Screening for breast cancer: an update for the U.S. Preventive Services Task Force.
BACKGROUND
This systematic review is an update of evidence since the 2002 U.S. Preventive Services Task Force recommendation on breast cancer screening.


OBJECTIVE
To determine the effectiveness of mammography screening in decreasing breast cancer mortality among average-risk women aged 40 to 49 years and 70 years or older, the effectiveness of clinical breast examination and breast self-examination, and the harms of screening.


METHODS
Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2008), MEDLINE (January 2001 to December 2008), reference lists, and Web of Science searches for published studies and Breast Cancer Surveillance Consortium for screening mammography data.


METHODS
Randomized, controlled trials with breast cancer mortality outcomes for screening effectiveness, and studies of various designs and multiple data sources for harms.


METHODS
Relevant data were abstracted, and study quality was rated by using established criteria.


RESULTS
Mammography screening reduces breast cancer mortality by 15% for women aged 39 to 49 years (relative risk, 0.85 [95% credible interval, 0.75 to 0.96]; 8 trials). Data are lacking for women aged 70 years or older. Radiation exposure from mammography is low. Patient adverse experiences are common and transient and do not affect screening practices. Estimates of overdiagnosis vary from 1% to 10%. Younger women have more false-positive mammography results and additional imaging but fewer biopsies than older women. Trials of clinical breast examination are ongoing; trials for breast self-examination showed no reductions in mortality but increases in benign biopsy results.


CONCLUSIONS
Studies of older women, digital mammography, and magnetic resonance imaging are lacking.


CONCLUSIONS
Mammography screening reduces breast cancer mortality for women aged 39 to 69 years; data are insufficient for older women. False-positive mammography results and additional imaging are common. No benefit has been shown for clinical breast examination or breast self-examination.
Nelson
Heidi D
HD
Oregon Health & Science University, Veterans Affairs Medical Center, Portland, OR 97239-3098, USA. nelsonh@ohsu.edu
Tyne
Kari
K
Naik
Arpana
A
Bougatsos
Christina
C
Chan
Benjamin K
BK
Humphrey
Linda
L
D000328:Adult; D000367:Age Factors; D000368:Aged; D001007:Anxiety / Q000209:etiology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality; D016504:Breast Self-Examination; D055088:Early Detection of Cancer; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics; D008327:Mammography / Q000009:adverse effects / Q000191:economics / Q000379:methods; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D010173:Palpation / Q000191:economics; D012307:Risk Factors