Individualization Improves Mammography Screening

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Individualization Improves Mammography Screening
Individualization Improves Mammography Screening

(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.

The researchers found that 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).

RELATED: Do Mammograms Save Lives?

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. 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, of the Harborview Medical Center, Department of Medicine, University of Washington School of Medicine in Seattle, and Barnett S. Kramer, MD, MPH, of the National Cancer Institute, said that the study results will help inform clinicians and patients about how best to proceed with mammogram screening.

RELATED: Breast Cancer Resource Center

"Balanced messaging is essential to help each woman make her own individual decision regarding her participation in screening mammography. This decision should start with facts, and Pace and Keating have provided an excellent summary of the risks and benefits," they wrote.

"Health professionals should not shortchange the discussion of potential harms or impose personal opinions in the decision-making process. Messages based on fear or guilt may impede full understanding. Women considering screening mammography should receive all the information they need, and their preferences should be respected."

References

  1. Pace LE, Keating NL. A Systematic Assessment of Benefits and Risks to Guide Breast Cancer Screening Decisions. JAMA. 2014;311(13):1327-1335.
  2. Elmore JG, Kramer BS. Breast Cancer Screening: Toward Informed Decisions. JAMA. 2014;311(13):1298-1299.

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