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Screening For Breast Cancer Using Film Mammography

The document provides recommendations from the US Preventive Services Task Force on screening for breast cancer. It recommends biennial mammography screening for women aged 50-74, and that the decision to screen women aged 40-49 be made on an individual basis. It finds insufficient evidence to recommend for or against screening women aged 75 and older or using methods other than film mammography.

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Aulia Ratu Pritari
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37 views2 pages

Screening For Breast Cancer Using Film Mammography

The document provides recommendations from the US Preventive Services Task Force on screening for breast cancer. It recommends biennial mammography screening for women aged 50-74, and that the decision to screen women aged 40-49 be made on an individual basis. It finds insufficient evidence to recommend for or against screening women aged 75 and older or using methods other than film mammography.

Uploaded by

Aulia Ratu Pritari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SCREENING FOR BREAST CANCER USING FILM MAMMOGRAPHY

CLINICAL SUMMARY OF 2009 U.S. PREVENTIVE SERVICES TASK FORCE RECOMMENDATION*


Population

Recommendation

Women
Aged 4049
Years
Individualize decision to begin biennial
screening according to the patients
context and values.

Grade: C

Risk Assessment

Screening Tests

Timing of Screening

Balance of Harms and


Benefits

Women
Aged 5074
Years

Women
Aged 75
Years

Screen every 2 years.

No recommendation.

Grade: B

Grade: I
(insufficient evidence)

This recommendation applies to women aged 40 years who are not at increased risk
by virtue of a known genetic mutation or history of chest radiation.
Increasing age is the most important risk factor for most women.
Standardization of film mammography has led to improved quality. Refer patients to facilities certified under
the Mammography Quality Standards Act (MQSA), listed at
www.fda.gov/cdrh/mammmography/certified.html.
Evidence indicates that biennial screening is optimal. A biennial schedule preserves most of the benefit of
annual screening and cuts the harms nearly in half. A longer interval may reduce the benefit.
There is convincing evidence that screening with film mammography reduces breast cancer mortality, with a
greater absolute reduction for women aged 50 to 74 years than for younger women.
Harms of screening include psychological harms, additional medical visits, imaging, and biopsies in women
without cancer, inconvenience due to false-positive screening results, harms of unnecessary treatment, and
radiation exposure. Harms seem moderate for each age group.
False-positive results are a greater concern for younger women; treatment of cancer that would not become
clinically apparent during a womans life (overdiagnosis) is an increasing problem as women age.

Rationale for No
Recommendation
(I Statement)
Relevant USPSTF
Recommendations

Among women 75 years or older,


evidence of benefit is lacking.
USPSTF recommendations on screening for genetic susceptibility for breast cancer and chemoprevention of breast cancer are available at
www.preventiveservices.ahrq.gov.

For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement, and supporting documents, please go to
http://www.preventiveservices.ahrq.gov.
* The Department of Health and Human Services, in implementing the Affordable Care Act under the standard it sets out in revised Section 2713(a)(5) of the Public Health Service Act,
utilizes the 2002 recommendation on breast cancer screening of the U.S. Preventive Services Task Force.

SCREENING FOR BREAST CANCER USING METHODS OTHER THAN FILM MAMMOGRAPHY
CLINICAL SUMMARY OF 2009 U.S. PREVENTIVE SERVICES TASK FORCE RECOMMENDATION*
Women Aged 40 Years

Population
Screening
Method

Digital Mammography

Recommendation

Rationale for No
Recommendation
or Negative
Recommendation

Magnetic Resonance
Imaging (MRI)

Clinical Breast
Examination
(CBE)

Grade: I (insufficient evidence)

Evidence is lacking for benefits of digital mammography and


MRI of the breast as substitutes for film mammography.

Breast
Self-Examination
(BSE)
Grade: D

Evidence of CBEs additional


benefit, beyond
mammography, is inadequate.

Adequate evidence
suggests that BSE does
not reduce breast cancer
mortality.

Considerations for Practice


Potential
Preventable
Burden

For younger women and women


with dense breast tissue, overall
detection is somewhat better with
digital mammography.

Potential Harms

It is not certain whether


overdiagnosis occurs more often
with digital than with film
mammography.

Contrast-enhanced MRI has been


shown to detect more cases of cancer
in very high-risk populations than does
mammography.
Contrast-enhanced MRI requires
injection of contrast material.
MRI yields many more
false-positive results and
potentially more overdiagnosis
than mammography.

Indirect evidence suggests that when


CBE is the only test available, it may
detect a significant proportion of
cancer cases.
Harms of CBE include false-positive
results, which lead to anxiety,
unnecessary visits, imaging, and
biopsies.

Harms of BSE include the


same potential harms as
for CBE and may be larger
in magnitude.

Costs of BSE are primarily


opportunity costs to
clinicians.
The number of cliniciams
Current Practice
Some clinical practices are now
MRI is not currently used to screen
No standard approach or reporting
who teach BSE to patients
switching to digital equipment.
women of average risk.
standards are in place.
is unknown; it is likely that
few clinicians teach BSE
to all women.
For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement, and supporting documents, please go to
http://www.preventiveservices.ahrq.gov.
* The Department of Health and Human Services, in implementing the Affordable Care Act under the standard it sets out in revised Section 2713(a)(5) of the Public Health Service Act,
utilizes the 2002 recommendation on breast cancer screening of the U.S. Preventive Services Task Force.
Costs

Digital mammography is more


expensive than film.

MRI is much more expensive than


mammography.

Costs of CBE are primarily opportunity


costs to clinicians.

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