8. Breast Cancer Screening
Author: Ismail Jatoi
Publisher: Springer International Publishing
Breast cancer screening is a major public health issue. Decisions concerning breast cancer screening should be based upon the results of randomized controlled trials, not observational studies. There are three important biases associated with observational studies that examine the effect of screening: lead time, length, and selection biases. Randomized trials have shown that mammography screening reduces breast cancer-specific mortality in postmenopausal women. Additionally, randomized trials are underway to assess the efficacy of screening clinical breast examination (CBE) and screening breast ultrasound. Two large randomized trials have failed to demonstrate a benefit of screening breast self-examination (BSE) in reducing breast cancer-specific mortality. Screening breast MRI is often utilized in mutation carriers and those with increased risk of breast cancer based upon family history, but there are no randomized trials that have examined its efficacy. There are also potential hazards of screening that should be considered: lead time, false-positives, radiation exposure (from screening mammography), overdiagnosis, and cost. Women should be informed about both the potential risks and the benefits of breast cancer screening.