An Overview of Mammography: Benefits and Limitations

Author:
Robert A. Smith From the American Cancer Society, Atlanta, Georgia.

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 PhD
Volume/Issue:
Volume 1: Issue 2
Online Publication Date:
Apr 2003
DOI:
https://doi.org/10.6004/jnccn.2003.0024
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Although broad consensus exists that mammography is beneficial, there has been persistent and evolving debate over the extent of the benefit, as well as concerns about cost-effectiveness. Ongoing evaluation of the world's randomized clinical trials as well as new evaluations of population service screening (ie, organized, community-based screening) clearly show that mammography is beneficial and that the benefit of modern mammography among women who attend screening exceeds what has conventionally been estimated from the trials. Limitations of mammography include human and financial costs associated with missed cancers and false-positive results. However, it is important to distinguish those limitations of mammography that are inherent limitations of the technology from those that can be reduced through greater attention to quality assurance.

Correspondence: Robert A. Smith, PhD, Cancer Control Science Department, American Cancer Society, 1599 Clifton Road, NE, Atlanta, Georgia 30329. E-mail: rsmith@cancer.org
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  • 1

    Wilson JMG, Junger G. Principles and Practice of Screening for Disease. Geneva, Switzerland: World Health Organization, 1968.

  • 2

    Parkin DM. Global cancer statistics in the year 2000. Lancet Oncol 2001;2:533–543.

  • 3

    American Cancer Society. American Cancer Society Facts and Figures. Atlanta: American Cancer Society, 2003. www.cancer.org.

  • 4

    Ries L, Eisner M, Kosary C et al.. SEER Cancer Statistics Review, 1973–1999. National Cancer Institute, 2002.

  • 5

    National Institutes of Health Consensus Development Panel. National Institutes of Health Consensus Development Conference Statement: Breast Cancer Screening for Women Ages 40–49, January 21–23, 1997. J Natl Cancer Inst 1997;89:1015–1026.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Smith-Bindman R, Kerlikowske K. Is there a downside to elderly women undergoing screening mammography? [editorial; comment]. J Natl Cancer Inst 1998;90:1322–1323.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Smith-Bindman R, Kerlikowske K, Gebretsadik T et al.. Is screening mammography effective in elderly women? Am J Med 2000;108:112–119.

  • 8

    Smith RA. Breast cancer screening among women younger than age 50: A current assessment of the issues. CA Cancer J Clin 2000;50:312–336.

  • 9

    Shapiro S, Venet W, Strax P et al.. Periodic Screening for Breast Cancer: The Health Insurance Plan Project and its Sequelae. Baltimore: Johns Hopkins Press, 1988.

  • 10

    Kerlikowske K, Salzmann P, Phillips KA et al.. Continuing screening mammography in women aged 70 to 79 years: Impact on life expectancy and cost-effectiveness. JAMA 1999;282:2156–2163.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Leitch AM, Dodd GD, Costanza M et al.. American Cancer Society guidelines for the early detection of breast cancer: Update 1997. CA Cancer J Clin 1997;47:150–153.

  • 12

    U.S. Preventive Services Task Force. Screening for breast cancer: recommendations and rationale. Ann Intern Med 2002;137(5 Part 1):344–346.

  • 13

    Kerlikowske K, Grady D, Barclay J et al.. Effect of age, breast density, and family history on the sensitivity of first screening mammography [see comments]. JAMA 1996;276:33–38.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Walter LC, Covinsky KE. Cancer screening in elderly patients: A framework for individualized decision making. JAMA 2001;285:2750–2756.

  • 15

    Tabar L, Vitak B, Chen HH et al.. The Swedish Two-County Trial twenty years later. Updated mortality results and new insights from long-term follow-up. Radiol Clin North Am 2000;38:625–651.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Shapiro S, Strax P, Venet L. Periodic breast cancer screening in reducing mortality from breast cancer. JAMA 1971; 215:1777–1785.

  • 17

    Miller AB, Baines CJ, To T et al.. Canadian National Breast Screening Study: 1. Breast cancer detection and death rates among women aged 40 to 49 years [published erratum appears in Can Med Assoc J 1993 Mar 1;148:718; see comments]. Can Med Assoc J 1992;147:1459–1476.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Miller AB, Baines CJ, To T et al.. Canadian National Breast Screening Study: 2. Breast cancer detection and death rates among women aged 50 to 59 years [published erratum appears in Can Med Assoc J 1993 Mar 1;148:718; see comments]. Can Med Assoc J 1992;147:1477–1488.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Tabar L, Fagerberg CJ, Gad A et al.. Reduction in mortality from breast cancer after mass screening with mammography. Randomised trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet 1985;1:829–832.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Andersson I, Aspegren K, Janzon L et al.. Mammographic screening and mortality from breast cancer: The Malmö mammographic screening trial. BMJ 1988;297:943–948.

