Choose a Set of Guidelines From a Major Medical Organization and Follow the Recommendations

Breast cancer remainsa significant healthconcern for women. Amongwomen at average risk,breast cancer will develop in1 of 8, and 1 in 30 will die ofthe disease.¹ Although therehas been recent excitementabout the potential of geneticscreening to predict individualbreast cancer risk, itis important to keep in mindthat nearly 75% of women inwhom breast cancer hasbeen diagnosed have hadno risk factors other thansex and age.²No benefit from physicalbreast exam alone.Despite the studies andcommentary that questionthe value of mammography,the evidence continuesto support its use as themost effective, widely accessiblescreening tool forearly detection of breastcancer. The 3 major breastcancer screening tools are:

• Breast self-examination(BSE).
• Clinical breast examination(CBE).
• Mammography.

Studies show that BSEand CBE alone have consistentlyfailed to demonstrateany impact on breastcancer outcome. Thus, recentscreening guidelinesfrom the United States PreventiveServices TaskForce (USPSTF) do notrecommend for or againsteither BSE or CBE on thestrength of the existing evidence.

²

However, theUSPSTF has reassertedthe value of routine mammographyin early breastcancer detection.

Evidence of benefitfrom mammography.

TheUSPSTF reviewed the availableevidence and found thatthe specificity of a singlemammogram was between94% and 97%. The positivepredictive value ranged from2% to 22% for abnormal resultsthat required furtherevaluation to 12% to 78% forabnormal results that requiredbiopsy (the positivepredictive value of abnormalresults increased with patientage).

²

Although therehas been controversy aboutthe effectiveness of mammographyin women aged40 to 49 years, recent evidencesupports a survivalbenefit even in this agegroup.

²

Thus, the USPSTFrecommends that all womenaged 40 years and older bescreened with mammographyevery 1 to 2 years.

Mammography recommendedby many organizations.

Many other organizationssupport this recommendation(with somevariation in the recommendedinterval between screenings).These include theAmerican Cancer Society,the American Academy ofFamily Physicians, theAMA, and the AmericanCollege of Obstetricians &Gynecologists. Until betterscreening technologies aredeveloped, tested, andmade widely available, physiciansshould feel confidentrecommending screeningmammography to their patients.A wise policy is tochoose a set of guidelinesfrom one of these organizationsand follow them incounseling all patients.

References:

REFERENCES:

1.

American Cancer Society. Cancerfacts and figures 2001. Available at:http://www.cancer.org. AccessedMay 15, 2003.

2.

Humphrey L, Helfand M, Chan B,Woolf S. Breast cancer screening: asummary of the evidence for the USPreventive Services Task Force.

AnnIntern Med

. 2002;137:E347-E367.