title: The Japanese Guidelines for Breast Cancer Screening.
abstract: OBJECTIVE
  The incidence of breast cancer has progressively increased, making it the leading cause of cancer deaths in Japan. Breast cancer accounts for 20.4% of all new cancers with a reported age-standardized rate of 63.6 per 100 000 women.
  
  
  METHODS
  The Japanese guidelines for breast cancer screening were developed based on a previously established method. The efficacies of mammography with and without clinical breast examination, clinical breast examination and ultrasonography with and without mammography were evaluated. Based on the balance of the benefits and harms, recommendations for population-based and opportunistic screenings were formulated.
  
  
  RESULTS
  Five randomized controlled trials of mammographic screening without clinical breast examination were identified for mortality reduction from breast cancer. The overall relative risk for women aged 40-74 years was 0.75 (95% CI: 0.67-0.83). Three randomized controlled trials of mammographic screening with clinical breast examination served as eligible evidence for mortality reduction from breast cancer. The overall relative risk for women aged 40-64 years was 0.87 (95% confidence interval: 0.77-0.98). The major harms of mammographic screening were radiation exposure, false-positive cases and overdiagnosis. Although two case-control studies evaluating mortality reduction from breast cancer were found for clinical breast examination, there was no study assessing the effectiveness of ultrasonography for breast cancer screening.
  
  
  CONCLUSIONS
  Mammographic screening without clinical breast examination for women aged 40-74 years and with clinical breast examination for women aged 40-64 years is recommended for population-based and opportunistic screenings. Clinical breast examination and ultrasonography are not recommended for population-based screening because of insufficient evidence regarding their effectiveness.
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan chamashi@ncc.go.jp.
authors.forename: Chisato
authors.initials: C
authors.lastname: Hamashima
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Chisato
authors.initials: C
authors.lastname: Hamashima C
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Hattori
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Honjo
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kasahara
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Katayama
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakai
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Tomio
authors.initials: T
authors.lastname: Nakayama
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Takako
authors.initials: T
authors.lastname: Morita
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Ohta
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Ohnuki
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Motoyasu
authors.initials: M
authors.lastname: Sagawa
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saito
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Seiju
authors.initials: S
authors.lastname: Sasaki
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Shimada
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Sobue
authors.affiliation: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Suto
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D055088:Early Detection of Cancer; D005189:False Positive Reactions; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007564:Japan; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D012306:Risk; D014463:Ultrasonography
keywords: breast cancer; cancer screening; clinical breast examination; guideline; mammography; meta-analysis; systematic review; ultrasonography