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Cover of Screening for Breast Cancer

Screening for Breast Cancer

Systematic Evidence Review Update for the US Preventive Services Task Force

Evidence Syntheses, No. 74

Investigators: , MD, MPH, , MD, , MD, , BS, , MS, , MA, and , MD, MPH.

Oregon Evidence-based Practice Center
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 10-05142-EF-1

Structured Abstract

Background:

This systematic review is an update of new 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 age 40–49 years and 70 years and older; the effectiveness of clinical breast examination (CBE) and breast self examination (BSE) in decreasing breast cancer mortality among women of any age; and harms of screening with mammography, CBE, and BSE.

Data Sources:

The Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2008), MEDLINE® searches (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 age 39–49 (relative risk [RR] 0.85; 95% credible interval [CrI], 0.75–0.96; 8 trials). Results are similar to those for women age 50–59 years (RR 0.86; 95% CrI, 0.75–0.99; 6 trials), but effects are less than for women age 60–69 years (RR 0.68; 95% CrI, 0.54–0.87; 2 trials). Data are lacking for women age 70 years and 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 1–10%. Younger women have more false-positive mammography results and additional imaging but fewer biopsies than older women. Trials of CBE are ongoing; trials of BSE showed no reductions in mortality but increases in benign biopsy results.

Limitations:

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

Conclusions:

Mammography screening reduces breast cancer mortality for women age 39–69 years; data are insufficient for women age 70 years and older. False-positive mammography results and additional imaging are common. No benefit has been shown for CBE or BSE.

Contents

Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239. www​.ohsu.edu/epc/usptf/index.htm

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC)1 under contract to the Agency for Healthcare Research and Quality (AHRQ),2 (Contract No. 290-02-0024). This project was funded by AHRQ for the U.S. Preventive Services Task Force (USPSTF). Additional support was provided by the Veteran’s Administration Women’s Health Fellowship (Dr. Tyne) and the Oregon Health & Science University Department of Surgery in conjunction with the Human Investigators Program (Dr. Naik). Data collection for some of this work was supported by the NCI-funded Breast Cancer Surveillance Consortium (BCSC) cooperative agreement (U01CA63740, U01CA86076, U01CA86082, U01CA63736, U01CA70013, U01CA69976, U01CA63731, U01CA70040). The collection of cancer incidence data used in this study was supported in part by several state public health departments and cancer registries throughout the United States. A full description of these sources is available at http://breastscreening.cancer.gov/work/acknowledgement.html.

Suggested citation:

Nelson HD, Tyne K, Naik A, Bougatsos C, Chan B, Nygren P, Humphrey L. Screening for Breast Cancer: Systematic Evidence Review Update for the U.S. Preventive Services Task Force. Evidence Review Update No. 74. AHRQ Publication No. 10-05142-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2009.

The investigators involved have declared no conflicts of interest with objectively conducting this research. The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

1

Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239. www​.ohsu.edu/epc/usptf/index.htm

2

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

Bookshelf ID: NBK36392PMID: 20722173
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