Abstract
Purpose of Review
The purpose of this review is to examine the most recent data and guidelines regarding screening for breast cancer in average risk women.
Recent Findings
The differing recommendations for screening reflect differences in value judgements between the benefits (decreased cancer-related death and morbidity) and the harms (potential for overdiagnosis, false positives, false negatives, anxiety, and cost of care) of breast cancer screening.
Summary
There are multiple organizations with recommendations for breast cancer screening in women at average risk. All organizations recommend mammography to screen for breast cancer but differ in the age at which to initiate mammograms, screening interval, and the age at which to stop screening. The final decision regarding breast cancer screening should be individualized based on the patient’s needs and values and include shared decision-making.
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References
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Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69:7–34. https://doi.org/10.3322/caac.21551 Epub 2019 Jan 8.
National Cancer Institute. Surveillance, Epidemiology and End Results Program. Cancer stat facts: female breast cancer. Bethesda, MD: National Cancer Institute. Accessed at https://seer.cancer.gov/statfacts/html/breast.html.
• American Academy of Family Physicians. Clinical preventive service recommendation: breast cancer. Accessed at www.aafp.org/patient-care/clinical-recommendations/all/breast-cancer.html. This is a summary of the American Academy of Family Physicians Society Guidelines regarding breast cancer screening.
• Oeffinger KC, ETH F, Etzioni R, et al. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA. 2015;314:1599–614. https://doi.org/10.1001/jama.2015.12783. This is a summary of the American Cancer Society Guidelines regarding breast cancer screening.
• American College of Obstetricians-Gynecologists. Practice bulletin no. 179: breast cancer risk assessment and screening in average risk women. Obstet-Gynecol. 2017;130:e1–16. https://doi.org/10.1097/AOG.0000000000002158. This is a summary of the American Collage of Obstetricians-Gynecologists Society Guidelines regarding breast cancer screening.
• Wilt TJ, Harris RP, Qaseem A, et al. High value task force of the American College of Physicians. Screening for Cancer: advice for high value care from the American College of Physicians. Ann Intern Med. 2015;2015(162):718. https://doi.org/10.7326/M14-2326. This is a summary of the American College of Physicians Society Guidelines regarding breast cancer screening.
• Qaseem A, Lin JS, Mustafa RA, et al. Screening for breast cancer in average risk women: a guidance statement from the American College of Physicians. Ann Intern Med. 2019;170(8):547–60. https://doi.org/10.7326/M18-2147. This is a guidance statement from the ACP regarding breast cancer screening.
• Maineiro MN, Lourenco A, Mahoney MC, et al. ACR appropriateness criteria breast cancer screening. J Am Coll Radiol. 2013;10(1):11–4. https://doi.org/10.1016/j.jacr.2012.09.036. This is a summary of the American College of Radiology Society Guidelines regarding breast cancer screening.
• NCCN. NCCN Clinical Practice Guidelines in oncology. Breast cancer screening and diagnosis. Fort Washington, PA 2018. Accessed at https://nccn.org . This is a summary of the NCCN Society Guidelines regarding breast cancer screening.
Siu A. US preventative services task force. Screening for breast cancer: US preventative services task force recommendation statement. Ann Intern Med. 2016;164:279–96. https://doi.org/10.7326/M15-2886 Epub 2016 Jan 12.
Marmot MG, Altman DG, Cameron DA, et al. The benefits and harms of breast cancer screening: an independent review. Br J Cancer. 2013;108:2205–40. https://doi.org/10.1038/bjc.2013.177 Epub 2013 Jun 6.
Tabar L, Vitak B, Chen TH, et al. Swedish two county trial: impact of mammographic screening on breast cancer mortality during 3 decades. Radiology. 2011;260(3):658–63. https://doi.org/10.1148/radiol.11110469 Epub 2011 Jun 28.
Myers ER, Moorman P, Gierisch JM, Havrilesky LJ, Grimm LJ, Ghate S, et al. Benefits and harms of breast cancer screening: a systematic review. JAMA. 2015 Oct;314(15):1615–34. https://doi.org/10.1001/jama.2015.13183.
Guth U, Huang DJ, Huber M, et al. Tumor size and detection in breast cancer: self-examination and clinical breast examination are at their limit. Cancer Detect Prev. 2008;32:224–8. https://doi.org/10.1016/j.cdp.2008.04.002 Epub 2008 Sep 13.
Miller AB, Baines CJ, To T, Wall C. Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50 to 59 years. CMAJ. 1992;147:1477–88.
Miller AB, To T, Baines CJ, Wall C. Canadian National Breast Screening Study-2: 13 year results of a randomized trial in women aged 50-59 years. J Natl Cancer Inst. 2000;92:1490–9.
Ghosh K, Wahner-Roedler D, Brandt K. Screening mammography starting at age 40: still relevant. Cleve Clin J Med. May 2015;82(5):276–9. https://doi.org/10.3949/ccjm.82a.14155.
Feig SA. Screening mammography benefit controversies: sorting the evidence. Radiol Clin North Am. 2014;52(3):455–80. https://doi.org/10.1016/j.rcl.2014.02.009.
Smart CR, Hendrick RE, Rutledge JH 3rd, Smith RA. Benefit of mammography screening in women ages 40-49 years. Current evidence from randomized controlled trials. Cancer. 1995;75:1619–26.
• US Preventive Services Task Force. Screening for breast cancer: US preventive service task force recommendation statement. Ann Inter Med. 2009;151(10):716–26. https://doi.org/10.7326/0003-4819-151-10-200911170-00008. This is the USPSTF task force recommendations regarding regarding breast cancer screening. This includes a summary of the metanalysis leading to the recommendations.
Feig SA. Number needed to screen. Appropriate use of this new basis for screening mammography guidelines. AJR Am J Roentgenol. 2012;198(5):723–8. https://doi.org/10.2214/AJR.11.8320.
Allen SS, Pruthi S. The mammography controversy: when should you screen? JFP. 2011;60(9):524–31.
Carter SM, Barratt A. What is overdiagnosis and why should it be take it seriously in cancer screening? Public Health Res Pract. 2017;27(3):e2731722. https://doi.org/10.17061/phrp2731722.
Monticciolo DL, Helvie MA, Hendrick RE. Current issues in the overdiagnosis and overtreatment of breast cancer. AJR. 2018;210:285–91. https://doi.org/10.2214/AJR.17.18629 Epub 2017 Nov 1.
Esserman LJ, Thompson IM, Reid B, Nelson P, Ransohoff DF, Welch HG, et al. Addressing overdiagnosis and overtreatment in cancer: a prescription for change. Lancet Oncol. 2014;15(6):e234–42. https://doi.org/10.1016/S1470-2045(13)70598-9.
Stout NK, Schechter CB, Kerlikowske K, et al. Benefits, harms and costs for breast cancer screening after US implementation of digital mammography. J Natl Cancer Inst. 2014;106(6):dju092. https://doi.org/10.1093/jnci/dju092 Print 2014 Jun.
Nelson HD, Pappas M, Cantor A, Griffin J, Daeges M, Humphrey L. Harms of breast cancer screening: systematic review to update the 2009 US preventive services task force recommendations. Ann Int Med. 2016;164(4):256–67. https://doi.org/10.7326/M15-0970 Epub 2016 Jan 12.
Nelson HD, O’Meara ES, Karlikowske K, et al. Factors associated with rates of false-positive and false negative results from digital mammography screening: an analysis of registry data. Ann Int Med. 2016;164(4):226–35. https://doi.org/10.7326/M15-0971 Epub 2016 Jan 12.
Rosenberg RD, Yankaskas BC, Abraham LA, Sickles EA, Lehman CD, Geller BM, et al. Performance benchmarks for screening mammography. Radiology. 2006;241:55–66.
Friedewald SM, Rafferty EA, Rose SL, Durand MA, Plecha DM, Greenberg JS, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 2014;311(24):2499–507. https://doi.org/10.1001/jama.2014.6095.
Rafferty EA, Durand MA, Conant EF, Copit DS, Friedewald SM, Plecha DM, et al. Breast cancer screening using tomosynthesis and digital mammography in dense and nondense breasts. JAMA. 2016;315(16):1784–6. https://doi.org/10.1001/jama.2016.1708.
Hruska CB. Molecular breast imaging for screening in dense breasts: state of the art and future directions. AJR Am J Roentgenol. 2017;208(2):275–83. https://doi.org/10.2214/AJR.16.17131 Epub 2016 Oct 20.
Burkett BJ, Hanemann CW. A review of supplemental screening ultrasound for breast cancer: certain populations of women with dense breast tissue may benefit. Acad Radiol. 2016;23(12):1604–9. https://doi.org/10.1016/j.acra.2016.05.017 Epub 2016 Jun 30.
Berg WA, Zhang Z, Lehrer D, Jong RA, Pisano ED, Barr RG, et al. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA. 2012;307(13):1394–404. https://doi.org/10.1001/jama.2012.388.
Melnikow J, Fenton JJ, Whitlock EP, Miglioretti DL, Weyrich MS, Thompson JH, et al. Supplemental screening for breast cancer in women with dense breasts: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2016;164(4):268–78. https://doi.org/10.7326/M15-1789 Epub 2016 Jan 12.
• Saslow D, Boetes C, Burke W, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007;57:75–89. This is a summary of the ACS recommendations regarding MRI for supplemental screening for breast cancer.
Covington M, Pizzitola VJ, Lorans R, et al. The future of contrast-enhanced mammography. AJR Am J Roent. 2018;210(2):292–300. https://doi.org/10.2214/AJR.17.18749 Epub 2017 Oct 24.
Kuhl CK, Schrading S, Strobel K, Schild HH, Hilgers RD, Bieling HB. Abbreviated breast magnetic resonance imaging (MRI): first post-contrast subtracted images and maximum-intensity projection—a novel approach to breast cancer screening with MRI. J Clin Oncol. 2014;32:2304–10. https://doi.org/10.1200/JCO.2013.52.5386 Epub 2014 Jun 23.
Panigrahi B, Mullen L, Falomo E, Panigrahi B, Harvey S. An abbreviated protocol for high-risk screening breast magnetic resonance imaging: impact on performance metrics and BI-RADS assessment. Acad Radiol. 2017;24(9):1132–8. https://doi.org/10.1016/j.acra.2017.03.014 Epub 2017 May 11.
Helvie MA, Bevers TB. Screening mammography for average risk women: the controversy and NCCN’s position. JNCCN. 2018;16(11):1398–404. https://doi.org/10.6004/jnccn.2018.7081.
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Christina Dilaveri, Christine Klassen, Robert Fazzio, and Karthik Ghosh declare no conflicts of interest relevant to this manuscript.
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Dilaveri, C., Klassen, C., Fazzio, R. et al. Breast Cancer Screening for Women at Average Risk. Curr Breast Cancer Rep 11, 123–128 (2019). https://doi.org/10.1007/s12609-019-00324-4
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DOI: https://doi.org/10.1007/s12609-019-00324-4