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Kay Dickersin, David Tovey, Nicholas Wilcken, Davina Ghersi; The Background Review for the USPSTF Recommendation on Screening for Breast Cancer. Annals of Internal Medicine. 2010 Apr;152(8):537.

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Letters | 20 April 2010

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

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

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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, 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;151:716-26, W-236. [PMID: 19920272]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

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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

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