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CLINICAL GUIDELINES

Breast Cancer Screening: A Summary of the Evidence for the U.S. Preventive Services Task Force

right arrow Linda L. Humphrey, MD, MPH; Mark Helfand, MD, MS; Benjamin K.S. Chan, MS; and Steven H. Woolf, MD, MPH

3 September 2002 | Volume 137 Issue 5 Part 1 | Pages 347-360

Purpose: To synthesize new data on breast cancer screening for the U.S. Preventive Services Task Force.

Data Sources: MEDLINE; the Cochrane Controlled Trials Registry; and reference lists of reviews, editorials, and original studies.

Study Selection: Eight randomized, controlled trials of mammography and 2 trials evaluating breast self-examination were included. One hundred fifty-four publications of the results of these trials, as well as selected articles about the test characteristics and harms associated with screening, were examined.

Data Extraction: Predefined criteria were used to assess the quality of each study. Meta-analyses using a Bayesian random-effects model were conducted to provide summary relative risk estimates and credible intervals (CrIs) for the effectiveness of screening with mammography in reducing death from breast cancer.

Data Synthesis: For studies of fair quality or better, the summary relative risk was 0.84 (95% CrI, 0.77 to 0.91) and the number needed to screen to prevent one death from breast cancer after approximately 14 years of observation was 1224 (CrI, 665 to 2564). Among women younger than 50 years of age, the summary relative risk associated with mammography was 0.85 (CrI, 0.73 to 0.99) and the number needed to screen to prevent one death from breast cancer after 14 years of observation was 1792 (CrI, 764 to 10 540). For clinical breast examination and breast self-examination, evidence from randomized trials is inconclusive.

Conclusions: In the randomized, controlled trials, mammography reduced breast cancer mortality rates among women 40 to 74 years of age. Greater absolute risk reduction was seen among older women. Because these results incorporate several rounds of screening, the actual number of mammograms needed to prevent one death from breast cancer is higher. In addition, each screening has associated risks and costs.

Author and Article Information
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From Oregon Health & Science University and Portland Veterans Affairs Medical Center, Portland, Oregon; and Medical College of Virginia, Virginia Commonwealth University, Fairfax, Virginia.

Note: This manuscript is based on a longer systematic evidence review that was reviewed by outside experts and representatives of professional societies. A complete list of peer reviewers is available online at http://www.ahrq.gov/clinic/uspstfix.htm.

Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Acknowledgments: The authors thank Stephanie Detlefsen, MD, for her contribution to this evidence review and David Atkins, MD, MPH, from the Agency for Healthcare Research and Quality and members of the U.S. Preventive Services Task Force for their comments on earlier versions of this review. They also thank Kathryn Pyle Krages, AMLS, MA, Susan Carson, MPH, Patty Davies, MS, Susan Wingenfeld, and Jim Wallace for their help with preparation of the manuscript and the full systematic evidence review.

Grant Support: This study was conducted by the Oregon Health & Science University Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (contract no. 290-97-0018, task order no. 2), Rockville, Maryland.

Requests for Single Reprints: Reprints are available from the Agency for Healthcare Research and Quality Web site (http://www.preventiveservices.ahrq.gov) or the Agency for Healthcare Research and Quality Publications Clearinghouse (800-358-9295).

Current Author Addresses: Drs. Humphrey and Helfand and Mr. Chan: Oregon Health & Science University, Mailcode BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098.

Dr. Woolf: Virginia Commonwealth University, 3712 Charles Stewart Drive, Fairfax, VA 22033.

 

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ANN INTERN MEDHome page
H. D. Nelson, L. H. Huffman, R. Fu, and E. L. Harris
Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility: Systematic Evidence Review for the U.S. Preventive Services Task Force
Ann Intern Med, September 6, 2005; 143(5): 362 - 379.
[Abstract] [Full Text] [PDF]


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BMJHome page
P. C Gotzsche and K. J Jorgensen
Model of outcomes of screening mammography: Information needs to support informed choices
BMJ, August 6, 2005; 331(7512): 350 - 351.
[Full Text]


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JNCI J Natl Cancer InstHome page
R. Harris
Effectiveness: The Next Question for Breast Cancer Screening
J Natl Cancer Inst, July 20, 2005; 97(14): 1021 - 1023.
[Full Text] [PDF]


