Harms of XXXX Screening: Systematic Review to Update the 2009 U.S. Preventive Services Task Force Recommendation.

@entity1 @entity0 @entity5 @entity148 @entity158 @entity204
BACKGROUND: In 2009, the U.S. Preventive Services Task Force recommended biennial mammography screening for @entity1 aged 50 to 74 years and selective screening for those aged 40 to 49 years. PURPOSE: To review studies of screening in average-risk @entity1 with mammography, magnetic resonance imaging, or ultrasonography that reported on false-positive results, overdiagnosis, @entity148 , @entity158 , and radiation exposure. DATA SOURCES: MEDLINE and Cochrane databases through December 2014. STUDY SELECTION: English-language systematic reviews, randomized trials, and observational studies of screening. DATA EXTRACTION: Investigators extracted and confirmed data from studies and dual-rated study quality. Discrepancies were resolved through consensus. DATA SYNTHESIS: Based on 2 studies of U.S. data, 10-year cumulative rates of false-positive mammography results and biopsies were higher with annual than biennial screening (61% vs. 42% and 7% vs. 5%, respectively) and for @entity1 aged 40 to 49 years, those with dense breasts, and those using combination hormone therapy. Twenty-nine studies using different methods reported overdiagnosis rates of 0% to 54%; rates from randomized trials were 11% to 22%. @entity1 with false-positive results reported more @entity148 , distress, and @entity0 -specific worry, although results varied across 80 observational studies. Thirty-nine observational studies indicated that some @entity1 reported @entity158 during mammography (1% to 77%); of these, 11% to 46% declined future screening. Models estimated 2 to 11 screening-related @entity204 from radiation-induced @entity5 per 100,000 @entity1 using digital mammography, depending on age and screening interval. Five observational studies of tomosynthesis and mammography indicated increased biopsies but reduced recalls compared with mammography alone. LIMITATIONS: Studies of overdiagnosis were highly heterogeneous, and estimates varied depending on the analytic approach. Studies of @entity148 and @entity158 used different outcome measures. Radiation exposure was based on models. CONCLUSION: False-positive results are common and are higher for annual screening, younger @entity1 , and @entity1 with dense breasts. Although overdiagnosis, @entity148 , @entity158 , and radiation exposure may cause harm, their effects on individual @entity1 are difficult to estimate and vary widely. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.
