Screening for breast cancer
- PMID: 15755947
- PMCID: PMC3149836
- DOI: 10.1001/jama.293.10.1245
Screening for breast cancer
Abstract
Context: Breast cancer screening in community practices may be different from that in randomized controlled trials. New screening modalities are becoming available.
Objectives: To review breast cancer screening, especially in the community and to examine evidence about new screening modalities.
Data sources and study selection: English-language articles of randomized controlled trials assessing effectiveness of breast cancer screening were reviewed, as well as meta-analyses, systematic reviews, studies of breast cancer screening in the community, and guidelines. Also, studies of newer screening modalities were assessed.
Data synthesis: All major US medical organizations recommend screening mammography for women aged 40 years and older. Screening mammography reduces breast cancer mortality by about 20% to 35% in women aged 50 to 69 years and slightly less in women aged 40 to 49 years at 14 years of follow-up. Approximately 95% of women with abnormalities on screening mammograms do not have breast cancer with variability based on such factors as age of the woman and assessment category assigned by the radiologist. Studies comparing full-field digital mammography to screen film have not shown statistically significant differences in cancer detection while the impact on recall rates (percentage of screening mammograms considered to have positive results) was unclear. One study suggested that computer-aided detection increases cancer detection rates and recall rates while a second larger study did not find any significant differences. Screening clinical breast examination detects some cancers missed by mammography, but the sensitivity reported in the community is lower (28% to 36%) than in randomized trials (about 54%). Breast self-examination has not been shown to be effective in reducing breast cancer mortality, but it does increase the number of breast biopsies performed because of false-positives. Magnetic resonance imaging and ultrasound are being studied for screening women at high risk for breast cancer but are not recommended for screening the general population. Sensitivity of magnetic resonance imaging in high-risk women has been found to be much higher than that of mammography but specificity is generally lower. Effect of the magnetic resonance imaging on breast cancer mortality is not known. A balanced discussion of possible benefits and harms of screening should be undertaken with each woman.
Conclusions: In the community, mammography remains the main screening tool while the effectiveness of clinical breast examination and self-examination are less. New screening modalities are unlikely to replace mammography in the near future for screening the general population.
Figures
Similar articles
-
Screening mammography for women aged 40 to 49 years at average risk for breast cancer: an evidence-based analysis.Ont Health Technol Assess Ser. 2007;7(1):1-32. Epub 2007 Jan 1. Ont Health Technol Assess Ser. 2007. PMID: 23074501 Free PMC article.
-
Screening for breast cancer: an update for the U.S. Preventive Services Task Force.Ann Intern Med. 2009 Nov 17;151(10):727-37, W237-42. doi: 10.7326/0003-4819-151-10-200911170-00009. Ann Intern Med. 2009. PMID: 19920273 Free PMC article. Review.
-
Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement.Ann Intern Med. 2009 Nov 17;151(10):716-26, W-236. doi: 10.7326/0003-4819-151-10-200911170-00008. Ann Intern Med. 2009. PMID: 19920272
-
Screening for Breast Cancer: A Systematic Review to Update the 2009 U.S. Preventive Services Task Force Recommendation [Internet].Rockville (MD): Agency for Healthcare Research and Quality (US); 2016 Jan. Report No.: 14-05201-EF-1. Agency for Healthcare Research and Quality (US). 2016. PMID: 26889531 Free Books & Documents. Review.
-
A systematic review of the effectiveness of magnetic resonance imaging (MRI) as an addition to mammography and ultrasound in screening young women at high risk of breast cancer.Eur J Cancer. 2007 Sep;43(13):1905-17. doi: 10.1016/j.ejca.2007.06.007. Epub 2007 Aug 2. Eur J Cancer. 2007. PMID: 17681781 Review.
Cited by 175 articles
-
Self-reported breast and cervical cancer screening practices among women in Ghana: predictive factors and reproductive health policy implications from the WHO study on global AGEing and adult health.BMC Womens Health. 2020 Jul 28;20(1):158. doi: 10.1186/s12905-020-01022-5. BMC Womens Health. 2020. PMID: 32723342 Free PMC article.
-
Fibrinogen-Like Protein 2 (FGL2) is a Novel Biomarker for Clinical Prediction of Human Breast Cancer.Med Sci Monit. 2020 Jul 27;26:e923531. doi: 10.12659/MSM.923531. Med Sci Monit. 2020. PMID: 32716910 Free PMC article.
-
Sociodemographic factors and clinical presentation of women attending Cancer Detection Centre, Kolkata for breast examination.J Clin Transl Res. 2020 Mar 19;5(3):132-139. eCollection 2020 Apr 13. J Clin Transl Res. 2020. PMID: 32617427 Free PMC article.
-
Naturally-Occurring Canine Mammary Tumors as a Translational Model for Human Breast Cancer.Front Oncol. 2020 Apr 28;10:617. doi: 10.3389/fonc.2020.00617. eCollection 2020. Front Oncol. 2020. PMID: 32411603 Free PMC article. Review.
-
Identification of a six-gene signature associated with tumor mutation burden for predicting prognosis in patients with invasive breast carcinoma.Ann Transl Med. 2020 Apr;8(7):453. doi: 10.21037/atm.2020.04.02. Ann Transl Med. 2020. PMID: 32395497 Free PMC article.
Publication types
MeSH terms
Grant support
LinkOut - more resources
-
Full Text Sources
- Cairn
- Elsevier Science
- Europe PubMed Central
- Ingenta plc
- Medical Online, Meteo Inc
- Ovid Technologies, Inc.
- PubMed Central
- Silverchair Information Systems
- Singapore Medical Association
- Sociedad Argentina de Investigacion Odontologica
- Taylor & Francis
- Tunisian Society for Medical Sciences
- UBM Medica LLC
-
Other Literature Sources
-
Medical