Breast cancer screening in average-risk women: towards personalized screening

Breast cancer screening is widely recognized for reducing breast cancer mortality. The objective in screening is to diagnose asymptomatic early stage disease, thereby improving treatment efficacy. Screening recommendations have been widely debated over the past years and controversies remain regarding the optimal screening frequency, age to start screening, and age to end screening. While there are no new trials, follow-up information of randomized controlled trials has become available. The American College of Physicians recently issued a new guidance statement on screening for breast cancer in average-risk women, with similar recommendations to the U.S. Preventive Services Task Force and to European guidelines. However, these guidelines differ from those ofother American specialty societies. The variations reflect differences in the organizations’ values, the metrics used to evaluate screening results, and the differences in healthcare organization (individualized or state-organized healthcare). False-positive rates and overdiagnosis of biologically insignificant cancer are perceived as the most important potential harms associated with mammographic screening; however, there is limited evidence on their actual consequences. Most specialty societies agree that physicians should offer mammographic screening at age 40 years for average-risk women and discuss its benefits and potential harms to achieve a personalized screening strategy through a shared decision-making process.

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Abbreviated Magnetic Resonance Imaging (MRI) for Breast Cancer Screening: Rationale, Concept, and Transfer to Clinical Practice

Annual Review of Medicine ◽

10.1146/annurev-med-121417-100403 ◽

2019 ◽

Vol 70 (1) ◽

pp. 501-519 ◽

Cited By ~ 16

Author(s):

Christiane K. Kuhl

Keyword(s):

Breast Cancer ◽

Magnetic Resonance Imaging ◽

Cancer Screening ◽

Magnetic Resonance ◽

Breast Cancer Screening ◽

Breast Cancer Mortality ◽

Mammographic Screening ◽

Resonance Imaging ◽

Magnetic Resonance Imaging Mri ◽

Sensitivity Profile

Given the increasing understanding of cancer as a heterogeneous group of diseases, detection methods should offer a sensitivity profile that ensures perfect sensitivity for biologically important cancers while screening out self-limiting pseudocancers. However, mammographic screening is biased toward detection of ductal carcinoma in situ and slowly growing cancers—and thus frequently fails to detect biologically aggressive cancers. This explains the persistently high rates of interval cancers and high rates of breast cancer mortality observed in spite of decades of mammographic screening. Magnetic resonance imaging (MRI), in contrast, has a sensitivity profile that matches clinical needs. Conventional MRI is not suitable for population-wide screening due to high cost, limited tolerability, and lack of availability. We introduced abbreviated MRI in 2014. Abbreviated MRI will change the way MRI is used in clinical medicine. This article describes the rationale to use MRI in general, and abbreviated MRI in particular, for breast cancer screening.

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Repeated mammographic screening reduces breast cancer mortality along the continuum of age

Journal of Medical Screening ◽

10.1136/jms.9.4.163 ◽

2002 ◽

Vol 9 (4) ◽

pp. 163-167 ◽

Cited By ~ 20

Author(s):

M.J.M. Broeders ◽

A.L.M. Verbeek ◽

H. Straatman ◽

P.G.M. Peer ◽

P.C.M. Pasker-de Jong ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Cancer Mortality ◽

