Breast Cancer Screening for Women at Average Risk

Process

Breast cancer is a leading cause of premature mortality among women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality.

Evidence Synthesis

Screening mammography in women aged 40 to 69 years is associated with a reduction in breast cancer deaths across a range of study designs, and inferential evidence supports breast cancer screening for women 70 years and older who are in good health. Estimates of the cumulative lifetime risk of false-positive examination results are greater if screening begins at younger ages because of the greater number of mammograms, as well as the higher recall rate in younger women. The quality of the evidence for overdiagnosis is not sufficient to estimate a lifetime risk with confidence. Analysis examining the screening interval demonstrates more favorable tumor characteristics when premenopausal women are screened annually vs biennially. Evidence does not support routine clinical breast examination as a screening method for women at average risk.

Recommendations

Women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation). Women aged 45 to 54 years should be screened annually (qualified recommendation). Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation). Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (qualified recommendation). Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation).

Conclusions and Relevance

These updated guidelines provide evidence-based recommendations for breast cancer screening for women at average risk of breast cancer. These recommendations should be considered by physicians and women in discussions about breast cancer screening.

Introduction

Breast cancer is the most common cancer in women worldwide. In the United States, an estimated 231 840 women will be diagnosed with breast cancer in 2015. Breast cancer continues to rank second, after lung cancer, as a cause of cancer death in women in the United States, and it is a leading cause of premature mortality for women. In 2012, deaths from breast cancer accounted for 783 000 years of potential life lost and an average of 19 years of life lost per death. Even though mortality from breast cancer has declined steadily since 1990, largely due to improvements in early detection and treatment, an estimated 40 290 women in the United States will die of breast cancer in 2015.
New evidence has accumulated from long-term follow-up of the randomized controlled trials (RCTs) and observational studies of organized, population-based screening (service screening) programs. In addition, there is now greater emphasis on estimating harms associated with screening; assessing the balance of benefits and harms; and supporting the interplay among values, preferences, informed decision making, and recommendations. In 2011, the ACS incorporated standards recommended by the Institute of Medicine into its guidelines development protocol to ensure a more trustworthy, transparent, and consistent process for developing and communicating guidelines.
In accordance with the new guideline development process, the ACS organized an interdisciplinary guideline development group (GDG) consisting of clinicians (n = 4), biostatisticians (n = 2), epidemiologists (n = 2), an economist (n = 1), and patient representatives (n = 2). The GDG developed 5 key questions using the general approach of specifying populations, interventions, comparisons, outcomes, timing of outcomes, and settings (PICOTS) for each question. After evaluating available methods to grade the evidence and the strength of recommendations, the GDG selected the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system. GRADE is an accepted approach with a defined analytic framework, an explicit consideration of values and preferences in addressing patient-centered outcomes, the capacity for flexibility in evaluating results from observational studies, and separation between quality of evidence and strength of recommendation.
The ACS GDG selected the Duke University Evidence Synthesis Group to conduct an independent systematic evidence review of the breast cancer screening literature, after a response to a request for proposals. This effort is referred to as the evidence review. In addition, the ACS commissioned the Breast Cancer Surveillance Consortium (BCSC) to update previously published analyses related to the screening interval and outcomes. The ACS Surveillance and Health Services Research Program provided supplementary data on disease burden using data from the Surveillance, Epidemiology, and End Results (SEER) Program.
The GDG deliberations on the evidence and framing of the recommendations were guided by the GRADE domains: the balance between desirable and undesirable outcomes, the diversity in women’s values and preferences, and confidence in the magnitude of the effects on outcomes. The GDG chose to assess recommendations as “strong” or “qualified,” in accordance with GRADE guidance. A strong recommendation conveys the consensus that the benefits of adherence to the intervention outweigh the undesirable effects. Qualified recommendations indicate there is clear evidence of benefit but less certainty about either the balance of benefits and harms, or about patients’ values and preferences, which could lead to different decisions.
The GDG members voted on agreement or disagreement with each recommendation and on the strength of recommendation. A record of the vote with respect to each question was made without attribution. The panel attempted to achieve 100% agreement whenever possible, but a three-quarters majority was considered acceptable
Prior to submitting the final guideline for publication, 26 relevant outside organizations and 22 expert advisors were invited to participate in an external review of the guideline. Responses were documented and reviewed by the GDG to determine if modifications in the narrative or recommendations were warranted.

