Breast Cancer Screening - USPSTF
Screening for Breast Cancer: USPSTF Recommendation Statement. (2009).
Take Aways - For patients without related signs or sx with no preexisting high risk factors
- Recommends biennial screening mammography for women 50-74 yo (B recommendation)
- Discuss risk/benefits for biennial screening mammo for women 40-49 yo (C recommendation)
- Insufficient evidence for 75+ yo screening
- Insufficient evidence for digital breast tomosynthesis as primary screening
- Insufficient evidence for US, MRI, DBT, other imaging for dense breast screening with negative mammo
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Digital breast tomosynthesis
- volumetric reconstruction of the whole breast from a finite number of low-dose two-dimensional projections obtained by different X-ray tube angles
- limited data shows it may reduce recall rates and increase cancer detection rates compared to mammo alone, but x2 amount of radiation vs mammo. Also uncertain how much overdiagnosis happens.
- insufficient evidence
Breast Cancer Deaths Avoided (95% CI) per 10,000 women screened by mammo
40-49 yo: 3 (0-9)
50-59 yo: 8 (2-17)
60-69 yo: 21 (11-32)
70-74 yo: 13 (0-32)
Harms of Screening
- overdiagnosis - best guess that 1 in 5 to 1 in 8 women diagnosed with breast cancer over 10 years are overdiagnosed
- fale positives
Other Screening Considerations
- biennial screening is best of balancing diagnosis with radiation risk
- stop at 74 yo (unless very few or no comorbidities), maybe even stop earlier at 70-74 if many severe comorbidities
Dense Breasts
- about 43% of 40-74 yo have heterogenously or extremely dense breasts (decreases with age)
- if you have dense breasts, increases risk for developing breast cancer by
> 40-49 yo: Relative Risk 1.23
> 50-64 yo: RR 1.29
> 65-74 yo: RR 1.3
The older you are with dense breasts, the higher relative risk you have for developing invasive breast cancer
Further Considerations
- 1 in 4 breast cancer is DCIS (ductal carcinoma in situ). DCIS is noninvasive, but is treated with surgery and chemopreventative agents. 20 yr breast cancer mortality post tx is 3%. But is this needed?
- most studies were on white women <70 yo. Uncertain about other racial groups or older women
Take Aways - For patients without related signs or sx with no preexisting high risk factors
- Recommends biennial screening mammography for women 50-74 yo (B recommendation)
- Discuss risk/benefits for biennial screening mammo for women 40-49 yo (C recommendation)
- Insufficient evidence for 75+ yo screening
- Insufficient evidence for digital breast tomosynthesis as primary screening
- Insufficient evidence for US, MRI, DBT, other imaging for dense breast screening with negative mammo
----
Digital breast tomosynthesis
- volumetric reconstruction of the whole breast from a finite number of low-dose two-dimensional projections obtained by different X-ray tube angles
- limited data shows it may reduce recall rates and increase cancer detection rates compared to mammo alone, but x2 amount of radiation vs mammo. Also uncertain how much overdiagnosis happens.
- insufficient evidence
Breast Cancer Deaths Avoided (95% CI) per 10,000 women screened by mammo
40-49 yo: 3 (0-9)
50-59 yo: 8 (2-17)
60-69 yo: 21 (11-32)
70-74 yo: 13 (0-32)
Harms of Screening
- overdiagnosis - best guess that 1 in 5 to 1 in 8 women diagnosed with breast cancer over 10 years are overdiagnosed
- fale positives
Other Screening Considerations
- biennial screening is best of balancing diagnosis with radiation risk
- stop at 74 yo (unless very few or no comorbidities), maybe even stop earlier at 70-74 if many severe comorbidities
Dense Breasts
- about 43% of 40-74 yo have heterogenously or extremely dense breasts (decreases with age)
- if you have dense breasts, increases risk for developing breast cancer by
> 40-49 yo: Relative Risk 1.23
> 50-64 yo: RR 1.29
> 65-74 yo: RR 1.3
The older you are with dense breasts, the higher relative risk you have for developing invasive breast cancer
Further Considerations
- 1 in 4 breast cancer is DCIS (ductal carcinoma in situ). DCIS is noninvasive, but is treated with surgery and chemopreventative agents. 20 yr breast cancer mortality post tx is 3%. But is this needed?
- most studies were on white women <70 yo. Uncertain about other racial groups or older women
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