矯正醫生的狂想曲--- Straight teeth and life

November 17, 2009 — The US Preventive Services Task Force (USPSTF) has issued new breast cancer screening guidelines, which are published in the November 17 issue of the Annals of Internal Medicine.

The new USPSTF recommendations are in opposition to other existing breast cancer screening guidelines from organizations such as the American Cancer Society and the American College of Radiology, which have both criticized the new document. Several agencies and organizations, such as the Seattle Cancer Care Alliance, have said they will continue to follow the American Cancer Society guidelines. However, according to an article in the New York Times, advocacy groups like the National Breast Cancer Coalition, Breast Cancer Action, and the National Women’s Health Network "welcomed the new guidelines."

The 10-year breast cancer risk is 1 in 69 for age 40 years, 1 in 42 for age 50 years, and 1 in 29 for age 60 years, according to the SEER Cancer Statistics Review, 1975-2006, by Horner and colleagues (11 from USPSTF statement).

In the September 3, 2002, issue of the Annals of Internal Medicine (6 from USPSTF statement), the USPSTF recommendations for breast cancer screening included screening mammography every 1 to 2 years for all women older than 40 years and cited insufficient evidence regarding BSE (breast self-examination) and CBE (clinical breast examination).

The USPSTF conducted a systematic review of benefits and harms of screening and a decision analysis using population modeling techniques to compare the projected health outcomes and resource needs of mammography screening for various age groups and annual vs biennial intervals.

Because of insufficient evidence to determine the benefits and harms of screening mammography in women older than 75 years, the updated guidelines recommend stopping screening at age 74 years.

Because the USPSTF found adequate evidence that teaching self-examination is not associated with a decrease in breast cancer mortality rates, the task force recommends against teaching breast self-examination (BSE).

Based on this information, the current updated recommendation statement from the USPSTF applies to women 40 years or older who are not at increased risk for breast cancer and addresses the efficacy of 5 screening methods for reducing breast cancer mortality rates: film mammography, CBE, BSE, digital mammography, and MRI.

• In women aged at least 40 years without increased risk for breast cancer, the USPSTF recommends screening mammography every 2 years for women aged 50 to 74 years and no routine screening before age 50 years and cites insufficient evidence to make recommendations for age 75 years and older.
• The USPSTF finds insufficient evidence to assess the benefits and harms of CBE beyond screening mammography in women 40 years or older and recommends against teaching BSE.