Screening Programme ◽

Breast Cancer Mortality ◽

Mammographic Screening ◽

Protective Effects ◽

Age Group ◽

The Continuum

OBJECTIVE: The optimal age boundaries for breast cancer screening are still under debate. A case-referent design was used to describe the effect of mammographic screening on breast cancer mortality along the continuum of age, based on a 20 year follow up period. SETTING: The population based breast cancer screening programme in Nijmegen, The Netherlands, which has biennially invited women over 35 years since 1975. METHODS: Cases, defined as women who died from primary breast cancer between 1987 and 1997, were selected from the group of women who received at least one invitation to the screening programme. For 157 cases, 785 women from the same group were selected as referents. Information on the index screening (the screening examination preceding diagnosis of the case) was collected for both cases and referents. The risk of dying from breast cancer was calculated per 10 year moving age group for women who had attended the index screening versus those who had not. RESULTS: The youngest 10 year age group showing an effect in our study were women aged 45–54 at their index screening. Breast cancer mortality for women in this group who attended the index screening was 32% lower, although not significant, than for women who did not (odds ratio (OR) 0.68, 95% confidence interval (95% CI) 0.33 to 1.41). This reduction in risk was not explained solely by an effect in women over 50 because the OR in women aged 45–49 was 0.56 (95% CI 0.20 to 1.61). Reductions in mortality became smaller with increasing age. Nevertheless, for women over 60 at index screening, participation in screening over a maximum 4 year period before diagnosis of the case yielded protective effects at least up to an age around 80. CONCLUSIONS: Although our results are based on a relatively small number of cases, they suggest that even in a programme with a 2 year screening interval there may be a benefit of starting screening around age 45. Also older women who participate at least once every 4 years still have much to gain from screening.

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A method for evaluating breast cancer screening strategies using screen-preventable loss of life

PLoS ONE ◽

10.1371/journal.pone.0243113 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243113

Author(s):

Kimbroe J. Carter ◽

Frank Castro ◽

Roy N. Morcos

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Task Force ◽

Mammographic Screening ◽

American Cancer Society ◽

Cancer Society ◽

Loss Of Life ◽

Screening Guidelines ◽

Clinical Awareness

The objective of this study is to describe how screen-preventable loss of life (screen-PLL) can be used to analyze the distribution of life savings with mammographic screening. The determination of screen-PLL with mammography is possible using a natural history model of breast cancer that simulates clinical and pathologic events of this disease. This investigation uses a Monte Carlo Markov model with data from the Surveillance, Epidemiology, and End Results Program; American Cancer Society; and National Vital Statistics System. Populations of one million women per screening strategy are simulated over a lifetime with mammographic screening based on current guidelines of the American Cancer Society (ACS), United States Preventive Services Task Force (USPSTF), triennial screening from age 50–70, and no screening. Screen-PLL curves are generated and show guideline performance over a lifetime. The screen-PLL curve with no screening is determined by tumor discovery through clinical awareness and has the highest values of screen-PLL. The ACS and USPSTF strategies demonstrate screen-PLL curves favoring the elderly. The curve for triennial screening is more uniform than the ACS or USPSTF curves but could be improved by adding screen(s) at either end of the 50–70 age range. This study introduces the use of screen-PLL as a tool to improve the understanding of screening guidelines and allowing a more balanced allocation of life savings across an aging population. The method presented shows how screen-PLL can be used to analyze and potentially improve breast cancer screening guidelines.

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Breast Cancer Screening: Evidence and Recommendations

10.1093/med/9780190270261.003.0002 ◽

2018 ◽

Author(s):

Karen J. Wernli ◽

Erin J. Bowles

Keyword(s):

Breast Cancer ◽

United States ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Mammography Screening ◽

Randomized Clinical Trials ◽

Task Force ◽

Breast Cancer Mortality ◽

The United States ◽

High Risk Women

Breast cancer screening in the United States was first recommended to women in 1976. Over the past decade, mammography screening has changed from film screen mammography to primarily digital mammography, which, as of 2016, accounts for over 97% of all mammograms performed in the United States. Several systematic reviews, which have included results from up to 9 randomized clinical trials from the United States, Europe, and Canada, have demonstrated a reduced risk of breast cancer mortality associated with breast cancer screening. Potential harms from breast cancer screening include false-positive mammograms (which may lead to unnecessary additional imaging and benign breast biopsies), overdiagnosis, and radiation exposure. This chapter summarizes evidence from randomized controlled trials for mortality benefit; current society and task force recommendations for mammography screening; evaluation of the evidence; risk–benefit analysis; and supplemental screening in high-risk women.

