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Heidi D. Nelson, Arpana Naik, Linda Humphrey, Kari Tyne; The Background Review for the USPSTF Recommendation on Screening for Breast Cancer. Annals of Internal Medicine. 2010 Apr;152(8):538-539.

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Letters | 20 April 2010

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

Heidi D. Nelson, MD, MPH; Arpana Naik, MD; Linda Humphrey, MD, MPH; and Kari Tyne, MD

From Oregon Health & Science University and Veteran's Administration Medical Center, Portland, OR 97239, and HealthPartners, St. Paul, MN 55114.

Potential Conflicts of Interest: None disclosed.

Ann Intern Med. 2010;152(8):538-539. doi:10.7326/0003-4819-152-8-201004200-00199

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IN RESPONSE:

We agree with the comments from Dr. Dickersin and colleagues that the findings of our systematic review and of relevant Cochrane reviews (1 - 2) provide corroborative evidence about the benefits and harms of breast cancer screening. When we completed our final literature search in December 2008, the existing Cochrane review had not yet included the Age trial in its meta-analysis of mammography trials. This was added to the 2009 Cochrane meta-analysis, with similar results as our estimate (1).

We also agree with points raised by Ms. DeFrank and Dr. Brewer regarding the transience of the effects of false-positive mammography results. In our article, we state that results of studies are mixed, and in “several studies, women had persistent anxiety, despite eventual negative [biopsy] results, whereas some showed only transient anxiety.” Certainly, the long-term adverse effects of false-positive mammography results can be important, and we did not intend to minimize this problem.

Drs. Jørgensen and Gøtzsche raise important issues about studies of overdiagnosis. We did not include the articles they cite because they were published after our review was completed. We also identified many problems with the available studies, including inconsistent methods, use of different outcome measures, lack of reporting results by age, and lack of estimates specific to U.S. populations. As a result, we determined that the studies were too heterogeneous to combine statistically and described them qualitatively. Most agree that overdiagnosis is an important adverse effect of screening, but data to accurately estimate its magnitude and appropriately apply this information to patient decision making in U.S. practice are not yet available.

Heidi D. Nelson, MD, MPH

Arpana Naik, MD

Oregon Health & Science University

Portland, OR 97239

Linda Humphrey, MD, MPH

Portland Veterans Affairs Medical Center

Portland, OR 97239

Kari Tyne, MD

HealthPartners

St. Paul, MN 55114

References

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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References

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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