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Cancer screening with digital mammography for women at average risk for breast cancer, magnetic resonance imaging (MRI) for women at high risk: an evidence-based analysis.

Abstract The purpose of this review is to determine the effectiveness of 2 separate modalities, digital mammography (DM) and magnetic resonance imaging (MRI), relative to film mammography (FM), in the screening of women asymptomatic for breast cancer. A third analysis assesses the effectiveness and safety of the combination of MRI plus mammography (MRI plus FM) in screening of women at high risk. An economic analysis was also conducted.
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Screening mammography for women aged 40 to 49 years at average risk for breast cancer: an evidence-based analysis.

Authors

Mayor MeshTerms
Keywords
Journal Title ontario health technology assessment series
Publication Year Start
%A Health Quality Ontario
%T Cancer screening with digital mammography for women at average risk for breast cancer, magnetic resonance imaging (MRI) for women at high risk: an evidence-based analysis.
%J Ontario health technology assessment series, vol. 10, no. 3, pp. 1-55
%D 03/2010
%V 10
%N 3
%M eng
%B The purpose of this review is to determine the effectiveness of 2 separate modalities, digital mammography (DM) and magnetic resonance imaging (MRI), relative to film mammography (FM), in the screening of women asymptomatic for breast cancer. A third analysis assesses the effectiveness and safety of the combination of MRI plus mammography (MRI plus FM) in screening of women at high risk. An economic analysis was also conducted.
%P 1
%L 55
%W PHY
%G AUTHOR
%R 2010.......10....1.

@Article{HealthQualityOntario2010,
author="{Health Quality Ontario}",
title="Cancer screening with digital mammography for women at average risk for breast cancer, magnetic resonance imaging (MRI) for women at high risk: an evidence-based analysis.",
journal="Ontario health technology assessment series",
year="2010",
month="Mar",
day="01",
volume="10",
number="3",
pages="1--55",
abstract="The purpose of this review is to determine the effectiveness of 2 separate modalities, digital mammography (DM) and magnetic resonance imaging (MRI), relative to film mammography (FM), in the screening of women asymptomatic for breast cancer. A third analysis assesses the effectiveness and safety of the combination of MRI plus mammography (MRI plus FM) in screening of women at high risk. An economic analysis was also conducted.",
issn="1915-7398",
url="http://www.ncbi.nlm.nih.gov/pubmed/23074406",
language="eng"
}

%0 Journal Article
%T Cancer screening with digital mammography for women at average risk for breast cancer, magnetic resonance imaging (MRI) for women at high risk: an evidence-based analysis.
%A Health Quality Ontario
%J Ontario health technology assessment series
%D 2010
%8 March 01
%V 10
%N 3
%@ 1915-7398
%G eng
%F HealthQualityOntario2010
%X The purpose of this review is to determine the effectiveness of 2 separate modalities, digital mammography (DM) and magnetic resonance imaging (MRI), relative to film mammography (FM), in the screening of women asymptomatic for breast cancer. A third analysis assesses the effectiveness and safety of the combination of MRI plus mammography (MRI plus FM) in screening of women at high risk. An economic analysis was also conducted.
%U http://www.ncbi.nlm.nih.gov/pubmed/23074406
%P 1-55

PT Journal
AU Health Quality Ontario
TI Cancer screening with digital mammography for women at average risk for breast cancer, magnetic resonance imaging (MRI) for women at high risk: an evidence-based analysis.
SO Ontario health technology assessment series
JI Ont Health Technol Assess Ser
PD 03
PY 2010
BP 1
EP 55
VL 10
IS 3
LA eng
AB The purpose of this review is to determine the effectiveness of 2 separate modalities, digital mammography (DM) and magnetic resonance imaging (MRI), relative to film mammography (FM), in the screening of women asymptomatic for breast cancer. A third analysis assesses the effectiveness and safety of the combination of MRI plus mammography (MRI plus FM) in screening of women at high risk. An economic analysis was also conducted.
ER

