This guideline from the USPSTF is based on current evidence on mammography, digital breast tomography, and supplemental screening for breast cancer. The recommendations apply to asymptomatic women ...

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Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement

Importance Breast cancer is a leading cause of premature mortality among US women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality. Objective To update the American Cancer Society (ACS) 2003 breast cancer screening guideline for women at average risk for breast cancer. Process The ACS commissioned a systematic evidence review of the breast cancer screening literature to inform the update and a supplemental analysis of mammography registry data to address questions related to the screening interval. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. 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 The ACS recommends that 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). The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation). Conclusions and Relevance These updated ACS 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.

/pdf/breast-cancer-screening-for-women-at-average-risk-2015-2zpe99a39l.pdf

Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society

Data from a large, diverse set of breast imaging facilities in the Breast Cancer Surveillance Consortium, linked to state cancer registries, provide performance benchmarks for diagnostic mammography in the era of digital mammography.

National Performance Benchmarks for Modern Screening Digital Mammography: Update from the Breast Cancer Surveillance Consortium

Screening tests are widely used in medicine to assess the likelihood that members of a defined population have a particular disease. This article presents an overview of such tests including the definitions of key technical (sensitivity and specificity) and population characteristics necessary to assess the benefits and limitations of such tests. Several examples are used to illustrate calculations, including the characteristics of low dose computed tomography as a lung cancer screen, choice of an optimal PSA cutoff and selection of the population to undergo mammography. The importance of careful consideration of the consequences of both false positives and negatives is highlighted. Receiver operating characteristic curves are explained as is the need to carefully select the population group to be tested.

https://www.tandfonline.com/doi/pdf/10.3109/08958378.2014.955932

Screening tests: a review with examples

The diagnosis and management of breast cancer are undergoing a paradigm shift from a one-size-fits-all approach to an era of personalized medicine. Sophisticated diagnostics, including molecular imaging and genomic expression profiles, enable improved tumor characterization. These diagnostics, combined with newer surgical techniques and radiation therapies, result in a collaborative multidisciplinary approach to minimizing recurrence and reducing treatment-associated morbidity. This article reviews the diagnosis and treatment of breast cancer, including screening, staging, and multidisciplinary management.

https://jnm.snmjournals.org/content/jnumed/57/Supplement_1/9S.full.pdf

Clinical Diagnosis and Management of Breast Cancer

mammography + tomosynthesis; difference, 1.3 (95% CI, 0.4-2.1; P = .004); for cancer detection, 4.2 (95% CI, 3.8-4.7) with digital mammography vs 5.4 (95% CI, 4.9-6.0) with digital mammography + tomosynthesis; difference, 1.2 (95% CI, 0.8-1.6; P < .001); and for invasive cancer detection, 2.9 (95% CI, 2.5-3.2) with digital mammography vs 4.1 (95% CI, 3.7-4.5) with digital mammography + tomosynthesis; difference, 1.2 (95% CI, 0.8-1.6; P < .001). The in situ cancer detection rate was 1.4 (95% CI, 1.2-1.6) per 1000 screens with both methods. Adding tomosynthesis was associated with an increase in the positive predictive value for recall from 4.3% to 6.4% (difference, 2.1%; 95% CI, 1.7%-2.5%; P < .001) and for biopsy from 24.2% to 29.2% (difference, 5.0%; 95% CI, 3.0%-7.0%; P < .001). CONCLUSIONS AND RELEVANCE Addition of tomosynthesis to digital mammography was associated with a decrease in recall rate and an increase in cancer detection rate. Further studies are needed to assess the relationship to clinical outcomes.

/pdf/breast-cancer-screening-using-tomosynthesis-in-combination-81xjvvorax.pdf

Breast Cancer Screening Using Tomosynthesis in Combination With Digital Mammography

To determine the effect of tomosynthesis imaging as a function of age for breast cancer screening Screening performance metrics from 13 institutions were examined for 12 months prior to introduction of tomosynthesis (period 1) and compared to those after introduction of tomosynthesis (period 2, range 3–22 months) Screening metrics for women ages 40–49, 50–59, 60–69, and 70+ , included rates per 1000 screens for recalls, biopsies, cancers, and invasive cancers detected Performance parameters were compared for women screened with digital mammography alone (n = 278,908) and digital mammography + tomosynthesis (n = 173,414) Addition of tomosynthesis to digital mammography produced significant reductions in recall rates for all age groups and significant increases in cancer detection rates for women 40–69 Largest recall rate reduction with tomosynthesis was for women 40–49, decreasing from 137 (95% CI 117–156) to 115 (95% CI 95–135); difference, −22 (95% CI −26 to −18; P < 001) Simultaneous increase in invasive cancer detection rate for women 40–49 from 16 (95% CI 12–19) to 27 (95% CI 22–31) with tomosynthesis (difference, 11; 95% CI 06–16; P < 001) was observed Addition of tomosynthesis to digital mammography increased invasive cancer detection rates for women 40–69 and decreased recall rates for all age groups with largest performance gains seen in women 40–49 The similar performance seen with tomosynthesis screening for women in their 40s compared to digital mammography for women in their 50s argues strongly for commencement of mammography screening at age 40 using tomosynthesis

Effect of age on breast cancer screening using tomosynthesis in combination with digital mammography

Screening with digital breast tomosynthesis improves sensitivity and specificity, reveals more invasive cancers with fewer poor prognosis subtypes, and demonstrates a trend toward lower false-negat...

https://pubs.rsna.org/doi/pdf/10.1148/radiol.2020202858

Linda N. Greer

Papers

Breast Cancer Screening Using Tomosynthesis in Combination With Digital Mammography

Effect of age on breast cancer screening using tomosynthesis in combination with digital mammography

False-Negative Rates of Breast Cancer Screening with and without Digital Breast Tomosynthesis.