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They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U. Department of Health and Human Services.
The USPSTF makes recommendations about the effectiveness of specific preventive care services for patients without obvious related s or symptoms. It bases its recommendations on the evidence of both the benefits and harms of the service, and an assessment of the balance. Clinicians should understand the evidence but individualize decisionmaking to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.
Breast cancer is the second-leading cause of cancer death among women in the United States. Inan estimatedwomen were diagnosed with the disease and 40, women died of it. It is most frequently diagnosed among women aged 55 to 64 years, and the median age of death from breast cancer is 68 years. The USPSTF found adequate evidence that mammography screening reduces breast cancer mortality in women aged 40 to 74 years. The of breast cancer deaths averted increases with age; women aged 40 to 49 years benefit the least and women aged 60 to 69 years benefit the most. Age is the most important risk factor for breast cancer, and the increased benefit observed with age is at least partly due to the increase in risk.
Women aged 40 to 49 years who have a first-degree relative with breast cancer have a risk for breast that 70s show boobs similar to that of women aged 50 to 59 years without a family history. Direct evidence about the benefits of screening mammography in women aged 75 years or older is lacking. The USPSTF found adequate evidence that screening for breast cancer with mammography in harms for women aged 40 to 74 years. False-positive are common and lead to unnecessary and sometimes invasive follow-up testing, with the potential for psychological harms such as anxiety.
False-negative that is, missed cancer also occur and may provide false reassurance. Radiation-induced breast cancer and resulting death that 70s show boobs also occur, although the of both of these events is predicted to be low. Similarly, the USPSTF found inadequate evidence on the benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, MRI, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram.
In both cases, while there is some information about the accuracy of these methods, there is no information on the effects of their use on health outcomes, such as breast cancer incidence, mortality, or overdiagnosis rates. The USPSTF concludes with moderate certainty that the net benefit of screening mammography in women aged 50 to 74 years is moderate. The USPSTF concludes with moderate certainty that the net benefit of screening mammography in the general population of women aged 40 to 49 years, while positive, is small.
The USPSTF concludes that the evidence on mammography screening in women age 75 years and older is insufficient, and the balance of benefits and harms cannot be determined. The USPSTF concludes that the evidence on DBT as a primary screening modality for breast cancer is insufficient, and the balance of benefits and harms cannot be determined. The USPSTF concludes that the evidence on adjunctive screening for breast cancer using breast ultrasound, MRI, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram is insufficient, and the balance of benefits and harms cannot be determined.
The of the meta-analysis of clinical trials from the systematic evidence review commissioned by the USPSTF are summarized in Table 1. The benefit is smaller in younger women: screening 10, women aged 50 to 59 years will result in 8 CI, 2 to 17 fewer breast cancer deaths, and screening 10, women aged 40 to 49 years will result in 3 CI, 0 to 9 fewer breast cancer deaths.
Mammography imaging has since improved, which may result in more tumors being detected at a curable stage today than at the time of these trials. However, breast that 70s show boobs treatments have also improved, and as treatment improves, the advantage of earlier detection decreases, so that some of the women who died of breast cancer in the nonscreened groups in these trials would survive today.
The most important harm of screening is the detection and treatment of invasive and noninvasive cancer that would never have been detected, or threaten health, in the absence of screening overdiagnosis and overtreatment. Existing science does not allow for the ability to determine precisely what proportion of cancer diagnosed by mammography today reflects overdiagnosis, and estimates vary widely depending on the data source and method of calculation used. If overdiagnosis is the only explanation for the increase, 1 in 3 women diagnosed with breast cancer today is being treated for cancer that would never have been discovered or caused her health problems in the absence of screening.
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 overdiagnosed. The rate increases with an earlier start age or with annual mammography. The other principal harms of screening are false-positivewhich require further imaging and often breast biopsy, and false-negative. Table 2 summarizes the rates of these harms per screening round using registry data for digital mammography from the Breast Cancer Surveillance Consortium BCSCa collaborative network of 5 mammography registries and 2 affiliated sites with linkages to tumor registries across the United States.
Clinical trials, observational studies, and modeling studies all demonstrate that the likelihood of avoiding a breast cancer death with regular screening mammography increases with age, and this increase in benefit likely occurs gradually rather than abruptly at any particular age. In contrast, the harms of screening mammography either remain constant or decrease with age.
For example, about the same of breast biopsies are performed as a result of screening mammography in women aged 40 to 49 years as in those aged 60 to 69 years, but many more of these biopsies will result in a diagnosis of invasive cancer in the older age group.
Thus, the balance of benefit and harms improves with age Table 3. 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 who benefit from starting regular screening mammography is smaller and the experiencing harm is larger compared with older women.
For women in their 40s, the benefit still outweighs the harms, but to a smaller degree; this balance may therefore be more subject to individual values and preferences than it is in older women. Women that 70s show boobs their 40s must weigh a very important but infrequent benefit reduction in breast cancer deaths against a group of meaningful and more common harms overdiagnosis and overtreatment, unnecessary and sometimes invasive follow-up testing and psychological harms associated with false-positive testand false reassurance from false-negative test.
Women who value the possible benefit of screening mammography more than they value avoiding its harms can make an informed decision to begin screening. Neither clinical trials nor models can precisely predict the potential benefits and harms that an individual woman can expect from beginning screening at age 40 rather than 50 years, as these data represent population effects. However, model may be the easiest way for women to visualize the relative tradeoffs of beginning screening at age 40 versus 50 years. CISNET conducted modeling studies to predict the lifetime benefits and harms of screening with contemporary digital mammography at different starting and stopping ages and screening intervals.