PMID- 23074406
OWN - NLM
STAT- PubMed-not-MEDLINE
DA  - 20121017
DCOM- 20121018
LR  - 20151026
IS  - 1915-7398 (Electronic)
IS  - 1915-7398 (Linking)
VI  - 10
IP  - 3
DP  - 2010
TI  - Cancer screening with digital mammography for women at average risk for breast
      cancer, magnetic resonance imaging (MRI) for women at high risk: an
      evidence-based analysis.
PG  - 1-55
AB  - OBJECTIVE: The purpose of this review is to determine the effectiveness of 2
      separate modalities, digital mammography (DM) and magnetic resonance imaging
      (MRI), relative to film mammography (FM), in the screening of women asymptomatic 
      for breast cancer. A third analysis assesses the effectiveness and safety of the 
      combination of MRI plus mammography (MRI plus FM) in screening of women at high
      risk. An economic analysis was also conducted. RESEARCH QUESTIONS: How does the
      sensitivity and specificity of DM compare to FM?How does the sensitivity and
      specificity of MRI compare to FM?How do the recall rates compare among these
      screening modalities, and what effect might this have on radiation exposure? What
      are the risks associated with radiation exposure?How does the sensitivity and
      specificity of the combination of MRI plus FM compare to either MRI or FM
      alone?What are the economic considerations? CLINICAL NEED: The effectiveness of
      FM with respect to breast cancer mortality in the screening of asymptomatic
      average- risk women over the age of 50 has been established. However, based on a 
      Medical Advisory Secretariat review completed in March 2006, screening is not
      recommended for women between the ages of 40 and 49 years. Guidelines published
      by the Canadian Task Force on Preventive Care recommend mammography screening
      every 1 to 2 years for women aged 50 years and over, hence, the inclusion of such
      women in organized breast cancer screening programs. In addition to the
      uncertainty of the effectiveness of mammography screening from the age of 40
      years, there is concern over the risks associated with mammographic screening for
      the 10 years between the ages of 40 and 49 years. The lack of effectiveness of
      mammography screening starting at the age of 40 years (with respect to breast
      cancer mortality) is based on the assumption that the ability to detect cancer
      decreases with increased breast tissue density. As breast density is highest in
      the premenopausal years (approximately 23% of postmenopausal and 53% of
      premenopausal women having at least 50% of the breast occupied by high density), 
      mammography screening is not promoted in Canada nor in many other countries for
      women under the age of 50 at average risk for breast cancer. It is important to
      note, however, that screening of premenopausal women (i.e., younger than 50 years
      of age) at high risk for breast cancer by virtue of a family history of cancer or
      a known genetic predisposition (e.g., having tested positive for the breast
      cancer genes BRCA1 and/or BRCA2) is appropriate. Thus, this review will assess
      the effectiveness of breast cancer screening with modalities other than film
      mammography, specifically DM and MRI, for both pre/perimenopausal and
      postmenopausal age groups. International estimates of the epidemiology of breast 
      cancer show that the incidence of breast cancer is increasing for all ages
      combined whereas mortality is decreasing, though at a slower rate. The observed
      decreases in mortality rates may be attributable to screening, in addition to
      advances in breast cancer therapy over time. Decreases in mortality attributable 
      to screening may be a result of the earlier detection and treatment of invasive
      cancers, in addition to the increased detection of ductal carcinoma in situ
      (DCIS), of which certain subpathologies are less lethal. Evidence from the
      Surveillance, Epidemiology and End Results (better known as SEER) cancer registry
      in the United States, indicates that the age-adjusted incidence of DCIS has
      increased almost 10-fold over a 20 year period, from 2.7 to 25 per 100,000. There
      is a 4-fold lower incidence of breast cancer in the 40 to 49 year age group than 
      in the 50 to 69 year age group (approximately 140 per 100,000 versus 500 per
      100,000 women, respectively). The sensitivity of FM is also lower among younger
      women (approximately 75%) than for women aged over 50 years (approximately 85%). 
      Specificity is approximately 80% for younger women versus 90% for women over 50
      years. The increased density of breast tissue in younger women is likely
      responsible for the decreased accuracy of FM. Treatment options for breast cancer
      vary with the stage of disease (based on tumor size, involvement of surrounding
      tissue, and number of affected axillary lymph nodes) and its pathology, and may
      include a combination of surgery, chemotherapy and/or radiotherapy. Surgery is
      the first-line intervention for biopsy-confirmed tumors. The subsequent use of
      radiation, chemotherapy or hormonal treatments is dependent on the
      histopathologic characteristics of the tumor and the type of surgery. There is
      controversy regarding the optimal treatment of DCIS, which is considered a
      noninvasive tumour. Women at high risk for breast cancer are defined as genetic
      carriers of the more commonly known breast cancer genes (BRCA1, BRCA2 TP53),
      first degree relatives of carriers, women with varying degrees of high risk
      family histories, and/or women with greater than 20% lifetime risk for breast
      cancer based on existing risk models. Genetic carriers for this disease,
      primarily women with BRCA1 or BRCA2 mutations, have a lifetime probability of
      approximately 85% of developing breast cancer. Preventive options for these women
      include surgical interventions such as prophylactic mastectomy and/or
      oophorectomy, i.e., removal of the breasts and/or ovaries. Therefore, it is
      important to evaluate the benefits and risks of different screening modalities,
