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Screening for Breast Cancer: An Update for the U.S. Preventive Services Task Force
- Heidi D. Nelson, MD, MPH;
- Kari Tyne, MD;
- Arpana Naik, MD;
- Christina Bougatsos, BS;
- Benjamin K. Chan, MS; and
- Linda Humphrey, MD, MPH
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.
Article and Author Information
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Disclaimer: 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 the 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.
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Acknowledgment: The authors acknowledge the contributions of AHRQ Project Officer Mary Barton, MD, MPP, and USPSTF leads Russ Harris, MD, MPH; Allen Dietrich, MD; Carol Loveland-Cherry, PhD, RN; Judith Ockene, PhD, Med; and Bernadette Melnyk, PhD, RN, CPNP/NPP. The authors thank the BCSC investigators, participating mammography facilities, and radiologists for the data used in this project. A list of the BCSC investigators and procedures for requesting BCSC data for research purposes are available at http://breastscreening.cancer.gov/. They also thank Patricia A. Carney, PhD; Steve Taplin, MD; Sebastien Haneuse, PhD; and Rod Walker, MS; for direct work with investigators, along with Andrew Hamilton, MLS, MS, for literature searches, and Sarah Baird, MS, for managing the bibliography at the Oregon Evidence-based Practice Center at the Oregon Health & Science University.
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Grant Support: By the Oregon Evidence-based Practice Center under contract to the AHRQ (contract 290-02-0024); 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 National Cancer Institute–funded 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.
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Potential Conflicts of Interest: None disclosed.
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Requests for Single Reprints: Heidi D. Nelson, MD, MPH, Oregon Evidence-based Practice Center, Oregon Health & Science University, Mailcode BICC, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098; e-mail, nelsonh{at}ohsu.edu.
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Current Author Addresses: Drs. Nelson and Humphrey, Ms. Bougatsos, and Mr. Chan: Oregon Evidence-based Practice Center, Oregon Health & Science University, Mailcode BICC, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098.
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Dr. Tyne: 1112 Woodland Trail, Northfield, MN 55057
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Dr. Naik: The Breast Center, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098.
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Author Contributions: Conception and design: H.D. Nelson, A. Naik, C. Bougatsos, B.K. Chan, L. Humphrey.
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Analysis and interpretation of the data: H.D. Nelson, K. Tyne, A. Naik, B.K. Chan, L. Humphrey.
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Drafting of the article: H.D. Nelson, K. Tyne, A. Naik, C. Bougatsos, B.K. Chan.
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Critical revision of the article for important intellectual content: H.D. Nelson, A. Naik, B.K. Chan, L. Humphrey.
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Final approval of the article: H.D. Nelson, A. Naik, B.K. Chan, L. Humphrey.
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Provision of study materials or patients: H.D. Nelson, A. Naik, B.K. Chan.
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Obtaining of funding: H.D. Nelson, A. Naik, B.K. Chan.
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Administrative, technical, or logistic support: H.D. Nelson, A. Naik, C. Bougatsos, B.K. Chan.
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Collection and assembly of data: H.D. Nelson, A. Naik, C. Bougatsos, B.K. Chan, L. Humphrey.
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