Abstract
Breast cancer remains the most common nonskin cancer, the second leading cause of cancer deaths, and the leading cause of premature death in US women. Mammography screening has been proven effective in reducing breast cancer deaths in women age 40 years and older. A mortality reduction of 40% is possible with regular screening. Treatment advances cannot overcome the disadvantage of being diagnosed with an advanced-stage tumor. The ACR and Society of Breast Imaging recommend annual mammography screening beginning at age 40, which provides the greatest mortality reduction, diagnosis at earlier stage, better surgical options, and more effective chemotherapy. Annual screening results in more screening-detected tumors, tumors of smaller sizes, and fewer interval cancers than longer screening intervals. Screened women in their 40s are more likely to have early-stage disease, negative lymph nodes, and smaller tumors than unscreened women. Delaying screening until age 45 or 50 will result in an unnecessary loss of life to breast cancer and adversely affects minority women in particular. Screening should continue past age 74 years, without an upper age limit unless severe comorbidities limit life expectancy. Benefits of screening should be considered along with the possibilities of recall for additional imaging and benign biopsy and the less tangible risks of anxiety and overdiagnosis. Although recall and biopsy recommendations are higher with more frequent screening, so are life-years gained and breast cancer deaths averted. Women who wish to maximize benefit will choose annual screening starting at age 40 years and will not stop screening prematurely.
Original language | English (US) |
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Pages (from-to) | 1280-1288 |
Number of pages | 9 |
Journal | Journal of the American College of Radiology |
Volume | 18 |
Issue number | 9 |
DOIs | |
State | Published - Sep 2021 |
Funding
Dr Friedewald reports Hologic consultant and Google research grant; Dr Leung reports advisory board Subtle Medical; speaker at educational events supported by Fujfilm, GE Healthcare , and Hologic; Dr Hendrick reports consultant, GE Healthcare; Dr Moy reports iCAD advisory board, institutional grants Siemens , stock unit. The other authors state that they have no conflict of interest related to the material discussed in this article. Dr Monticciolo, Dr Malak, Dr Friedewald, Dr Eby, Dr Newell, Dr Moy, Dr Leung, and Dr Smetherman are nonpartner, non–partnership track employees. Dr Hendrick is retired. Dr Destounis is Partner; Owner and Managing Partner at Elizabeth Wende Breast Care, Rochester, New York.
Keywords
- Breast cancer
- breast cancer screening
- early detection
- mammography
- mammography screening
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging