Screening of Breast Cancer ; USPSTF recommends biennial
breast cancer screening beginning at age 50.
The USPSTF today once more made an
important update to its 2009 U.S. Preventive Services Task Force (USPSTF)
recommendation on screening for breast cancer. The USPSTF recommends biennial
screening mammography for women aged 50 to 74 years. (B recommendation).These
recommendations were published in the on-line issue of Annals of Internal
Medicine on January 12, 2016.
Breast cancer is the second-leading
cause of cancer death among women in the United States.
In 2015, an estimated 232 000 women were diagnosed with the disease and
40,000 women died of it.
USPSTF 2015
40–49 years Screening decision should be an informed,
individual one, after she weighs the potential benefit against the potential
harms.( C recommendations )
50–74 years Mammography every 2 years (B recommendation)
≥75 years Data were not sufficient to establish the benefits
of mammography screening in women aged 75 years or older.( I statement)
Ob/Gyn Updated
Tuesday, January 12, 2016
USPSTF recommends biennial breast cancer screening beginning at age 50.
 |
The USPSTF today once more
made an important update to its 2009 U.S. Preventive Services Task Force
(USPSTF) recommendation on screening for breast cancer. The USPSTF recommends
biennial screening mammography for women aged 50 to 74 years. (B
recommendation).These recommendations were published
in the on-line issue of Annals of Internal Medicine on January 12, 2016.
Breast Cancer Screening Recommendations for
Average-Risk Women
|
Agency
issuing guidelines
|
Recommendations
|
|
USPSTF 2015
|
|
|
40–49
years
|
Screening decision should be an
informed, individual one, after she weighs the potential benefit against the
potential harms.( C recommendations )
|
|
50–74
years
|
Mammography
every 2 years (B recommendation)
|
|
≥75 years
|
Data were not sufficient to
establish the benefits of mammography screening in women aged 75 years or
older.( I statement)
|
|
ACOG
|
|
|
40
years ≥
|
Annual
mammograms beginning at age 40.
|
|
ACS
|
|
|
45
years
|
Annual
screening beginning at age 45
|
|
45-54
years
|
Annual
screening
|
|
55
and older
|
Transition
to biennial screening or have the opportunity to continue screening annually depending
upon personal preference. Women should continue screening mammography as long
as their overall health is good and they have a life expectancy of 10 years
or longer
|
|
NCCN
|
|
|
40
years ≥
|
Clinical
breast exam every 6-12 + annual mammogram beginning at age 40years.
Upper
age limit for screening not established; screening can continue if the woman
is in good health and is expected to live at least 10 more years
|
Breast cancer is the
second-leading cause of cancer death among women in the United States.
In 2015, an estimated
232 000 women were diagnosed with the disease and 40,000 women died of it.
There are approximately 125
new cases of breast cancer and about 22 deaths per 100 000 U.S. women each
year. The mean age at diagnosis has remained unchanged at 64 years since the
late 1970s.
It is most frequently
diagnosed among women aged 55 to 64 years, and the median age of death from
breast cancer is 68 years.
Across all ages, screening
mammography has a sensitivity of approximately 77% to 95% and a specificity of
about 94% to 97%
Dr.The USPSTF did a difficult
job well, considering updated evidence reviews, fuller panoply of potential
harms, and tradeoffs of different screening strategies.”
She also said that “
Although for many years the dogma was that women should have mammograms “once a
year for a lifetime” starting at age 40 years, current evidence shows that the
balance of risks and benefits of screening, particularly among women in their
40s, warrants more nuanced decision making. Potential harms of over diagnosis
and overtreatment of lesions with little progressive potential and harms of
false-positive screening results with unnecessary biopsies and multiple
repeated examinations must be considered”.
The following recommendation
(originally issued in 2009) still stands: Each average-risk woman between the
ages of 40 and 49 years should make her own decision about whether to have a
mammogram, based on her personal balancing of the benefits and harms of
screening (a grade “C” recommendation).
Benefit of Screening
Over a 10-year period,
screening 10 000 women aged 60 to 69 years will result in 21 (95% CI, 11
to 32) fewer breast cancer deaths. The benefit is smaller in younger women:
Screening 10 000 women aged 50 to 59 years will result in 8 (CI, 2 to 17)
fewer breast cancer deaths, and screening 10 000 women aged 40 to 49 years
will result in 3 (CI, 0 to 9) fewer breast cancer deaths.
Harms of screening
The harms of
screening are over diagnosis and over screening that is diagnosis and treatment
of non invasive and invasive cancer that would never have been detected in the
absence of screening. Existing technology does not allow us to segregate with
precision about how much is over diagnosis and how much was real diagnosis.
The best estimates from
randomized, controlled trials (RCTs) evaluating the effect of mammography
screening on breast cancer mortality suggest that 1 in 5 women diagnosed with
breast cancer over approximately 10 years will be over diagnosed.
Based on data from the
National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)
Program: The baseline breast cancer incidence rate was 105 to 111 cases per
100 000 women (depending on whether one considers invasive disease or invasive
plus noninvasive disease together). With the widespread diffusion of
mammography screening in last 30 years, this rate increased to 165 cases of
noninvasive plus invasive disease per 100 000 women in 2011 (an excess of
54 to 60 cases per 100 000 women, or about a 50% increase).
Breast cancer mortality
rates have declined at a slower rate, from 31 to 22 cases (or a reduction of 9
deaths) per 100,000 women over the same time period.
The USPSTF concludes that
while there are harms of mammography, the benefit of screening mammography
outweighs the harms by at least a moderate amount from age 50 to 74 years and
is greatest for women in their 60s. For women in their 40s, the number who
benefit from starting regular screening mammography is smaller and the number
experiencing harm is larger compared with older women.
The current recommendations
by USPSTF are based upon modeling studies conducted in support
by the Cancer Intervention and Surveillance Modeling Network (CISNET). The investigators at CISNET evaluated data from six models that were
grouped according to various screening strategies, various starting age and
frequency. The model with no screening served as reference.
It was seen that strategies
involving screening every 2 years were consistently the most efficient for
women at average risk for breast cancer.
The models showed
that for women in the age group 50 to 74 years, biennial screening would
prevent a median of seven breast-cancer deaths, compared with no screening vs.
if the screening started at age 40, three additional breast cancer deaths would
be prevented, but there would be 1988 more false-positive results and seven
more over diagnoses for every 1000 women screened.
Dissatisfaction with the updated guidelines.
Many of the National
agencies like National Comprehensive Cancer Network (NCCN) and M.D. Anderson
Cancer Center are continue to screen women annually beginning at age 40 till
she is within a decade of the predicted end of her life according to Therese
Bevers, MD, medical director of the Cancer Prevention Center at the M.D.
Anderson Cancer Center in Houston, and chair of NCCN guideline panels on breast
cancer screening and diagnosis and breast cancer risk reduction.
National breast cancer
screening programs in other countries like the United Kingdom, Netherlands, Switzerland,
Poland, Norway, Luxembourg, Germany, Finland, Denmark, and Belgium offer
mammography screening every 2 to 3 years for women aged 50 up to 74 years.
References:
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