  • 21

    Frisell J, Eklund G, Hellstrom L et al.. Randomized study of mammography screening—Preliminary report on mortality in the Stockholm trial. Breast Cancer Res Treat 1991;18:49–56.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Bjurstam N, Bjorneld L, Duffy SW et al.. The Gothenburg breast screening trial: First results on mortality, incidence, and mode of detection for women ages 39–49 years at randomization [see comments]. Cancer 1997;80:2091–2099.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Alexander FE, Anderson TJ, Brown HK et al.. The Edinburgh randomised trial of breast cancer screening: Results after 10 years of follow-up. Br J Cancer 1994;70:542–548.

  • 24

    Hendrick RE, Smith RA, Rutledge JH 3rd et al.. Benefit of screening mammography in women aged 40–49: A new meta-analysis of randomized controlled trials. J Natl Cancer Inst Monogr 1997;22:87–92.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Kerlikowske K. Efficacy of screening mammography among women aged 40 to 49 years and 50 to 69 years: Comparison of relative and absolute benefit. J Natl Cancer Inst Monogr 1997;22:79–86.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Humphrey LL, Helfand M, Chan BK et al.. Breast cancer screening: A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002;137(5 Part 1):347–360.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Nystrom L, Andersson I, Bjurstam N et al.. Long-term effects of mammography screening: Updated overview of the Swedish randomised trials. Lancet 2002;359:909–919.

  • 28

    Dodd GD. American Cancer Society guidelines on screening for breast cancer. An overview. Cancer 1992;69(Suppl 7):1885–1887.

  • 29

    Goodman NW. Screening mammography: but how do women decide? Lancet 2002;360:171.

  • 30

    Sox H. Screening mammography for younger women: back to basics. Ann Intern Med 2002;137(5 Part 1):361–362.

  • 31

    Feig SA. Estimation of currently attainable benefit from mammographic screening of women aged 40–49 years. Cancer 1995;75:2412–2419.

  • 32

    Berry DA. Benefits and risks of screening mammography for women in their forties: a statistical appraisal. J Natl Cancer Inst 1998;90:1431–1439.

  • 33

    Olsen O, Gøtzsche PC. Screening for breast cancer with mammography (Cochrane Review). Cochrane Database Syst Rev 2001;4:CD001877.

  • 34

    Olsen O, Gøtzsche PC. Cochrane review on screening for breast cancer with mammography. Lancet 2001;358: 1340–1342.

  • 35

    Veronese U, Forrest P, Wood W et al.. Statement from the chair. Global Summit on Mammographic Screening, 3–5 June 2002: European Institute of Oncology, 2002.

  • 36

    Swedish Board of Health and Welfare. Vilka Effekter Har Mammografiscreening? Referat av ett expertmöte anordnat av Socialstyrelsen och Cancerfonden i Stockholm den 15 februari 2002.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Health Council of the Netherlands. The benefit of population screening for breast cancer with mammography. Health Council of the Netherlands, 2002.

  • 38

    Tabar L, Smith RA, Duffy SW. Update on effects of screening mammography. Lancet 2002;360:337; discussion 39–40.

  • 39

    Duffy SW. Interpretation of breast screening trials: A commentary on the recent paper by Gøtzsche and Olsen. The Breast 2001;10:209–212.

  • 40

    Duffy S, Tabar L, Chen HH et al.. The impact of organized mammographic service screening on breast cancer mortality in seven Swedish counties. Cancer 2002;95:458–469.

  • 41

    Olsen O, Gøtzsche P. Systematic Review of Screening for Breast Cancer with Mammography (vol 2001). 2001. http://image.thelancet.com/lancet/extra/fullreport.pdf

  • 42

    Horton R. Screening mammography-an overview revisited. Lancet 2001;358:1284–1285.

  • 43

    Miller AB, To T, Baines CJ et al.. The Canadian National Breast Screening Study-1: breast cancer mortality after 11 to 16 years of follow-up. A randomized screening trial of mammography in women age 40 to 49 years. Ann Intern Med 2002;137(5 Part 1):305–312.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44

    Kopans DB. An overview of the breast cancer screening controversy. J Natl Cancer Inst Monogr 1997;22:1–3.

  • 45

    Hurley SF, Kaldor JM. The benefits and risks of mammographic screening for breast cancer. Epidemiol Rev 1992;14: 101–130.

  • 46

    Vainio H, Bianchini F. Breast Cancer Screening (vol. 7). Lyon: IARC Press, 2002.

  • 47

    Organizing Committee and Collaborators. Breast cancer screening with mammography in women aged 40–49 years. Report of the organizing committee and collaborators, Falun meeting, Falun, Sweden (21and 22 March, 1996). Int J Cancer 1996;68:693–699.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48

    Paci E, Duffy SW, Giorgi D et al.. Quantification of the effect of mammographic screening on fatal breast cancers: The Florence Programme 1990–96. Br J Cancer 2002;87:65–69.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49

    Morrison A. Screening in Chronic Disease. New York: Oxford University Press, 1992.

  • 50

    Anderson ED, Muir BB, Walsh JS et al.. The efficacy of double reading mammograms in breast screening [see comments]. Clin Radiol 1994;49:248–251.

