Journal ArticleDOI
Benefits and Harms of Breast Cancer Screening: A Systematic Review
Evan R. Myers,Patricia G. Moorman,Jennifer M Gierisch,Laura J. Havrilesky,Laura J. Havrilesky,Lars J. Grimm,Sujata V. Ghate,Brittany A. Davidson,Ranee Chatterjee Mongtomery,Matthew J Crowley,Matthew J Crowley,Matthew J Crowley,Douglas C McCrory,Douglas C McCrory,Douglas C McCrory,Amy S Kendrick,Gillian D Sanders,Gillian D Sanders +17 more
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TLDR
Evidence for the relationship between screening and life expectancy and quality-adjusted life expectancy was low in quality and uncertainty remains about the magnitude of associated mortality reduction in the entire US population, among women 40 to 49 years, and with annual screening compared with biennial screening.Abstract:
Importance Patients need to consider both benefits and harms of breast cancer screening. Objective To systematically synthesize available evidence on the association of mammographic screening and clinical breast examination (CBE) at different ages and intervals with breast cancer mortality, overdiagnosis, false-positive biopsy findings, life expectancy, and quality-adjusted life expectancy. Evidence Review We searched PubMed (to March 6, 2014), CINAHL (to September 10, 2013), and PsycINFO (to September 10, 2013) for systematic reviews, randomized clinical trials (RCTs) (with no limit to publication date), and observational and modeling studies published after January 1, 2000, as well as systematic reviews of all study designs. Included studies (7 reviews, 10 RCTs, 72 observational, 1 modeling) provided evidence on the association between screening with mammography, CBE, or both and prespecified critical outcomes among women at average risk of breast cancer (no known genetic susceptibility, family history, previous breast neoplasia, or chest irradiation). We used summary estimates from existing reviews, supplemented by qualitative synthesis of studies not included in those reviews. Findings Across all ages of women at average risk, pooled estimates of association between mammography screening and mortality reduction after 13 years of follow-up were similar for 3 meta-analyses of clinical trials (UK Independent Panel: relative risk [RR], 0.80 [95% CI, 0.73-0.89]; Canadian Task Force: RR, 0.82 [95% CI, 0.74-0.94]; Cochrane: RR, 0.81 [95% CI, 0.74-0.87]); were greater in a meta-analysis of cohort studies (RR, 0.75 [95% CI, 0.69 to 0.81]); and were comparable in a modeling study (CISNET; median RR equivalent among 7 models, 0.85 [range, 0.77-0.93]). Uncertainty remains about the magnitude of associated mortality reduction in the entire US population, among women 40 to 49 years, and with annual screening compared with biennial screening. There is uncertainty about the magnitude of overdiagnosis associated with different screening strategies, attributable in part to lack of consensus on methods of estimation and the importance of ductal carcinoma in situ in overdiagnosis. For women with a first mammography screening at age 40 years, estimated 10-year cumulative risk of a false-positive biopsy result was higher (7.0% [95% CI, 6.1%-7.8%]) for annual compared with biennial (4.8% [95% CI, 4.4%-5.2%]) screening. Although 10-year probabilities of false-positive biopsy results were similar for women beginning screening at age 50 years, indirect estimates of lifetime probability of false-positive results were lower. Evidence for the relationship between screening and life expectancy and quality-adjusted life expectancy was low in quality. There was no direct evidence for any additional mortality benefit associated with the addition of CBE to mammography, but observational evidence from the United States and Canada suggested an increase in false-positive findings compared with mammography alone, with both studies finding an estimated 55 additional false-positive findings per extra breast cancer detected with the addition of CBE. Conclusions and Relevance For women of all ages at average risk, screening was associated with a reduction in breast cancer mortality of approximately 20%, although there was uncertainty about quantitative estimates of outcomes for different breast cancer screening strategies in the United States. These findings and the related uncertainty should be considered when making recommendations based on judgments about the balance of benefits and harms of breast cancer screening.read more
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Journal ArticleDOI
Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society
Kevin C. Oeffinger,Elizabeth T. H. Fontham,Ruth Etzioni,Abbe Herzig,James S. Michaelson,Ya Chen Tina Shih,Louise C. Walter,Timothy R. Church,Christopher R. Flowers,Samuel J. LaMonte,Andrew M.D. Wolf,Carol DeSantis,Joannie Lortet-Tieulent,Kimberly S. Andrews,Deana Manassaram-Baptiste,Debbie Saslow,Robert A. Smith,Otis W. Brawley,Richard C. Wender +18 more
TL;DR: The updated ACS guidelines for breast cancer screening for women at average risk of breast cancer provide evidence-based recommendations and should be considered by physicians and women in discussions about breast cancer Screening.