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Arch Intern MedHome page
L. Nekhlyudov, R. Li, and S. W. Fletcher
Information and Involvement Preferences of Women in Their 40s Before Their First Screening Mammogram
Arch Intern Med, June 27, 2005; 165(12): 1370 - 1374.
[Abstract] [Full Text] [PDF]


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Endocr Relat CancerHome page
C J Fabian, B F Kimler, M S Mayo, and S A Khan
Breast-tissue sampling for risk assessment and prevention
Endocr. Relat. Cancer, June 1, 2005; 12(2): 185 - 213.
[Abstract] [Full Text] [PDF]


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Am. J. Roentgenol.Home page
J. W. T. Leung
Screening Mammography Reduces Morbidity of Breast Cancer Treatment
Am. J. Roentgenol., May 1, 2005; 184(5): 1508 - 1509.
[Abstract] [Full Text] [PDF]


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JAMAHome page
J. G. Elmore, K. Armstrong, C. D. Lehman, and S. W. Fletcher
Screening for Breast Cancer
JAMA, March 9, 2005; 293(10): 1245 - 1256.
[Abstract] [Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
S. Taplin, M. Ulcickas-Yood, A. Geiger, L. Ichikawa, K. Bischoff, and W. Barlow
RESPONSE: Re: Reason for Late-Stage Breast Cancer: Absence of Screening or Detection, or Breakdown in Follow-Up?
J Natl Cancer Inst, March 2, 2005; 97(5): 400 - 401.
[Full Text] [PDF]


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Am. J. Public HealthHome page
S. E. Jelinski, C. J. Maxwell, J. Onysko, and C. M. Bancej
The Influence of Breast Self-Examination on Subsequent Mammography Participation
Am J Public Health, March 1, 2005; 95(3): 506 - 511.
[Abstract] [Full Text] [PDF]


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Am. J. Roentgenol.Home page
R. J. Barth Jr., G. R. Gibson, P. A. Carney, L. A. Mott, R. D. Becher, and S. P. Poplack
Detection of Breast Cancer on Screening Mammography Allows Patients to Be Treated with Less-Toxic Therapy
Am. J. Roentgenol., January 1, 2005; 184(1): 324 - 329.
[Abstract] [Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
E. White, D. L. Miglioretti, B. C. Yankaskas, B. M. Geller, R. D. Rosenberg, K. Kerlikowske, L. Saba, P. M. Vacek, P. A. Carney, D. S. M. Buist, et al.
Biennial Versus Annual Mammography and the Risk of Late-Stage Breast Cancer
J Natl Cancer Inst, December 15, 2004; 96(24): 1832 - 1839.
[Abstract] [Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
W. E. Barlow, C. Chi, P. A. Carney, S. H. Taplin, C. D'Orsi, G. Cutter, R. E. Hendrick, and J. G. Elmore
Accuracy of Screening Mammography Interpretation by Characteristics of Radiologists
J Natl Cancer Inst, December 15, 2004; 96(24): 1840 - 1850.
[Abstract] [Full Text] [PDF]


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CA Cancer J ClinHome page
D. Saslow, J. Hannan, J. Osuch, M. H. Alciati, C. Baines, M. Barton, J. K. Bobo, C. Coleman, M. Dolan, G. Gaumer, et al.
Clinical Breast Examination: Practical Recommendations for Optimizing Performance and Reporting
CA Cancer J Clin, November 1, 2004; 54(6): 327 - 344.
[Abstract] [Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
C. J. Fabian, B. F. Kimler, and M. S. Mayo
Ductal Lavage for Early Detection--What Doesn't Come Out in the Wash
J Natl Cancer Inst, October 20, 2004; 96(20): 1488 - 1489.
[Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
S. H. Taplin, L. Ichikawa, M. U. Yood, M. M. Manos, A. M. Geiger, S. Weinmann, J. Gilbert, J. Mouchawar, W. A. Leyden, R. Altaras, et al.
Reason for Late-Stage Breast Cancer: Absence of Screening or Detection, or Breakdown in Follow-up?
J Natl Cancer Inst, October 20, 2004; 96(20): 1518 - 1527.
[Abstract] [Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
P. C. Gotzsche
Re: Trends in the Treatment of Ductal Carcinoma In Situ of the Breast
J Natl Cancer Inst, August 18, 2004; 96(16): 1257 - 1257.
[Full Text] [PDF]