  • 51

    Feig SA. Strategies for improving sensitivity of screening mammography for women aged 40 to 49 years [editorial; comment]. JAMA 1996;276:73–74.

  • 52

    Laya MB, Larson EB, Taplin SH et al.. Effect of estrogen replacement therapy on the specificity and sensitivity of screening mammography [see comments]. J Natl Cancer Inst 1996;88:643–649.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53

    Linver MN, Paster SB, Rosenberg RD et al.. Improvement in mammography interpretation skills in a community radiology practice after dedicated teaching courses: 2-year medical audit of 38,633 cases [published erratum appears in Radiology 1992;184:878]. Radiology 1992;184:39–43.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 54

    Mandelson MT, Oestreicher N, Porter PL et al.. Breast density as a predictor of mammographic detection: Comparison of interval- and screen-detected cancers. J Natl Cancer Inst 2000;92:1081–1087.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55

    Esserman L, Cowley H, Eberle C et al.. Improving the accuracy of mammography: Volume and outcome relationships. J Natl Cancer Inst 2002;94:369–375.

  • 56

    Beam CA, Sullivan DC, Layde PM. Effect of human variability on independent double reading in screening mammography. Acad Radiol 1996;3:891–897.

  • 57

    Thurfjell EL, Lernevall KA, Taube AA. Benefit of independent double reading in a population-based mammography screening program [see comments]. Radiology 1994;191:241–244.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58

    Warren Burhenne LJ, Wood SA et al.. Potential contribution of computer-aided detection to the sensitivity of screening mammography. Radiology 2000;215:554–562.

  • 59

    Freer TW, Ulissey MJ. Screening mammography with computer-aided detection: Prospective study of 12,860 patients in a community breast center. Radiology 2001;220:781–786.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 60

    Sickles EA. Successful methods to reduce false-positive mammography interpretations. Radiol Clin North Am 2000;38:693–700.

  • 61

    Elmore JG, Barton MB, Moceri VM et al.. Ten-year risk of false positive screening mammograms and clinical breast examinations [see comments]. N Engl J Med 1998;338:1089–1096.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 62

    Brenner RJ. False-negative mammograms. Medical, legal, and risk management implications. Radiol Clin North Am 2000;38:741–757.

  • 63

    Kerlikowske K, Grady D, Barclay J et al.. Positive predictive value of screening mammography by age and family history of breast cancer [see comments]. JAMA 1993;270:2444–2450.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 64

    Ernster VL, Ballard-Barbash R, Barlow WE et al.. Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst 2002;94:1546–1554.

  • 65

    Page DL, Dupont WD & Rogers LW et al. Continued local recurrence of carcinoma 15–25 years after a diagnosis of low grade ductal carcinoma in situ of the breast treated only by biopsy. Cancer 1995;76:1197–1200.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 66

    Dupont EL, Ku NN, McCann C et al.. Ductal carcinoma in situ of the breast. Cancer Control 1999;6:264–271.

  • 67

    Duffy S, Tabar L, Vitak B et al.. The relative contributions of screen-detected in situ and invasive carcinomas in reducing mortality from the disease. Eur J Oncol 2003 (in press).

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 68

    Yen MF, Tabar L, Vitak B et al.. Quantifying the potential problem of overdiagnosis of ductal carcinoma in situ in breast cancer screening. Eur J Oncol (in press) 2003.

  • 69

    Ernster VL, Barclay J, Kerlikowske K et al.. Incidence of and treatment for ductal carcinoma in situ of the breast [see comments]. JAMA 1996;275:913–918.

  • 70

    Rimer BK, Bluman LG. The psychological consequences of mammography. J Natl Cancer Inst Monog 1997;22: 131–138.

  • 71

    McCann J, Stockton D, Godward S. Impact of false-positive mammography on subsequent screening attendance and risk of cancer (Abstr). Breast Cancer Res 2002;4:R11.

  • 72

    Hislop TG, Harris SR, Jackson J et al.. Satisfaction and anxiety for women during investigation of an abnormal screening mammogram. Breast Cancer Res Treat 2002;76: 245–254.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 73

    Schwartz LM, Woloshin S, Sox HC et al.. US women's attitudes to false positive mammography results and detection of ductal carcinoma in situ: cross sectional survey. BMJ 2000;320:1635–1640.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 74

    Day NE, Williams DR, Khaw KT. Breast cancer screening programmes: The development of a monitoring and evaluation system. Br J Cancer 1989;59:954–958.

Copyright:
Copyright © 2003 by the National Comprehensive Cancer Network 2003
Page Numbers:
8
Article Category:
Research Article
Received:
02 Jan 2002
Accepted:
24 Jan 2003
Print Publication Date:
01 Apr 2003
Online Publication Date:
Apr 2003
Keywords:
Adult; breast neoplasms/radiography; carcinoma/radiography; carcinoma; intraductal; noninfiltrating/radiography; female; logistic models; mammography/methods/standards; middle age; quality control; retrospective studies; sensitivity and specificity
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