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Screening for Breast Cancer
Evidence Syntheses, No. 74
Investigators: Heidi D Nelson, MD, MPH, Kari Tyne, MD, Arpana Naik, MD, Christina Bougatsos, BS, Benjamin Chan, MS, Peggy Nygren, MA, and Linda Humphrey, MD, MPH.
Author Information and AffiliationsStructured 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
- Acknowledgements
- 1. Introduction
- 2. Methods
- 3. Results
- Key Question 1a. Does screening with mammography (film and digital) or MRI decrease breast cancer mortality among women age 40–49 years and 70 years and older?
- Key Question 1b. Does CBE screening decrease breast cancer mortality? Alone or with mammography?
- Key Question 1c. Does BSE practice decrease breast cancer mortality?
- Key Question 2a. What are the harms associated with screening with mammography (film and digital) and MRI?
- Key Question 2b. What are the harms associated with CBE?
- Key Question 2c. What are the harms associated with BSE?
- 4. Discussion
- References
- Appendix A1. Acronyms and Abbreviations
- Appendix B. Detailed Methods
- Appendix C. Other Results
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.
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- Review Screening for breast cancer: an update for the U.S. Preventive Services Task Force.[Ann Intern Med. 2009]Review Screening for breast cancer: an update for the U.S. Preventive Services Task Force.Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L, U.S. Preventive Services Task Force. Ann Intern Med. 2009 Nov 17; 151(10):727-37, W237-42.
- Review Screening for Breast Cancer: A Systematic Review to Update the 2009 U.S. Preventive Services Task Force Recommendation[ 2016]Review Screening for Breast Cancer: A Systematic Review to Update the 2009 U.S. Preventive Services Task Force RecommendationNelson HD, Cantor A, Humphrey L, Fu R, Pappas M, Daeges M, Griffin J. 2016 Jan
- Screening mammography for women aged 40 to 49 years at average risk for breast cancer: an evidence-based analysis.[Ont Health Technol Assess Ser....]Screening mammography for women aged 40 to 49 years at average risk for breast cancer: an evidence-based analysis.Medical Advisory Secretariat. Ont Health Technol Assess Ser. 2007; 7(1):1-32. Epub 2007 Jan 1.
- Review Screening for Breast Cancer[ 2002]Review Screening for Breast CancerHumphrey L, Chan BKS, Detlefsen S, Helfand M. 2002 Aug
- Review Supplemental Screening for Breast Cancer in Women With Dense Breasts: A Systematic Review for the U.S. Preventive Service Task Force[ 2016]Review Supplemental Screening for Breast Cancer in Women With Dense Breasts: A Systematic Review for the U.S. Preventive Service Task ForceMelnikow J, Fenton JJ, Whitlock EP, Miglioretti DL, Weyrich MS, Thompson JH, Shah K. 2016 Jan
- Screening for Breast CancerScreening for Breast Cancer
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