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 ?
Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk.
CONTEXT Annual ultrasound screening may detect small , node-negative breast cancers that are not seen on mammography . Magnetic resonance imaging ( MRI ) may reveal additional breast cancers missed by both mammography and ultrasound screening . OBJECTIVE To determine supplemental cancer detection yield of ultrasound and MRI in women at elevated risk for breast cancer . DESIGN , SETTING , AND PARTICIPANTS From April 2004-February 2006 , 2809 women at 21 sites with elevated cancer risk and dense breasts consented to 3 annual independent screens with mammography and ultrasound in r and omized order . After 3 rounds of both screenings , 612 of 703 women who chose to undergo an MRI  had complete data . The reference st and ard was defined as a combination of pathology ( biopsy results that showed in situ or infiltrating ductal carcinoma or infiltrating lobular carcinoma in the breast or axillary lymph nodes ) and 12-month follow-up . MAIN OUTCOME MEASURES Cancer detection rate ( yield ) , sensitivity , specificity , positive predictive value ( PPV3 ) of biopsies performed and interval cancer rate . RESULTS A total of 2662 women underwent 7473 mammogram and ultrasound screenings  , 110 of whom had 111 breast cancer events : 33 detected by mammography only , 32 by ultrasound only , 26 by both , and 9 by MRI after mammography plus ultrasound ; 11 were not detected by any imaging screen . Among 4814 incidence screens in the second and third years combined , 75 women were diagnosed with cancer . Supplemental incidence-screening ultrasound identified 3.7 cancers per 1000 screens ( 95 % CI , 2.1 - 5.8 ; P < .001 ) . Sensitivity for  mammography plus ultrasound  was 0.76 ( 95 % CI , 0.65 - 0.85 ) ; specificity , 0.84 ( 95 % CI , 0.83 - 0.85 ) ; and PPV3 , 0.16 ( 95 % CI , 0.12 - 0.21 ) . For mammography alone , sensitivity was 0.52 ( 95 % CI , 0.40 - 0.64 ) ; specificity , 0.91 ( 95 % CI , 0.90 - 0.92 ) ; and PPV3 , 0.38 ( 95 % CI , 0.28 - 0.49 ; P < .001 all comparisons ) . Of the MRI participants , 16 women ( 2.6 % ) had breast cancer diagnosed . The supplemental yield of MRI  was 14.7 per 1000 ( 95 % CI , 3.5 - 25.9 ; P = .004 ) . Sensitivity for MRI and mammography plus ultrasound was 1.00 ( 95 % CI , 0.79 - 1.00 ) ; specificity , 0.65 ( 95 % CI , 0.61 - 0.69 ) ; and PPV3 , 0.19 ( 95 % CI , 0.11 - 0.29 ) . For mammography and ultrasound , sensitivity was 0.44 ( 95 % CI , 0.20 - 0.70 , P = .004 ) ; specificity 0.84 ( 95 % CI , 0.81 - 0.87 ; P < .001 ) ; and PPV3 , 0.18 ( 95 % CI , 0.08 to 0.34 ; P = .98 ) . The number of screens needed to detect 1 cancer was 127 ( 95 % CI , 99 - 167 ) for mammography ; 234 ( 95 % CI , 173 - 345 ) for supplemental ultrasound ; and 68 ( 95 % CI , 39 - 286 ) for MRI after negative mammography and ultrasound results . CONCLUSION The addition of screening ultrasound or MRI to mammography in women at increased risk of breast cancer result ed in not only a higher cancer detection yield but also an increase in false-positive findings . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00072501
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 ?