Two studies have put rough estimates to the benefit/harm trade-off for screening mammography.


In a study published in in JAMA Internal Medicine, H. Gilbert Welch, MD, MPH, and Honor J. Passow, PhD, of the Dartmouth Institute for Health Policy and Clinical Practice, evaluated the absolute frequency of three outcomes important to the mammography decision: breast cancer deaths avoided, false alarms and overdiagnosis.

Among 1,000 U.S. women aged 50 years who are screened annually for a decade, 0.3 to 3.2 will avoid death from breast cancer, 490 to 670 will have at least one false alarm, and 3 to 14 will be overdiagnosed and will undergo unnecessary treatment.

The authors acknowledged that many women will find these ranges insufficiently precise to make an informed decision about screening, and that women will likely desire more precise estimates regarding benefits and harms.


In other breast-cancer screening news, the United States Preventive Services Task Force (USPSTF) now recommends that primary-care providers screen asymptomatic women who have a family history of breast, ovarian, tubal or peritoneal cancers with one of several tools designed to identify a family history that may be associated with an increased risk for potentially harmful mutations in the breast-cancer susceptibility genes BRCA1 and BRCA2.

Writing in Annals of Internal Medicine on behalf of the USPSTF, guideline author Virginia A. Moyer, MD, MPH, advises women with positive screening results seek genetic counseling, followed by BRCA testing if indicated after counseling. 


References

  1. Welch GH, Passow HJ. JAMA Intern Med. 2013; doi:10.1001/jamainternmed.2013.13635.
  2. Moyer VA et al. Ann Intern Med. 2013; doi:10.7326/M13-2747.