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Breast Cancer Screening: Is There Room for De-escalation?

Leah S Kim1, Donald R Lannin1

  • 1Department of Surgery and Yale Comprehensive Cancer Center, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520 USA.

Current Breast Cancer Reports
|November 21, 2022
PubMed
Summary

Screening mammography reduces breast cancer mortality by 20%, but harms 20-30% of patients through overdiagnosis. De-escalating screening can help avoid unnecessary treatments for cancers that would never cause harm.

Keywords:
Breast cancer screeningDe-escalation of breast cancer screeningHarms of breast cancer screeningOverdiagnosis

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Area of Science:

  • Oncology
  • Radiology
  • Public Health

Background:

  • Breast cancer screening guidelines vary significantly among agencies.
  • Screening mammography is widely utilized in the USA, often with a
  • more is better
  • mentality.

Purpose of the Study:

  • To objectively assess the risks and benefits of screening mammography.
  • To explore potential areas for de-escalating breast cancer screening.

Main Methods:

  • Review of recent meta-analyses on screening mammography.
  • Analysis of benefits versus harms, including overdiagnosis.

Main Results:

  • Screening mammography offers a 20% reduction in breast cancer mortality, benefiting approximately 5% of detected cancers.
  • Overdiagnosis, the detection of cancers that would not cause harm, affects 20-30% of screening-detected cancers, increasing with more intensive screening.

Conclusions:

  • The primary harm of screening mammography is overdiagnosis, leading to unnecessary treatment.
  • A shift in focus towards avoiding overdiagnosis is crucial.
  • De-escalation of screening mammography may be appropriate in certain patient groups to minimize harm.