Tuesday, April 21, 2015
USPSTF 2015 mammogram recommendations
"We believe that women should be aware of the potential benefits and harms and be guided to make a decision based on their own values and preferences," Dr Bibbins-Domingo told Medscape Medical News.
Summary of the Draft Recommendations on Screening for Breast Cancer
The recommendation that women 50 to 74 years undergo screening mammography every 2 years is given a grade of B in the updated guidelines. This means that the USPSTF recommends this service and that there is high certainty that the net benefit is moderate or that there is moderate certainty that the net benefit is moderate to substantial.
The decision to start screening mammography before the age of 50 should be an individual one. Women 40 to 49 years who place a higher value on the potential benefit than the potential harms can choose to undergo screening every 2 years. This recommendation is given a grade of C, which means that the USPSTF recommends selectively offering or providing this service to individual patients on the basis of professional judgment and patient preference, and that there is at least moderate certainty that the net benefit is small.
The evidence is insufficient to assess the effectiveness of screening mammography in women 75 years and older. The I statement that this recommendation received from the USPSTF indicates that evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
The statement that evidence is insufficient to determine the effectiveness of 3D mammography as a screening tool for breast cancer also received an I.
For women with dense breasts but negative results on mammogram, evidence to determine the effectiveness of additional screening for breast cancer with ultrasound, MRI, 3D mammography, or other methods is insufficient, and also received an I.
The recommendation against clinicians teaching breast self-examination to patients was not updated and is given a grade of D, which means that the USPSTF recommends against the service. However, the USPSTF believes it is important for women to report lumps and other significant changes they note in their breasts to their healthcare provider.
"Our findings suggest that enhanced awareness is probably the reason for the reduction of late-stage cancer, not screening," the investigators noted.
Extrapolating their findings, they added that "after 10 years of biennial mammography screening, for every 2,500 women invited, 6-10 women have been overdiagnosed, 20 women are diagnosed with breast cancer ... and one death from breast cancer has been prevented.
"To put it differently, if 2,500 women are invited to undergo mammography screening over 10 years, 2,470-2,474 women will not be diagnosed with breast cancer, 2,499 will not die of breast cancer, but 6-10 women will be overdiagnosed," they said.
This study was supported by the Research Council of Norway and Frontier Science. Dr. Kalager and her coauthors had no relevant disclosures.
Overdiagnosis in mammography screening: a 45 year journey from shadowy idea to acknowledged reality - BMJ