Abstract
The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years. (C recommendation)
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older. (I statement)
The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer. (I statement)
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging (MRI), DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram. (I statement)
Summary of Recommendations and Evidence
Rationale
Importance
Benefit and Harms of Screening and Early Treatment
USPSTF Assessment
Clinical Considerations
Benefit of Screening
Harms of Screening
Trends in invasive and noninvasive breast cancer incidence and mortality since the widespread introduction of screening mammography in the United States.
The figure depicts changes in age-adjusted invasive and combined invasive and noninvasive breast cancer incidence and mortality rates in the United States from 1975 through 2011. The baseline breast cancer incidence rate was 105 to 111 cases per 100 000 women (depending on whether one considers invasive disease or invasive plus noninvasive disease together). With the widespread diffusion of mammography screening, this rate increased to 165 cases of noninvasive plus invasive disease per 100 000 women in 2011 (an excess of 54 to 60 cases per 100 000 women, or about a 50% increase). Breast cancer mortality rates have declined at a slower rate, from 31 to 22 cases (or a reduction of 9 deaths) per 100 000 women over the same time period. Based on data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program (5).
When to Start Screening
Risk Factors That May Influence When to Start Screening
How Often to Screen
When to Consider Stopping Screening
Screening in Women Aged 75 Years or Older
DBT as a Primary Screening Strategy
Background
Potential Benefits
Potential Harms
Primary and Adjunctive Screening in Women With Dense Breasts
Epidemiology of Dense Breasts
Primary Screening Test Performance Characteristics
Primary Screening Frequency
Adjunctive Screening
Potential Benefits.
Potential Harms.
Current Practice.
Assessment
Other Approaches to Prevention
Other Considerations
Research Needs and Gaps
Discussion
Scope of Review
Burden of Disease
Risk Factors: Additional Considerations
Accuracy of Screening Tests
Effectiveness of Early Detection and Treatment
Primary Screening With Conventional Mammography
Primary Screening With DBT
Adjunctive Screening in Women With Dense Breasts
Harms of Early Detection and Treatment
Primary Screening With Conventional Mammography
Primary Screening With DBT
Adjunctive Screening in Women With Dense Breasts
Estimate of Magnitude of Net Benefit
Update of Previous USPSTF Recommendation
Response to Public Comment
Benefits of Contemporary Screening Mammography
Screening Mammography in Women Aged 40 to 49 Years
Screening Mammography in Women Aged 70 to 74 Years or Older
Definition of Overdiagnosis
DBT
Comparison of the USPSTF’s Recommendations With Those of Other Organizations
Insurance Coverage and Access to Mammography
Appendix: Members of the USPSTF
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