      to identify additional options for these women. This Medical Advisory Secretariat
      review is the second of 2 parts on breast cancer screening, and concentrates on
      the evaluation of both DM and MRI relative to FM, the standard of care. Part I of
      this review (March 2006) addressed the effectiveness of screening mammography in 
      40 to 49 year old average-risk women. The overall objective of the present review
      is to determine the optimal screening modality based on the evidence. EVIDENCE
      REVIEW STRATEGY: THE MEDICAL ADVISORY SECRETARIAT FOLLOWED ITS STANDARD
      PROCEDURES AND SEARCHED THE FOLLOWING ELECTRONIC DATABASES: Ovid MEDLINE, EMBASE,
      Ovid MEDLINE In-Process & Other Non-Indexed Citations, Cochrane Central Register 
      of Controlled Trials, Cochrane Database of Systematic Reviews and The
      International Network of Agencies for Health Technology Assessment database. The 
      subject headings and keywords searched included breast cancer, breast neoplasms, 
      mass screening, digital mammography, magnetic resonance imaging. The detailed
      search strategies can be viewed in Appendix 1. Included in this review are
      articles specific to screening and do not include evidence on diagnostic
      mammography. The search was further restricted to English-language articles
      published between January 1996 and April 2006. Excluded were case reports,
      comments, editorials, nonsystematic reviews, and letters. DIGITAL MAMMOGRAPHY: In
      total, 224 articles specific to DM screening were identified. These were examined
      against the inclusion/exclusion criteria described below, resulting in the
      selection and review of 5 health technology assessments (HTAs) (plus 1 update)
      and 4 articles specific to screening with DM. MAGNETIC RESONANCE IMAGING: In
      total, 193 articles specific to MRI were identified. These were examined against 
      the inclusion/exclusion criteria described below, resulting in the selection and 
      review of 2 HTAs and 7 articles specific to screening with MRI. The evaluation of
      the addition of FM to MRI in the screening of women at high risk for breast
      cancer was also conducted within the context of standard search procedures of the
      Medical Advisory Secretariat. as outlined above. The subject headings and
      keywords searched included the concepts of breast cancer, magnetic resonance
      imaging, mass screening, and high risk/predisposition to breast cancer. The
      search was further restricted to English-language articles published between
      September 2007 and January 15, 2010. Case reports, comments, editorials,
      nonsystematic reviews, and letters were not excluded. MRI PLUS MAMMOGRAPHY: In
      total, 243 articles specific to MRI plus FM screening were identified. These were
      examined against the inclusion/exclusion criteria described below, resulting in
      the selection and review of 2 previous HTAs, and 1 systematic review of 11 paired
      design studies. INCLUSION CRITERIA: English-language articles, and English or
      French-language HTAs published from January 1996 to April 2006,
      inclusive.Articles specific to screening of women with no personal history of
      breast cancer.Studies in which DM or MRI were compared with FM, and where the
      specific outcomes of interest were reported.Randomized controlled trials (RCTs)
      or paired studies only for assessment of DM.Prospective, paired studies only for 
      assessment of MRI. EXCLUSION CRITERIA: Studies in which outcomes were not
      specific to those of interest in this report.Studies in which women had been
      previously diagnosed with breast cancer.Studies in which the intervention (DM or 
      MRI) was not compared with FM.Studies assessing DM with a sample size of less
      than 500. INTERVENTION: Digital mammography.Magnetic resonance imaging.
      COMPARATOR: Screening with film mammography. OUTCOMES OF INTEREST: Breast cancer 
      mortality (although no studies were found with such long
      follow-up).Sensitivity.Specificity.Recall rates. SUMMARY OF FINDINGS: DIGITAL
      MAMMOGRAPHY: There is moderate quality evidence that DM is significantly more
      sensitive than FM in the screening of asymptomatic women aged less than 50 years,
      those who are premenopausal or perimenopausal, and those with heterogeneously or 
      extremely dense breast tissue (regardless of age). It is not known what effect
      these differences in sensitivity will have on the more important effectiveness
      outcome measure of breast cancer mortality, as there was no evidence of such an
      assessment. Other factors have been set out to promote DM, for example, issues of
      recall rates and reading and examination times. (ABSTRACT TRUNCATED)
CN  - Health Quality Ontario
LA  - eng
PT  - Journal Article
DEP - 20100301
PL  - Canada
TA  - Ont Health Technol Assess Ser
JT  - Ontario health technology assessment series
JID - 101521610
PMC - PMC3377503
OID - NLM: PMC3377503
EDAT- 2010/01/01 00:00
MHDA- 2010/01/01 00:01
CRDT- 2012/10/18 06:00
PHST- 2010/03/01 [epublish]
PST - ppublish
SO  - Ont Health Technol Assess Ser. 2010;10(3):1-55. Epub 2010 Mar 1.
TY  - JOUR
AU  - Health Quality Ontario
PY  - 2010/03/01
TI  - Cancer screening with digital mammography for women at average risk for breast cancer, magnetic resonance imaging (MRI) for women at high risk: an evidence-based analysis.
T2  - Ont Health Technol Assess Ser
JO  - Ontario health technology assessment series
SP  - 1
EP  - 55
VL  - 10
IS  - 3
N2  - The purpose of this review is to determine the effectiveness of 2 separate modalities, digital mammography (DM) and magnetic resonance imaging (MRI), relative to film mammography (FM), in the screening of women asymptomatic for breast cancer. A third analysis assesses the effectiveness and safety of the combination of MRI plus mammography (MRI plus FM) in screening of women at high risk. An economic analysis was also conducted.
SN  - 1915-7398
UR  - http://www.ncbi.nlm.nih.gov/pubmed/23074406
ID  - HealthQualityOntario2010
ER  - 
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