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Breast cancer screening controversies.
Beverly B Green1, Stephen H Taplin
1Center for Health Studies, and the Department of Preventive Care, Group Health Cooperative, Seattle, WA 98101-1448, USA.
The Journal of the American Board of Family Practice
|May 21, 2003
Summary
Contradictory evidence exists regarding mammography screening effectiveness. While some reviews question its benefit, the balance of evidence supports screening mammography for women 40 and older. Breast self-examination (BSE) training shows no mortality benefit.
Area of Science:
- Oncology
- Preventive Medicine
- Radiology
Background:
- Conflicting conclusions on mammography screening efficacy from major health organizations.
- Controversies stem from differing interpretations of randomized controlled trials.
- Recent updates in screening guidelines by US and Canadian task forces.
Purpose of the Study:
- To review controversies surrounding breast cancer screening methods.
- To evaluate the effectiveness of mammography, clinical breast examination (CBE), and breast self-examination (BSE).
- To synthesize current evidence on breast cancer screening modalities.
Main Methods:
- Systematic literature review using keywords and cross-referencing.
- Analysis of data from the Group Health Cooperative Breast Cancer Screening Program.
- Evaluation of clinical breast examination sensitivity for cancer detection.
Main Results:
- Mammography generally shows a decrease in breast cancer deaths, despite trial validity debates.
- Limited evidence exists on optimal mammography screening intervals.
- Clinical breast examination (CBE) alone detects 8% of cancers, but its mortality benefit is unproven.
- Breast self-examination (BSE) training does not improve cancer diagnosis or decrease mortality.
Conclusions:
- Limitations exist in randomized controlled trials and meta-analyses.
- Evidence favors screening mammography for women aged 40+ every 2 years.
- The added benefit of CBE to mammography for mortality reduction is unknown.
- Population-based BSE training is unlikely to reduce breast cancer deaths; women should monitor for changes.