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      Screening mammography with special reference to guidelines in South Africa

      review-article
      1 ,
      SA Journal of Radiology
      AOSIS

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          Abstract

          Screening mammography is known to reduce mortality from breast cancer. Controversy regarding screening has led to much confusion in the medical fraternity. The purpose of this review is to point out the ‘pros and cons’ of screening. The benefits and perceived harms of screening will be discussed using evidence-based literature from the past 30 years. The literature was obtained from various journals sourced from the Internet. General findings are that screening mammography from the age of 40 saves lives, but that the problem of overdiagnosis and overtreatment of certain breast cancers overrides the benefit of screening. The article also covers the debate on what age to begin screening. Screening in the South African context is discussed. Screening in the future will need to be more selective of patients and of which cancers to treat less aggressively, if at all.

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          Most cited references47

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          Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society.

          Breast cancer is a leading cause of premature mortality among US women. Early detection has been shown to be associated with reduced breast cancer morbidity and mortality.
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            Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement.

            (2009)
            Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for breast cancer in the general population. The USPSTF examined the evidence on the efficacy of 5 screening modalities in reducing mortality from breast cancer: film mammography, clinical breast examination, breast self-examination, digital mammography, and magnetic resonance imaging in order to update the 2002 recommendation. To accomplish this update, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review of 6 selected questions relating to benefits and harms of screening, and 2) a decision analysis that used population modeling techniques to compare the expected health outcomes and resource requirements of starting and ending mammography screening at different ages and using annual versus biennial screening intervals. The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms. (Grade C recommendation) The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years. (Grade B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older. (I statement) The USPSTF recommends against clinicians teaching women how to perform breast self-examination. (Grade D recommendation) The USPSTF concludes that the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging instead of film mammography as screening modalities for breast cancer. (I statement).
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              Screening for breast cancer: an update for the U.S. Preventive Services Task Force.

              This systematic review is an update of evidence since the 2002 U.S. Preventive Services Task Force recommendation on breast cancer screening. To determine the effectiveness of mammography screening in decreasing breast cancer mortality among average-risk women aged 40 to 49 years and 70 years or older, the effectiveness of clinical breast examination and breast self-examination, and the harms of screening. Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2008), MEDLINE (January 2001 to December 2008), reference lists, and Web of Science searches for published studies and Breast Cancer Surveillance Consortium for screening mammography data. Randomized, controlled trials with breast cancer mortality outcomes for screening effectiveness, and studies of various designs and multiple data sources for harms. Relevant data were abstracted, and study quality was rated by using established criteria. Mammography screening reduces breast cancer mortality by 15% for women aged 39 to 49 years (relative risk, 0.85 [95% credible interval, 0.75 to 0.96]; 8 trials). Data are lacking for women aged 70 years or older. Radiation exposure from mammography is low. Patient adverse experiences are common and transient and do not affect screening practices. Estimates of overdiagnosis vary from 1% to 10%. Younger women have more false-positive mammography results and additional imaging but fewer biopsies than older women. Trials of clinical breast examination are ongoing; trials for breast self-examination showed no reductions in mortality but increases in benign biopsy results. Studies of older women, digital mammography, and magnetic resonance imaging are lacking. Mammography screening reduces breast cancer mortality for women aged 39 to 69 years; data are insufficient for older women. False-positive mammography results and additional imaging are common. No benefit has been shown for clinical breast examination or breast self-examination.
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                Author and article information

                Journal
                SA J Radiol
                SA J Radiol
                SAJR
                SA Journal of Radiology
                AOSIS
                1027-202X
                2078-6778
                31 October 2018
                2018
                : 22
                : 2
                : 1370
                Affiliations
                [1 ]Dr Shirley Lipschitz and Associates, Sunninghill, Sandton, South Africa
                Author notes
                Corresponding author: Shirley Lipschitz, hofsrj@ 123456mweb.co.za
                Author information
                https://orcid.org/0000-0002-3543-324X
                Article
                SAJR-22-1370
                10.4102/sajr.v22i2.1370
                6837783
                31754518
                c9f0230b-8213-41e1-b8c1-881b3a26e60c
                © 2018. The Authors

                Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.

                History
                : 31 May 2018
                : 27 July 2018
                Categories
                Review Article

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