For example , mammography screening does not seem to create anxiety in women who are given a clear result after a mammogram .
The incidence of breast cancer and mortality increases with age , and the GDG extrapolated that the absolute health benefits are greater in women aged 45 to 49 than those aged 40 to 44 years .
However , for the 45- to 49-year age group , the higher breast cancer incidence and mortality compared with women between the ages of 40 and 44 , as well as observational evidence showing a greater benefit in this age group ( 33 ) , led the GDG to judge that the balance of health effects probably favors screening , although the required re sources for screening likely differ across setting s ( 34 , 35 ) .
Other EtD criteria also were generally in favor of implementing organized mammography screening in this age group .
Despite intensified efforts by the European Council since 2003 , the implementation of organized , population -based mammography screening is not uniform across Europe and depends greatly on the policies in place in different countries , the organization of health care , and available re sources ( 1 ) .
Since the last edition of the European Guidelines on Breast Cancer Screening and Diagnosis was published in 2006 ( 2 ) , new evidence regarding breast cancer and innovation in guideline methodology prompted the European Commission Initiative on Breast Cancer ( ECIBC ) to develop new evidence -based recommendations ( in short , the European Breast Guidelines ) .
These guidelines inform women , health professionals , and policymakers about important questions related to organized mammography screening and breast cancer diagnosis , but recommendations may apply in context s in which organized screening programs are not in place .
Women generally consider these undesirable effects acceptable ( low certainty of evidence ) , and a systematic review suggested that women place a relatively low value on the psychosocial and physical effects of false-positive results and overdiagnosis ; however , some studies raised concerns about whether women fully underst and the result ing implication s ( 15 ) .
How Often Should Women Attend an Organized Mammography Screening Program ?
Breast cancer screening with tomosynthesis (3D mammography) with acquired or synthetic 2D mammography compared with 2D mammography alone (STORM-2): a population-based prospective study.
BACKGROUND Breast tomo synthesis ( pseudo-3D mammography ) improves breast cancer detection when added to 2D mammography . In this study , we examined whether integrating 3D mammography with either st and ard 2D mammography acquisitions or with synthetic 2D images ( reconstructed from 3D mammography ) would detect more cases of breast cancer than 2D mammography alone , to potentially reduce the radiation burden from the combination of 2D plus 3D acquisitions . METHODS The Screening with Tomo synthesis Or st and ard Mammography-2 ( STORM-2 ) study was a prospect i ve population -based screening study comparing integrated 3D mammography ( dual-acquisition 2D-3D mammography or 2D synthetic-3D mammography ) with 2D mammography alone . Asymptomatic women aged 49 years or older who attended population -based screening in Trento , Italy were recruited for the study . All participants underwent digital mammography with 2D and 3D mammography acquisitions , with the use of software that allowed synthetic 2D mammographic images to be reconstructed from 3D acquisitions . Mammography screen-reading was done in two parallel double-readings conducted sequentially for 2D acquisitions followed by integrated acquisitions . Recall based on a positive mammography result was defined as recall at any screen read . Primary outcome measures were a comparison between integrated ( 2D-3D or 2D synthetic-3D ) mammography and 2D mammography alone of the number of cases of screen-detected breast cancer , the cancer detection rate per 1000 screens , the incremental cancer detection rate , and the number and percentage of false-positive recalls . FINDINGS Between May 31 , 2013 , and May 29 , 2015 , 10 255 women were invited to participate , of whom 9672 agreed to participate and were screened . In these 9672 participants ( median age 58 years [ IQR 53 - 63 ] ) , screening detected 90 cases of breast cancer , including 74 invasive breast cancers , in 85 women ( five women had bilateral breast cancer ) . To account for these bilateral cancers in cancer detection rate estimates , the number of screens used for analysis was 9677 . Both 2D-3D mammography ( cancer detection rate 8·5 per 1000 screens [ 82 cancers detected in 9677 screens ] ; 95 % CI 6·7 - 10·5 ) and 2D synthetic-3D mammography ( 8·8 per 1000 [ 85 in 9677 ] ; 7·0 - 10·8 ) had significantly higher rates of breast cancer detection  than 2D mammography alone ( 6·3 per 1000 [ 61 in 9677 ] , 4·8 - 8·1 ; p<0·0001 for both comparisons ) . The cancer detection rate did not differ significantly between 2D-3D mammography and 2D synthetic-3D mammography ( p=0·58 ) . Compared with 2D mammography alone , the incremental cancer detection rate from 2D-3D mammography was 2·2 per 1000 screens ( 95 % CI 1·2 - 3·3 ) and that from 2D synthetic-3D mammography was 2·5 per 1000 ( 1·4 - 3·8 ) . Compared with the proportion of false-positive recalls from 2D mammography alone ( 328 of 9587 participants not found to have cancer at assessment ) [ 3·42 % ; 95 % CI 3·07 - 3·80 ] ) , false-positive recall was significantly higher for 2D-3D mammography ( 381 of 9587 [ 3·97 % ; 3·59 - 4·38 ] , p=0·00063 ) and for 2D synthetic-3D mammography ( 427 of 9587 [ 4·45 % ; 4·05 - 4·89 ] , p<0·0001 ) . INTERPRETATION Integration of 3D mammography ( 2D-3D or 2D synthetic-3D ) detected more cases of breast cancer  than 2D mammography alone , but increased the percentage of false-positive recalls in sequential screen-reading . These results should be considered in the context of the trade-off between benefits and harms inherent in population breast cancer screening , including that significantly increased breast cancer detection from integrating 3D mammography into screening has the potential to augment screening benefit and also possibly contribute to overdiagnosis . FUNDING None
For example , mammography screening does not seem to create anxiety in women who are given a clear result after a mammogram .
The incidence of breast cancer and mortality increases with age , and the GDG extrapolated that the absolute health benefits are greater in women aged 45 to 49 than those aged 40 to 44 years .
However , for the 45- to 49-year age group , the higher breast cancer incidence and mortality compared with women between the ages of 40 and 44 , as well as observational evidence showing a greater benefit in this age group ( 33 ) , led the GDG to judge that the balance of health effects probably favors screening , although the required re sources for screening likely differ across setting s ( 34 , 35 ) .
Other EtD criteria also were generally in favor of implementing organized mammography screening in this age group .
Despite intensified efforts by the European Council since 2003 , the implementation of organized , population -based mammography screening is not uniform across Europe and depends greatly on the policies in place in different countries , the organization of health care , and available re sources ( 1 ) .
Since the last edition of the European Guidelines on Breast Cancer Screening and Diagnosis was published in 2006 ( 2 ) , new evidence regarding breast cancer and innovation in guideline methodology prompted the European Commission Initiative on Breast Cancer ( ECIBC ) to develop new evidence -based recommendations ( in short , the European Breast Guidelines ) .
These guidelines inform women , health professionals , and policymakers about important questions related to organized mammography screening and breast cancer diagnosis , but recommendations may apply in context s in which organized screening programs are not in place .
Women generally consider these undesirable effects acceptable ( low certainty of evidence ) , and a systematic review suggested that women place a relatively low value on the psychosocial and physical effects of false-positive results and overdiagnosis ; however , some studies raised concerns about whether women fully underst and the result ing implication s ( 15 ) .
How Often Should Women Attend an Organized Mammography Screening Program ?