Highlights
- •Mammographic screening was introduced when randomised trials showed the technique reduced mortality rates.
- •The ‘real world’ benefits and harms are now being reconsidered.
- •Mammographic screening has potential harms as well as benefits.
- •Women need balanced information to make a decision about participation in screening.
Abstract
Mammographic screening programs were established around the world following randomised
clinical trials showing that women who were screened had a significant reduction in
the risk of dying from breast cancer. Now, decades later, several harms of screening
have become apparent and the degree of risk reduction is being debated.
This article aims to provide clinicians with evidence-based information about the
benefits and harms of screening mammography to enable them to confidently discuss
the issues with their patients.
The issues around screening for breast cancer in asymptomatic women at average risk
are complex. Women need accurate, balanced information to make an informed decision
about whether they wish to participate in screening. The decision will vary from one
woman to another, depending on her level of anxiety about cancer and recall, her personal
values and her philosophy about health care.
Keywords
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References
- Evidence on screening for breast cancer from a randomized trial.Cancer. 1977; 39: 2772-2782
- Reduction in mortality from breast cancer after mass screening with mammography: randomised Trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare.Lancet. 1985; 325: 829-832
- Cancer Australia, Familial Risk Assessment – Breast and Ovarian Cancer (FRA-BOC)..2016 (<https://canceraustralia.gov.au/clinical-best-practice/gynaecological-cancers/familial-risk-assessment-fra-boc> 2011 (accessed May 2016))
- Overdiagnosis in mammography screening: a 45 year journey from shadowy idea to acknowledged reality.BMJ. 2015; 350
- Weighing the benefits and harms: screening mammography in the balance.in: Houssami N. Miglioretti D. Breast Cancer Screening: An Examination of Scientific Evidence, Academic Press. Elsevier), 2016
- Screening for breast cancer with mammography.Cochrane Database Syst. Rev. 2013; 6: Cd001877
- The benefits and harms of breast cancer screening: an independent review.Br. J. Cancer. 2013; 108: 2205-2240
- Meta-analysis of breast cancer mortality benefit and overdiagnosis adjusted for adherence: improving information on the effects of attending screening mammography.Br. J. Cancer. 2016;
- Factors associated with rates of false-Positive and false-Negative results from digital mammography screening: an analysis of registry data.Ann. Internal Med. 2016; 164: 226-235
- Over-reassurance and undersupport after a ‘false alarm': a systematic review of the impact on subsequent cancer symptom attribution and help seeking.BMJ Open. 2015; 5: e007002
- The risk of radiation-induced breast cancers due to biennial mammographic screening in women aged 50–69 years is minimal.Acta Radiol. Stockholm, Sweden. 2014; 55 (1987): 1174-1179
- Risk of radiation-induced breast cancer from mammographic screening.Radiology. 2011; 258: 98-105
- Digital breast tomosynthesis: state of the art.Radiology. 2015; 277: 663-684
- The effect of mammography pain on repeat participation in breast cancer screening: a systematic review.Breast. 2013; 22: 389-394
- Correlation of microarray-based breast cancer molecular subtypes and clinical outcomes: implications for treatment optimization.BMC Cancer. 2011; 11 (143–143)
- Ductal carcinoma in situ at core-Needle biopsy: meta-analysis of underestimation and predictors of invasive Breast cancer.Radiology. 2011; 260: 119-128
- Predictive factors for invasive cancer in surgical specimens following an initial diagnosis of ductal carcinoma in situ after stereotactic vacuum-assisted breast biopsy in microcalcification-only lesions.Diagn. Interventional Radiol. (Ankara Turkey). 2016; 22: 29-34
- Meta-analysis of the effect of preoperative breast MRI on the surgical management of ductal carcinoma in situ.Br. J. Surg. 2015; 102: 883-893
- Preoperative clinicopathologic factors and breast magnetic resonance imaging features can predict ductal carcinoma in situ with invasive components.Eur. J. Radiol. 2016; 85: 780-789
- Addressing overtreatment of screen detected DCIS; the LORIS trial.Eur. J. Cancer. 2015; 51: 2296-2303
- Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial.Lancet. 2015; 385: 1642-1652
Informed Choice about Cancer Screening, NHS breast screening- Helping you decide, 2013.
- Breast Cancer Screening.2015 (http://www.nhs.uk/conditions/breast-cancer-screening/Pages/Introduction.aspx, (accessed May 2016))
- BreastScreen and You: Information about Mammography Screening.2016 (http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/194B6BD076D4A6F9CA257D71007BF9F5/$File/Breastscreen_Brochure_March_WEB.pdf, (accessed May 2016))
Article info
Publication history
Published online: August 11, 2016
Accepted:
August 7,
2016
Received:
August 1,
2016
Identification
Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.