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Awareness, Attitude and Practices Regarding Breast Cancer Screening among Community Women

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20210823 ◽

2021 ◽

Vol 11 (8) ◽

pp. 158-166

Author(s):

Ratna Kumari Maharjan ◽

Bimala Panthee ◽

Shanti Awale

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Early Detection ◽

Breast Cancer Screening ◽

Early Stage ◽

Breast Cancer Mortality ◽

Sampling Technique ◽

Good Knowledge ◽

Cross Sectional ◽

Common Cancer

Background: Breast cancer is the most common cancer among women worldwide. In Nepal, it is the second most common cancer. Early detection of breast cancer serves a leading role in the reduction of breast cancer mortality. The aim of this study was to assess the awareness, attitude and practices regarding breast cancer screening among community women Method: A cross sectional descriptive study was carried among 316 community women. Probability simple random sampling technique was used to select the sample. Self-administered questionnaire was used to collect data. Data analysis was done by using SPSS version 16. Result: Our results indicated that very few (7.3%) participants had good knowledge towards breast cancer screening. Half (50%) had poor attitude. Sixty two percent of participants had done breast self-examination, one fourth (25%) had done clinical breast examination and very low (10%) had done mammogram. Though very few participants demonstrated good knowledge, about 90% of participants were aware that lump in breast can be related to breast cancer and agreed that every woman is risk for breast cancer. Conclusion: Majority of women demonstrated poor knowledge, attitude and practice towards breast cancer screening. Thus, effort should be put forth to increase the awareness of breast cancer screening for the early detection of breast cancer in the early stage. Key words: attitude, awareness, practice, breast cancer screening, community women.

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Mammography rates after the 2009 US Preventive Services Task Force breast cancer screening recommendation

Preventive Medicine ◽

10.1016/j.ypmed.2012.09.012 ◽

2012 ◽

Vol 55 (5) ◽

pp. 485-487 ◽

Cited By ~ 39

Author(s):

David H. Howard ◽

E. Kathleen Adams

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Task Force ◽

Preventive Services

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Lower attendance rates in immigrant versus non-immigrant women in the Norwegian Breast Cancer Screening Programme

Journal of Medical Screening ◽

10.1177/0969141317733771 ◽

2017 ◽

Vol 25 (3) ◽

pp. 155-161 ◽

Cited By ~ 10

Author(s):

Sameer Bhargava ◽

Kaitlyn Tsuruda ◽

Kåre Moen ◽

Ida Bukholm ◽

Solveig Hofvind

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Screening Programme ◽

Immigrant Women ◽

Population Based ◽

Mammographic Screening ◽

Attendance Rates ◽

Breast Cancer Screening Programme ◽

Cancer Screening Programme

Objective The Norwegian Breast Cancer Screening Programme invites women aged 50–69 to biennial mammographic screening. Although 84% of invited women have attended at least once, attendance rates vary across the country. We investigated attendance rates among various immigrant groups compared with non-immigrants in the programme. Methods There were 4,053,691 invitations sent to 885,979 women between 1996 and 2015. Using individual level population-based data from the Cancer Registry and Statistics Norway, we examined percent attendance and calculated incidence rate ratios, comparing immigrants with non-immigrants, using Poisson regression, following women's first invitation to the programme and for ever having attended. Results Immigrant women had lower attendance rates than the rest of the population, both following the first invitation (53.1% versus 76.1%) and for ever having attended (66.9% versus 86.4%). Differences in attendance rates between non-immigrant and immigrant women were less pronounced, but still present, when adjusted for sociodemographic factors. We also identified differences in attendance between immigrant groups. Attendance increased with duration of residency in Norway. A subgroup analysis of migrants' daughters showed that 70.0% attended following the first invitation, while 82.3% had ever attended. Conclusions Immigrant women had lower breast cancer screening attendance rates. The rationale for immigrant women's non-attendance needs to be explored through further studies targeting women from various birth countries and regions.

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