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1、ClinicalReview&EducationReviewASystematicAssessmentofBenefitsandRiskstoGuideBreastCancerScreeningDecisionsLydiaE.Pace,MD,MPH;NancyL.Keating,MD,MPHEditorialpage1298IMPORTANCEBreastcanceristhesecondleadingcauseofcancerdeathsamongUSwomen.AuthorVideoIntervie
2、watMammographyscreeningmaybeassociatedwithreducedbreastcancermortalitybutcanjama.comalsocauseharm.Guidelinesrecommendindividualizingscreeningdecisions,particularlyforRelatedarticlepage1336youngerwomen.SupplementalcontentatOBJECTIVESWereviewedtheevidenceo
3、nthemortalitybenefitandchiefharmsofjama.commammographyscreeningandwhatisknownabouthowtoindividualizemammographyCMEQuizatscreeningdecisions,includingcommunicatingrisksandbenefitstopatients.jamanetworkcme.comandCMEQuestionspage1352EVIDENCEACQUISITIONWesear
4、chedMEDLINEfrom1960-2014todescribe(1)benefitsofmammography,(2)harmsofmammography,and(3)individualizingscreeningdecisionsandpromotinginformeddecisionmaking.Wealsomanuallysearchedreferencelistsofkeyarticlesretrieved,selectedreviews,meta-analyses,andpractic
5、erecommendations.WeratedthelevelofevidenceusingtheAmericanHeartAssociationguidelines.RESULTSMammographyscreeningisassociatedwitha19%overallreductionofbreastcancermortality(approximately15%forwomenintheir40sand32%forwomenintheir60s).Fora40-or50-year-oldwo
6、manundergoing10yearsofannualmammograms,thecumulativeriskofafalse-positiveresultisabout61%.About19%ofthecancersdiagnosedduringthat10-yearperiodwouldnothavebecomeclinicallyapparentwithoutscreening(overdiagnosis),althoughthereisuncertaintyaboutthisestimate.
7、ThenetbenefitofAuthorAffiliations:Divisionofscreeningdependsgreatlyonbaselinebreastcancerrisk,whichshouldbeincorporatedintoWomen’sHealth,BrighamandWomen’sHospital,Boston,screeningdecisions.DecisionaidshavethepotentialtohelppatientsintegrateinformationMas
8、sachusetts(Pace);Divisionofaboutrisksandbenefitswiththeirownvaluesandpriorities,althoughtheyarenotyetwidelyGeneralInternalMedicine,Brighamavailableforuseinclinicalpractice.andWomen’sHospital,Boston,Massachusetts(Keating);D
