
Breast Neoplasms
Breast Self-Examination
Mortality
Breast
Information Storage and Retrieval
Biopsy
Health Services Research
Early Detection of Cancer
MEDLINE
Randomized Controlled Trials
Magnetic Resonance Imaging
Clinical Trials
Databases

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Screening for breast cancer : An update for the U.S. Preventive Services Task Force. / Nelson, Heidi; Tyne, Kari; Naik, Arpana; Bougatsos, Christina; Chan, Benjamin K.; Humphrey, Linda.

In: Annals of Internal Medicine, Vol. 151, No. 10, 17.11.2009, p. 727-737.

Research output: Contribution to journalArticle

Nelson, Heidi ; Tyne, Kari ; Naik, Arpana ; Bougatsos, Christina ; Chan, Benjamin K. ; Humphrey, Linda. / Screening for breast cancer : An update for the U.S. Preventive Services Task Force. In: Annals of Internal Medicine. 2009 ; Vol. 151, No. 10. pp. 727-737.
@article{4ab2c77fac90436daff5fa6234d1233b,
title = "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 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. Primary Funding Source: Agency for Healthcare Research and Quality.",
author = "Heidi Nelson and Kari Tyne and Arpana Naik and Christina Bougatsos and Chan, {Benjamin K.} and Linda Humphrey",
year = "2009",
month = "11",
day = "17",
doi = "10.1059/0003-4819-151-10-200911170-00009",
language = "English (US)",
volume = "151",
pages = "727--737",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "10",

}

TY - JOUR

T1 - Screening for breast cancer

T2 - An update for the U.S. Preventive Services Task Force

AU - Nelson, Heidi

AU - Tyne, Kari

AU - Naik, Arpana

AU - Bougatsos, Christina

AU - Chan, Benjamin K.

AU - Humphrey, Linda

PY - 2009/11/17

Y1 - 2009/11/17

N2 - 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. Primary Funding Source: Agency for Healthcare Research and Quality.

AB - 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. Primary Funding Source: Agency for Healthcare Research and Quality.

UR - http://www.scopus.com/inward/record.url?scp=72049090936&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=72049090936&partnerID=8YFLogxK

U2 - 10.1059/0003-4819-151-10-200911170-00009

DO - 10.1059/0003-4819-151-10-200911170-00009

M3 - Article

VL - 151

SP - 727

EP - 737

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 10

ER -