Journal ArticleDOI
A view on drug resistance in cancer
TL;DR: A reductionist approach is taken to define and separate the key determinants of drug resistance, which include tumour burden and growth kinetics; tumour heterogeneity; physical barriers; the immune system and the microenvironment; undruggable cancer drivers; and the many consequences of applying therapeutic pressures.
Journal ArticleDOI
Cancer screening in the United States, 2018: A review of current American Cancer Society guidelines and current issues in cancer screening
Robert A. Smith,Kimberly S. Andrews,Durado Brooks,Stacey A. Fedewa,Deana Manassaram-Baptiste,Debbie Saslow,Otis W. Brawley,Richard C. Wender +7 more
TL;DR: The new American Cancer Society colorectal cancer screening guidelines are summarized and a clarification in the language of the 2013 lung cancer screening guideline is included.
Journal ArticleDOI
Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening.
Robert A. Smith,Kimberly S. Andrews,Durado Brooks,Stacey A. Fedewa,Deana Manassaram-Baptiste,Debbie Saslow,Richard C. Wender +6 more
TL;DR: The current American Cancer Society cancer screening guidelines are summarized, and the most current data from the National Health Interview Survey are provided on the utilization of cancer screening for men and women and on the adherence of men andWomen to multiple recommended screening tests.
Journal ArticleDOI
Cancer screening in the United States, 2017: A review of current American Cancer Society guidelines and current issues in cancer screening
Robert A. Smith,Kimberly S. Andrews,Durado Brooks,Stacey A. Fedewa,Deana Manassaram-Baptiste,Debbie Saslow,Otis W. Brawley,Richard C. Wender +7 more
TL;DR: The American Cancer Society published a summary of its guidelines for early cancer detection, data and trends in cancer screening rates, and select issues related to cancer screening as discussed by the authors, and provided the latest data on utilization of cancer screening from the National Health Interview Survey.
References
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Effect of screening and adjuvant therapy on mortality from breast cancer
Donald A. Berry,Kathleen A. Cronin,Sylvia K. Plevritis,Dennis G. Fryback,Lauren Clarke,Marvin Zelen,Jeanne S. Mandelblatt,Andrei Yakovlev,J. Dik F. Habbema,Eric J. Feuer +9 more
TL;DR: Seven statistical models showed that both screening mammography and treatment have helped reduce the rate of death from breast cancer in the United States.
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GRADE guidelines: A new series of articles in the Journal of Clinical Epidemiology △
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Screening for breast cancer with mammography.
TL;DR: It is found that breast cancer mortality was an unreliable outcome that was biased in favour of screening, mainly because of differential misclassification of cause of death.
Journal ArticleDOI
The benefits and harms of breast cancer screening: an independent review
TL;DR: It is concluded that screening reduces breast cancer mortality but that some overdiagnosis occurs, and results from observational studies support the occurrence of over Diagnosis, but estimates of its magnitude are unreliable.
Journal ArticleDOI
Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society
Kevin C. Oeffinger,Elizabeth T. H. Fontham,Ruth Etzioni,Abbe Herzig,James S. Michaelson,Ya Chen Tina Shih,Louise C. Walter,Timothy R. Church,Christopher R. Flowers,Samuel J. LaMonte,Andrew M.D. Wolf,Carol DeSantis,Joannie Lortet-Tieulent,Kimberly S. Andrews,Deana Manassaram-Baptiste,Debbie Saslow,Robert A. Smith,Otis W. Brawley,Richard C. Wender +18 more
TL;DR: The updated ACS guidelines for breast cancer screening for women at average risk of breast cancer provide evidence-based recommendations and should be considered by physicians and women in discussions about breast cancer Screening.
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