Individualized risk should guide mammography

Individualized risk should guide mammography
Individualized risk should guide mammography

HealthDay News -- Better decision aids that incorporate individualized risk could improve breast cancer screening, according to a review published in the April 2 issue of the Journal of the American Medical Association.

Lydia E. Pace, MD, and Nancy L. Keating, MD, both from Brigham and Women's Hospital in Boston, conducted a systematic literature review to identify studies describing the benefits and harms of mammography and individualizing screening decisions and promoting informed decision making.

Mammography screening was associated with a 19% overall reduction in breast cancer mortality (approximately 15% for women in their 40s and 32% for women in their 60s). The cumulative risk of a false-positive result was about 61% for a 40- or 50-year-old woman undergoing 10 years of annual mammograms, the researchers found.

Over 10 years, roughly 19% of the cancers diagnosed would not have become clinically apparent without screening (overdiagnosis), although there is uncertainty about this estimate. Baseline breast cancer risk was found to greatly determine the net benefit of screening; this risk should be incorporated into screening decisions.

"To maximize the benefit of mammography screening, decisions should be individualized based on patients' risk profiles and preferences," the researchers wrote.

In an accompanying editorial, Joann G. Elmore, MD, MPH, and Barnett S. Kramer, MD, MPH, point out that most other countries recommend beginning breast cancer screening at age 50 years rather than 40, and at less frequent intervals, every two to three years vs. annually.

"Women bear not only financial charges, but also important human costs," Elmore and Kramer wrote. "Screening mammography can trigger recalls for more testing, biopsies, mastectomies, radiation, systemic therapy, days off work and debt related to healthcare costs. These byproducts of screening can lead to adverse financial consequences and personal harm."

References

  1. Pace LE et al. JAMA. 2014;311(13):1327-1335.
  2. Elmore JG, Kramer BS. JAMA. 2014; 311(13):1298-1299.

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