All participants in the guideline development process were required to disclose all financial and nonfinancial (personal, intellectual, practice-related) relationships and activities that might be perceived as posing a conflict of interest in development of the breast cancer screening guidelines. The chairpersons of the ACS GDG had the responsibility to ensure balanced perspectives were considered in deliberations and decision making. In addition to the disclosures listed in the Article Information section, nonfinancial disclosures of the authors are reported in the eMethods in the supplement.

[Know more about Breast Cancer Treatment]

Questions Guiding the Evidence Review

This evidence-based breast cancer screening guideline for women at average risk focuses on 3 key questions of the 5 original key question.

Key Questions (KQs) Guiding the Evidence Review

Key Questions Addressed in This Guideline Update
KQ 1: What are the relative benefits, limitations, and harms associated with mammography screening compared with no screening among average-risk women 40 years and older, and how do they vary by age, screening interval, and prior screening history?
KQ 2: Among average-risk women who are screened with mammography, what are the relative benefits, limitations, and harms associated with annual, biennial, triennial, or other screening interval, and how do they vary by age?
KQ 3: What are the benefits, limitations, and harms associated with clinical breast examination (CBE) among average-risk women 20 years and older compared with no CBE, and how do they vary by age, interval, and participation rates in mammography screening?
Other Key Questions
KQ 4a: Among women with an increased risk of breast cancer due to factors known prior to the onset of screening (eg, family history, BRCA mutation carrier, history of chest irradiation), what are the relative benefits, limitations, and harms associated with different screening modalities compared with no screening (ie, what ages to start and stop screening) and compared with each other?
KQ 4b: Among women with an increased risk of breast cancer due to factors identified as the result of screening or diagnosis (eg, prior diagnosis of proliferative lesions), what are the benefits, limitations, and harms associated with different screening modalities compared with no screening and compared with each other?
KQ 5a: Among women with an increased risk of breast cancer due to factors known prior to the onset of screening (eg, family history, BRCA mutation carrier, history of chest irradiation), what are the relative benefits, limitations, and harms associated with different screening modalities at different intervals, and how do these vary by age?
KQ 5b: Among women with an increased risk of breast cancer due to factors identified as the result of screening or diagnosis (eg, prior diagnosis of proliferative lesions), what are the benefits, limitations, and harms associated with different screening modalities at different intervals, and how do these vary by age?
  • What are the relative benefits, limitations, and harms associated with mammography screening compared with no screening in average-risk women 40 years and older, and how do they vary by age, screening interval, and prior screening history?
  • Among average-risk women who are screened with mammography, what are the relative benefits, limitations, and harms associated with annual, biennial, triennial, or other screening interval, and how do they vary by age?
  • What are the benefits, limitations, and harms associated with clinical breast examination (CBE) among average-risk women 20 years and older compared with no CBE, and how do they vary by age, interval, and participation rates in mammography screening?

[Find procedure for Breast Cancer Treatment]

20 thoughts on “Breast Cancer Screening for Women at Average Risk”

  1. Hey there! Exceptional posting! I find nice the method that you described Breast Cancer
    Screening for Women at Average Risk. Quite interesting process of conveying Breast Cancer Screening
    for Women at Average Risk. Effective service! This can be a very good write-up .

    I will start my own online site far too even so
    i have little available free time. Anticipated the tasks I actually can’t sometimes
    compose lots of the documentation not to mention objectives for the institution of higher education.
    However, there is best ways to clear up concern. Should to travel
    to essaysitefit.com you will find a net by using shown evaluation of online paper text vendors.

    You can select that which is the best for as well as sequence a real
    newspapers you may need

  2. We have got all read that insecticides and pesticides would be the cause of honey bee deaths that claims certainly
    they make sense. Raw honey boasts medicinal properties and it is chock full of nutrients.
    When they do swarm, the hive splits off into distinct colonies and new queens please take a portion of the workers
    to new colonies with the old queen utilizing the majority.

  3. Having read this I thought it was rather enlightening.
    I appreciate you spending some time and effort to put this short article together.
    I once again find myself spending a lot of time both reading and commenting.
    But so what, it was still worthwhile!

  4. I am extrewmely impressed ѡith youг writing skills ɑnd aⅼso wіth tһe layout on your weblog.
    Ιs tһis a paid theme or did you customize it yourself?
    Anyway keep up thee nice quality writing, іt’ѕ rare
    tо see a great blog like this one these dɑys.

Leave a Reply

Your email address will not be published. Required fields are marked *