The Background Review for the USPSTF Recommendation on Screening for Breast Cancer
Authors: Kay Dickersin
Journal: Annals of Internal Medicine (2010)

Letters20 April 2010The Background Review for the USPSTF Recommendation on Screening for Breast CancerFREEKay Dickersin, MA, PhD, David Tovey, MBChB, Nicholas Wilcken, MBBS, PhD, and Davina Ghersi, MPH, PhDKay Dickersin, MA, PhDFrom Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21205; The Cochrane Library, London SE1 2LP, United Kingdom; University of Sydney, Wentworthville, New South Wales 2145, Australia; and University of Sydney, Sydney School of Public Health, Sydney, New South Wales 2006, Australia., David Tovey, MBChBFrom Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21205; The Cochrane Library, London SE1 2LP, United Kingdom; University of Sydney, Wentworthville, New South Wales 2145, Australia; and University of Sydney, Sydney School of Public Health, Sydney, New South Wales 2006, Australia., Nicholas Wilcken, MBBS, PhDFrom Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21205; The Cochrane Library, London SE1 2LP, United Kingdom; University of Sydney, Wentworthville, New South Wales 2145, Australia; and University of Sydney, Sydney School of Public Health, Sydney, New South Wales 2006, Australia., and Davina Ghersi, MPH, PhDFrom Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21205; The Cochrane Library, London SE1 2LP, United Kingdom; University of Sydney, Wentworthville, New South Wales 2145, Australia; and University of Sydney, Sydney School of Public Health, Sydney, New South Wales 2006, Australia.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-8-201004200-00196 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The recent changes to the U.S. Preventive Services Task Force (USPSTF) breast cancer screening recommendations are welcome and reflect the best available current evidence (1). The updated systematic review by Nelson and colleagues (2), which is the basis for the changes, concurs substantially with the relevant Cochrane review on mammography and, indeed, the Cochrane review of breast self-examination or clinical examination (3, 4).Persons raising concerns about Nelson and colleagues' review should be reassured that the summary breast cancer mortality reduction of 15% from screening mammography is similar to that presented in the Cochrane review, which was performed independently, and leads to similar estimates of the numbers needed to invite for examination to prevent or delay 1 death from breast cancer.Perhaps the most important addition to the revised USPSTF recommendations is the examination of harms from screening, in particular false-positive results and overdiagnosis. Again, the figures for false-positive results are similar between the 2 reviews and suggest that almost half of U.S. women who have been screened 10 times can expect at least 1 false-positive result with mammography. Both the USPSTF and Cochrane reviews found that overdiagnosis was related to mammography, although the estimation of its frequency varies between the 2 assessments.Evidence-based decision making requires high-quality reliable reviews. The similar findings of Nelson and colleagues' review and the Cochrane review should be reassuring to women working with their physicians to make evidence-based, informed decisions about screening mammography.Kay Dickersin, MA, PhDJohns Hopkins University, Bloomberg School of Public HealthBaltimore, MD 21205David Tovey, MBChBThe Cochrane LibraryLondon SE1 2LP, United KingdomNicholas Wilcken, MBBS, PhDUniversity of SydneyWentworthville, New South Wales 2145, AustraliaDavina Ghersi, MPH, PhDUniversity of Sydney, Sydney School of Public HealthSydney, New South Wales 2006, AustraliaReferences1. 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. Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L; U.S. Preventive Services Task Force. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151:727-37, W237-42. [PMID: 19920273] LinkGoogle Scholar3. Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2009;:CD001877. [PMID: 19821284] MedlineGoogle Scholar4. 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 Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21205; The Cochrane Library, London SE1 2LP, United Kingdom; University of Sydney, Wentworthville, New South Wales 2145, Australia; and University of Sydney, Sydney School of Public Health, Sydney, New South Wales 2006, Australia.Disclosures: All authors are members of the Cochrane Collaboration, which has published related reviews. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoScreening for Breast Cancer: U.S. Preventive Services Task Force Recommendation StatementScreening 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 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 The Background Review for the USPSTF Recommendation on Screening for Breast Cancer Heidi D. Nelson , Arpana Naik , Linda Humphrey , and Kari Tyne Metrics Cited byUnsupervised learning methods in X-ray spectral imaging material segmentationOptimal planar X-ray imaging soft tissue segmentation using a photon counting detectorPercepción de los profesionales de salud sobre el Programa de Detección Precoz del Cáncer de Mama en BarcelonaCitations of scientific results and conflicts of interest: the case of mammography screeningBreast Cancer Screening with MammographyWhen Evidence Collides With Anecdote, Politics, and Emotion: Breast Cancer ScreeningThe Editors 20 April 2010Volume 152, Issue 8Page: 537KeywordsBreast cancerBreast cancer screeningCancer screeningConflicts of interestDecision makingMammographySystematic reviews ePublished: 20 April 2010 Issue Published: 20 April 2010 Copyright & PermissionsCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...