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Med Decis MakingHome page
E. Chamot, A. Charvet, and T. V. Perneger
Women's Preferences for Doctor's Involvement in Decisions about Mammography Screening
Med Decis Making, August 1, 2004; 24(4): 379 - 385.
[Abstract] [PDF]


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BMJHome page
J. J Fenton and J. G Elmore
Balancing mammography's benefits and harms
BMJ, June 12, 2004; 328(7453): E301 - E302.
[Full Text] [PDF]


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Mayo Clin Proc.Home page
B. A. Mincey and E. A. Perez
Advances in Screening, Diagnosis, and Treatment of Breast Cancer
Mayo Clin. Proc., June 1, 2004; 79(6): 810 - 816.
[Abstract] [PDF]


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ANN INTERN MEDHome page
J. Mandelblatt, S. Saha, and M. Helfand
Cost-Effectiveness of Mammography for Older Women
Ann Intern Med, May 18, 2004; 140(10): 844 - 844.
[Full Text] [PDF]


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ANN INTERN MEDHome page
L. C. Walter, K. Lindquist, and K. E. Covinsky
Relationship between Health Status and Use of Screening Mammography and Papanicolaou Smears among Women Older Than 70 Years of Age
Ann Intern Med, May 4, 2004; 140(9): 681 - 688.
[Abstract] [Full Text] [PDF]


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Cancer Epidemiol. Biomarkers Prev.Home page
K. R. Yabroff, N. Breen, S. W. Vernon, H. I. Meissner, A. N. Freedman, and R. Ballard-Barbash
What Factors Are Associated with Diagnostic Follow-Up after Abnormal Mammograms? Findings from a U.S. National Survey
Cancer Epidemiol. Biomarkers Prev., May 1, 2004; 13(5): 723 - 732.
[Abstract] [Full Text] [PDF]


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RadiologyHome page
L. E. M. Duijm, J. H. Groenewoud, J. H. C. L. Hendriks, and H. J. de Koning
Independent Double Reading of Screening Mammograms in the Netherlands: Effect of Arbitration Following Reader Disagreements
Radiology, May 1, 2004; 231(2): 564 - 570.
[Abstract] [Full Text] [PDF]


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ANN INTERN MEDHome page
M. Carnes and J. E. Mahoney
Update in Women's Health
Ann Intern Med, April 6, 2004; 140(7): 538 - 544.
[Full Text] [PDF]


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The OncologistHome page
M. Koshy, N. Esiashvilli, J. C. Landry, C. R. Thomas Jr., and R. H. Matthews
Multiple Management Modalities in Esophageal Cancer: Epidemiology, Presentation and Progression, Work-up, and Surgical Approaches
Oncologist, April 1, 2004; 9(2): 137 - 146.
[Abstract] [Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
D. Gur, J. H. Sumkin, H. E. Rockette, M. Ganott, C. Hakim, L. Hardesty, W. R. Poller, R. Shah, and L. Wallace
Changes in Breast Cancer Detection and Mammography Recall Rates After the Introduction of a Computer-Aided Detection System
J Natl Cancer Inst, February 4, 2004; 96(3): 185 - 190.
[Abstract] [Full Text] [PDF]


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Int J EpidemiolHome page
D. A Freedman, D. B Petitti, and J. M Robins
On the efficacy of screening for breast cancer
Int. J. Epidemiol., February 1, 2004; 33(1): 43 - 55.
[Abstract] [Full Text] [PDF]


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Int J EpidemiolHome page
M. Baum
Commentary: False premises, false promises and false positives--the case against mammographic screening for breast cancer
Int. J. Epidemiol., February 1, 2004; 33(1): 66 - 67.
[Full Text] [PDF]


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Int J EpidemiolHome page
D. A Freedman, D. B Petitti, and J. M Robins
Rejoinder
Int. J. Epidemiol., February 1, 2004; 33(1): 69 - 73.
[Full Text] [PDF]




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