Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer
Authors: Peter B. Dean
Journal: Annals of Internal Medicine (2010)

Letters20 April 2010Comments and Response on the USPSTF Recommendation on Screening for Breast CancerFREEPeter B. Dean, MDPeter B. Dean, MDFrom University of Turku Faculty of Medicine and Turku University Hospital, 20520 Turku, Finland.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-8-201004200-00200 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The data search for published evidence from the randomized, controlled trials (RCTs) used by the U.S. Preventive Services Task Force (USPSTF) in its breast cancer screening recommendation (1) ended in December 2008. In June 2009, Holmberg and colleagues (2) presented a review of the data from the Swedish Two-County Trial, which showed that the methods used in the previous overview of the 2 Swedish trials (3) “resulted in a reduction of the estimate of the effect of screening.” Unfortunately, these erroneous data from the early overview (3) were used for both the 2002 and 2009 USPSTF evaluations.The USPSTF evaluation (1) and supporting articles are plagued with ambiguity over the terms “screen” and “screening” when used alone and in conjunction with the term “mammography.” Whereas the evidence of benefit has been drawn exclusively from intention-to-treat publications, the numerical conclusions have been directly applied by the USPSTF to the individual woman seeking advice from her physician. If the USPSTF evaluation is taken at face value, women will be told the estimated benefit of receiving an invitation to participate in a mammography screening program. This estimated benefit is considerably lower, by a factor of approximately 1.4, than the actual benefit of mammography (4). On the contrary, the harms estimated by the USPSTF are not calculated on an intention-to-treat basis, which introduced bias into the risk–benefit calculations.The benefits of regular mammography were measured in Sweden by using the ongoing service screening programs (5), and results for women aged 40 to 49 years have been submitted for publication. These comprehensive service screening data more closely answer the question posed by the USPSTF concerning the benefits resulting from regular mammography versus no mammography than do the historical RCT data, which were designed to answer a different question.Peter B. Dean, MDUniversity of Turku Faculty of Medicine and Turku University Hospital20520 Turku, FinlandReferences1. U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151:716-26, W-236. [PMID: 19920272] MedlineGoogle Scholar2. Holmberg L, Duffy SW, Yen AM, Tabár L, Vitak B, Nyström L, et al. Differences in endpoints between the Swedish W-E (two county) trial of mammographic screening and the Swedish overview: methodological consequences. J Med Screen. 2009;16:73-80. [PMID: 19564519] CrossrefMedlineGoogle Scholar3. Nyström L, Andersson I, Bjurstam N, Frisell J, Nordenskjöld B, Rutqvist LE. Long-term effects of mammography screening: updated overview of the Swedish randomised trials. Lancet. 2002;359:909-19. [PMID: 11918907] CrossrefMedlineGoogle Scholar4. Duffy SW, Tabár L, Chen HH, Holmqvist M, Yen MF, Abdsalah S, et al. The impact of organized mammography service screening on breast carcinoma mortality in seven Swedish counties. Cancer. 2002;95:458-69. [PMID: 12209737] CrossrefMedlineGoogle Scholar5. Swedish Organised Service Screening Evaluation Group. Reduction in breast cancer mortality from organized service screening with mammography: 1. Further confirmation with extended data. Cancer Epidemiol Biomarkers Prev. 2006;15:45-51. [PMID: 16434585] CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From University of Turku Faculty of Medicine and Turku University Hospital, 20520 Turku, Finland.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoScreening for Breast Cancer: U.S. Preventive Services Task Force Recommendation StatementWhen Evidence Collides With Anecdote, Politics, and Emotion: Breast Cancer ScreeningComments and Response on the USPSTF Recommendation on Screening for Breast Cancer R. Scott Braithwaite Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer Mitchell H. Gail and Catherine Schairer Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer Colin B. Begg Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer Richard Yoast Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer Victoria L. Seewaldt Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer Nananda F. Col , Moritz H. Hansen , Baruch Fischhoff , and Steven G. Pauker Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer Anita Ho Comments and Response on the USPSTF Recommendation on Screening for Breast Cancer Diana Pettiti and Ned Calonge Metrics Cited ByQuality varies across clinical practice guidelines for mammography screening in women aged 40–49 years as assessed by AGREE and AMSTAR instrumentsScreening women aged 40–49yearsWhen Evidence Collides With Anecdote, Politics, and Emotion: Breast Cancer ScreeningThe Editors 20 April 2010Volume 152, Issue 8Page: 539KeywordsBreast cancerBreast cancer screeningCancer screeningConflicts of interestMammography ePublished: 20 April 2010 Issue Published: 20 April 2010 CopyrightCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...