The models varied their assumptions about the natural history of invasive and noninvasive breast cancer and the effect of detection by digital mammography on survival. The models assumed the ideal circumstances of perfect adherence to screening and current best practices for therapy across the life span.
Table 3 compares the median and range across the models for predicted lifetime benefits and harms of screening biennially from ages 50 to 74 years with screening biennially from ages 40 to 74 years. Note that Table 3 differs from Tables 1 and 2 in terms of population metrics [per vs. It is, however, a false dichotomy to assume that the only options are to begin screening at age 40 or to wait until age 50 years.
As women advance through their 40s, the incidence of breast cancer rises. The balance of benefit and harms may also shift accordingly over this decade, such that women in the latter half of the decade likely have a more favorable balance than women in the first half. Indeed, the CISNET models suggest that most of the benefit of screening women aged 40 to 49 years would be realized by starting screening at age Advancing age is the most important risk factor for breast cancer in most women, but epidemiologic data from the BCSC suggest that having a first-degree relative with breast cancer is associated with an approximately 2-fold increased risk for breast cancer in women aged 40 to 49 years.
However, given the increased burden of disease and potential likelihood of benefit, women aged 40 to 49 years who have a known first-degree relative parent, child, or sibling with breast cancer may consider initiating screening earlier than age 50 years. Many other risk factors have been associated with breast cancer in epidemiologic studies, but most of these relationships are weak or inconsistent and would not likely influence how women value the tradeoffs of the potential benefits and harms of screening.
Once a woman has decided to begin screening, the next decision is how often to undergo screening. No clinical trials compared annual mammography with a longer interval in women of any age. In the randomized trials that demonstrated the effectiveness of mammography in reducing breast cancer deaths in women aged 40 to 74 years, screening intervals ranged from 12 to 33 months. Available observational evidence evaluating the effects of varying mammography intervals found no difference in the of breast cancer deaths between women aged 50 years or older who were screened biennially versus annually.
That 70s show boobs of the starting age for screening, the models consistently predict a small incremental increase in the of breast cancer deaths averted when moving from biennial to annual mammography, but also a large increase in the of harms Table 4. Clinical trial data for women aged 70 to 74 years are inconclusive. In its recommendation, 11 the USPSTF extended the recommendation for screening mammography to age 74 years based on the extrapolation that much of the benefit seen in women aged 60 to 69 years should continue in this age range, and modeling done at the that 70s show boobs supported this assumption.
Current CISNET models suggest that women aged 70 to 74 years with moderate to severe comorbid conditions that negatively affect their life expectancy are unlikely to benefit from mammography. Severe comorbid conditions include but are not limited to AIDS, chronic obstructive pulmonary disease, liver disease, chronic renal failure, dementia, congestive heart failure, and combinations of moderate comorbid conditions, as well as myocardial infarction, ulcer, and rheumatologic disease.
The USPSTF found insufficient evidence to assess the balance of benefits and harms of screening mammography in women aged 75 years or older. CISNET models suggest that biennial mammography screening may potentially continue to offer a net benefit after age 74 years among women with no or low comorbidity, 78 but no randomized trials of screening included women in this age group. Evidence on DBT is limited; a single study on the test characteristics of DBT as a primary screening strategy for breast cancer met the inclusion criteria of the systematic evidence review.
From the limited data available, DBT seems to reduce recall rates that is, follow-up for additional imaging or testing and increase cancer detection rates compared with conventional digital mammography alone. In addition, no studies of DBT looked at clinical outcomes, such as breast cancer morbidity or mortality or quality of life. As currently practiced in most settings, DBT exposes women to approximately twice the amount of radiation as conventional digital mammography. Food and Drug Administration approved a method to generate synthetic reconstruction of 2-dimensional images from 3-dimensional views, which reduces the total radiation dose associated with DBT.
Although the extent to which this new software technology has been implemented in mammography screening centers is not precisely known, it is currently thought to be low. In women with abnormal findings, DBT may also increase the rate of breast biopsy compared with conventional digital mammography. The USPSTF found insufficient evidence to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, MRI, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram.
The proportion of women with dense breasts is highest among those aged 40 to 49 years and decreases with age. Increased breast density is a risk factor for breast cancer. Data from the BCSC indicate that, compared with women with average breast density, women aged 40 to 49 years with heterogeneously or extremely dense breasts have a relative risk RR of 1. For women aged 50 to 64 years with heterogeneously or extremely dense breasts, the RR is 1. Increased breast density reduces the sensitivity and specificity of mammography for detecting cancer.
Good-quality studies of U. In 1 BCSC study, biennial screening mammography was associated with greater risk for advanced-stage cancer stage IIB or greater odds ratio, 2. Information about morbidity or mortality end points is not available, so whether these women ultimately fared any differently in their clinical outcomes is not known.
All women aged 40 to 74 years with increased breast density are at increased risk for a false-positive result, an unnecessary breast biopsy, or a false-negative result compared with women with average breast density. That 70s show boobs more frequently that is, annually vs.
Potential benefits. Current evidence on adjunctive screening is very limited, but it suggests that for women identified to have dense breasts on an otherwise negative mammogram, ultrasonography or MRI will detect additional breast cancer but will also result in a higher of false-positive. Data on DBT in women with dense breasts are limited, but in the short term, DBT also detects additional breast cancer. Most of the additional cancer detected by these methods are invasive tumors rather than ductal carcinoma in situ DCIS. Existing data do not allow for estimation of the proportion of cancer that falls into each category; therefore, the benefits on health cannot be estimated.
Potential harms.That 70s show boobs
email: [email protected] - phone:(517) 646-2871 x 1743
Breast Cancer: Screening