Breast Cancer Screening: Making Sense of Complex and Evolving Evidence PDF

Breast Cancer Screening: Making Sense of Complex and Evolving Evidence PDF
by Nehmat Houssami (Author), Diana Miglioretti (Author)

Breast Cancer Screening: Making Sense of Complex and Evolving Evidence covers broad aspects of breast cancer screening specifically focusing on current evidence, emerging evidence, and issues that will be critical for future breast screening practice such as tailored screening and shared decision-making in breast screening. The scope of the book is relevant to a global audience.

This book provides balanced perspectives on this increasingly controversial topic, using scientific evidence to explain the evolution of knowledge relating to breast cancer screening. Breast Cancer Screening covers the key points related to this debate including the context of increasingly complex and conflicting evidence, divergent opinions on the benefits and harms of breast screening, and variability in screening practice and outcomes across settings around the world.

Explains complex and evolving evidence on breast screening with a balanced approach
Provides balanced information and up-to-date evidence in an increasingly complex area
Addresses emerging topical issues such as screening trials of digital breast tomosynthesis, tailored breast screening, and shared decision-making in breast screening
Assists academics and researchers in identifying areas needing further research

A large body of evidence on population breast cancer screening with mammography has accumulated over five decades, including evidence from randomized controlled trials demonstrating efficacy.1,2Despite this, little in population health practice has received more attention, critique, praise, reinterpretation,and forensic-like scrutiny than mammography screening. The debate around breast cancer screening is unlikely to diminish as we move into a future of precision medicine, potentially competing screening technologies, and increasingly effective cancer treatments that require, more than ever before, working collaboratively to answer important questions about breast screening, based on the best available evidence. These questions include the optimal ages to start and stop routine screening, how often to screen, which modalities to use given a woman’s personal characteristics and risk factors, and how to ensure women are adequately informed about the benefits and harms of breast screening.It is well-established that mammography screening has the potential to confer benefit for many women by reducing breast cancer deaths through early-detection and treatment of the disease. Relative to younger or older counterparts, women aged 60–69 years are likely to benefit the most from mammography screening, given breast cancer is more common in this age-group than in younger women, and competing risk of death from other causes is still relatively low compared to older women.3
Although there is heterogeneity in estimates of the relative reduction in breast cancer mortality attributed to screening, reflecting differences in the design of studies and whether there was adjustment for screening participation, all estimates indicate the potential for benefit.1–3
Given this evidence of benefit, why is breast cancer screening still so controversial?The very same package through which this highly valued health benefit from mammography screening is achieved also causes harms. Harms include those associated with the technique itself comprising the relatively small risk associated with radiation exposure from mammography, and the inconvenience of an examination that briefly transitions the woman to a “patient” receiving an intervention. Because mammography is not a perfect test, somewhat more serious harms are false-positive interpretations, which result in additional imaging and biopsies of women without breast cancer

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