0
Letters |

The Background Review for the USPSTF Recommendation on Screening for Breast Cancer FREE

Kay Dickersin, MA, PhD; David Tovey, MBChB; Nicholas Wilcken, MBBS, PhD; and Davina Ghersi, MPH, PhD
[+] Article and Author Information

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.


Potential Conflicts of Interest: All authors are members of the Cochrane Collaboration, which has published related reviews.


Ann Intern Med. 2010;152(8):537. doi:10.7326/0003-4819-152-8-201004200-00196
Text Size: A A A

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 (34).

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, PhD

Johns Hopkins University, Bloomberg School of Public Health

Baltimore, MD 21205

David Tovey, MBChB

The Cochrane Library

London SE1 2LP, United Kingdom

Nicholas Wilcken, MBBS, PhD

University of Sydney

Wentworthville, New South Wales 2145, Australia

Davina Ghersi, MPH, PhD

University of Sydney, Sydney School of Public Health

Sydney, New South Wales 2006, Australia

References

U.S. Preventive Services Task Force.  Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009; 151. PubMed
 
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. PubMed
 
Gøtzsche PC, Nielsen M.  Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2009; CD001877. PubMed
 
Kösters JP, Gøtzsche PC.  Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database Syst Rev. 2003; CD003373. PubMed
 

Figures

Tables

References

U.S. Preventive Services Task Force.  Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009; 151. PubMed
 
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. PubMed
 
Gøtzsche PC, Nielsen M.  Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2009; CD001877. PubMed
 
Kösters JP, Gøtzsche PC.  Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database Syst Rev. 2003; CD003373. PubMed
 

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Want to Subscribe?

Learn more about subscription options

Advertisement
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)