The Background Review for the USPSTF Recommendation on Screening for Breast Cancer
Authors: Heidi D. Nelson
Journal: Annals of Internal Medicine (2010)

Letters20 April 2010The Background Review for the USPSTF Recommendation on Screening for Breast CancerFREEHeidi D. Nelson, MD, MPH, Arpana Naik, MD, Linda Humphrey, MD, MPH, and Kari Tyne, MDHeidi D. Nelson, MD, MPHFrom Oregon Health & Science University and Veteran's Administration Medical Center, Portland, OR 97239, and HealthPartners, St. Paul, MN 55114., Arpana Naik, MDFrom Oregon Health & Science University and Veteran's Administration Medical Center, Portland, OR 97239, and HealthPartners, St. Paul, MN 55114., Linda Humphrey, MD, MPHFrom Oregon Health & Science University and Veteran's Administration Medical Center, Portland, OR 97239, and HealthPartners, St. Paul, MN 55114., and Kari Tyne, MDFrom Oregon Health & Science University and Veteran's Administration Medical Center, Portland, OR 97239, and HealthPartners, St. Paul, MN 55114.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-8-201004200-00199 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We agree with the comments from Dr. Dickersin and colleagues that the findings of our systematic review and of relevant Cochrane reviews (1, 2) provide corroborative evidence about the benefits and harms of breast cancer screening. When we completed our final literature search in December 2008, the existing Cochrane review had not yet included the Age trial in its meta-analysis of mammography trials. This was added to the 2009 Cochrane meta-analysis, with similar results as our estimate (1).We also agree with points raised by Ms. DeFrank and Dr. Brewer regarding the transience of the effects of false-positive mammography results. In our article, we state that results of studies are mixed, and in "several studies, women had persistent anxiety, despite eventual negative [biopsy] results, whereas some showed only transient anxiety." Certainly, the long-term adverse effects of false-positive mammography results can be important, and we did not intend to minimize this problem.Drs. Jørgensen and Gøtzsche raise important issues about studies of overdiagnosis. We did not include the articles they cite because they were published after our review was completed. We also identified many problems with the available studies, including inconsistent methods, use of different outcome measures, lack of reporting results by age, and lack of estimates specific to U.S. populations. As a result, we determined that the studies were too heterogeneous to combine statistically and described them qualitatively. Most agree that overdiagnosis is an important adverse effect of screening, but data to accurately estimate its magnitude and appropriately apply this information to patient decision making in U.S. practice are not yet available.Heidi D. Nelson, MD, MPHArpana Naik, MDOregon Health & Science UniversityPortland, OR 97239Linda Humphrey, MD, MPHPortland Veterans Affairs Medical CenterPortland, OR 97239Kari Tyne, MDHealthPartnersSt. Paul, MN 55114References1. Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2009;:CD001877. [PMID: 19821284] MedlineGoogle Scholar2. Kösters JP, Gøtzsche PC. Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database Syst Rev. 2003;:CD003373. [PMID: 12804462] MedlineGoogle Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Heidi D. Nelson, MD, MPH; Arpana Naik, MD; Linda Humphrey, MD, MPH; Kari Tyne, MDAffiliations: From Oregon Health & Science University and Veteran's Administration Medical Center, Portland, OR 97239, and HealthPartners, St. Paul, MN 55114.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoScreening for Breast Cancer: An Update for the U.S. Preventive Services Task Force Heidi D. Nelson , Kari Tyne , Arpana Naik , Christina Bougatsos , Benjamin K. Chan , and Linda Humphrey When Evidence Collides With Anecdote, Politics, and Emotion: Breast Cancer ScreeningThe EditorsThe Background Review for the USPSTF Recommendation on Screening for Breast Cancer Kay Dickersin , David Tovey , Nicholas Wilcken , and Davina Ghersi The Background Review for the USPSTF Recommendation on Screening for Breast Cancer Jessica T. DeFrank and Noel T. Brewer The Background Review for the USPSTF Recommendation on Screening for Breast Cancer Karsten J. Jørgensen and Peter C. Gøtzsche Metrics Cited byCitations of scientific results and conflicts of interest: the case of mammography screeningWhen Evidence Collides With Anecdote, Politics, and Emotion: Breast Cancer ScreeningThe Editors 20 April 2010Volume 152, Issue 8 Page: 538-539 Keywords Anxiety Breast cancer Breast cancer screening Cancer screening Conflicts of interest Decision making Mammography Population statistics Qualitative studies Systematic reviews ePublished: 20 April 2010 Issue Published: 20 April 2010 Copyright & PermissionsCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...