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• W2000530780 abstract "Editorials1 May 2012Risk-Based Mammography Screening: An Effort to Maximize the Benefits and Minimize the HarmsOtis W. Brawley, MDOtis W. Brawley, MDFrom American Cancer Society, Atlanta, GA 30303.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-9-201205010-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail All major organizations publishing breast cancer screening recommendations agree that women aged 50 to 74 years should get routine mammographic screening (1). However, there is debate about whether screening should be done every year or every 2 years. There is also substantial disagreement about whether all women in their 40s should get routine screening.It is widely accepted that screening women aged 40 to 49 years can reduce mortality, but some concern exists about the high ratio of harm to benefit in this age group (1, 2). If screening efforts could focus on women at greatest risk for breast cancer, ...References1. Smith RA, Cokkinides V, Brooks D, Saslow D, Shah M, Brawley OW. Cancer screening in the United States, 2011: a review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin. 2011;61:8-30. [PMID: 21205832] CrossrefMedlineGoogle Scholar2. US Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151:716-26, W-236. [PMID: 19920272] MedlineGoogle Scholar3. van Ravesteyn NT, Miglioretti DL, Stout NK, Lee SJ, Schechter CB, Buist DS, et al. Tipping the balance of benefits and harms to favor screening mammography starting at age 40 years. A comparative modeling study of risk. Ann Intern Med. 2012;156:609-17. LinkGoogle Scholar4. Nelson HD, Zakher B, Cantor A, Fu R, Griffin J, O'Meara ES, et al. Risk factors for breast cancer for women aged 40 to 49 years. A systematic review and meta-analysis. Ann Intern Med. 2012;156:635-48. LinkGoogle Scholar5. Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W, et al. SEER Cancer Statistics Review, 1975-2008. Bethesda, MD: National Cancer Institute; 2012. Google Scholar6. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10-29. [PMID: 22237781] CrossrefMedlineGoogle Scholar7. Cronin KA, Feuer EJ, Clarke LD, Plevritis SK. Impact of adjuvant therapy and mammography on U.S. mortality from 1975 to 2000: comparison of mortality results from the cisnet breast cancer base case analysis. J Natl Cancer Inst Monogr. 2006;:112-21. [PMID: 17032901] CrossrefMedlineGoogle Scholar8. Haukka J, Byrnes G, Boniol M, Autier P. Trends in breast cancer mortality in Sweden before and after implementation of mammography screening. PLoS One. 2011;6:22422. [PMID: 21966354] CrossrefMedlineGoogle Scholar9. Swedish Organised Service Screening Evaluation Group. Reduction in breast cancer mortality from organized service screening with mammography: 1. Further confirmation with extended data. Cancer Epidemiol Biomarkers Prev. 2006;15:45-51. [PMID: 16434585] CrossrefMedlineGoogle Scholar10. Squiers LB, Holden DJ, Dolina SE, Kim AE, Bann CM, Renaud JM. The public's response to the U.S. Preventive Services Task Force's 2009 recommendations on mammography screening. Am J Prev Med. 2011;40:497-504. [PMID: 21496748] CrossrefMedlineGoogle Scholar11. Woloshin S, Schwartz LM. The benefits and harms of mammography screening: understanding the trade-offs. JAMA. 2010;303:164-5. [PMID: 20068211] CrossrefMedlineGoogle Scholar12. Kramer BS. The science of early detection. Urol Oncol. 2004;22:344-7. [PMID: 15283894] CrossrefMedlineGoogle Scholar13. Porter PL, El-Bastawissi AY, Mandelson MT, Lin MG, Khalid N, Watney EA, et al. Breast tumor characteristics as predictors of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst. 1999;91:2020-8. [PMID: 10580027] CrossrefMedlineGoogle Scholar14. Zahl PH, Strand BH, Maehlen J. Incidence of breast cancer in Norway and Sweden during introduction of nationwide screening: prospective cohort study. BMJ. 2004;328:921-4. [PMID: 15013948] CrossrefMedlineGoogle Scholar15. Elmore JG, Barton MB, Moceri VM, Polk S, Arena PJ, Fletcher SW. Ten-year risk of false positive screening mammograms and clinical breast examinations. N Engl J Med. 1998;338:1089-96. [PMID: 9545356] CrossrefMedlineGoogle Scholar16. Centers for Disease Control and Prevention (CDC). Cancer screening—United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;61:41-5. [PMID: 22278157] MedlineGoogle Scholar17. Habbema JD, Schechter CB, Cronin KA, Clarke LD, Feuer EJ. Modeling cancer natural history, epidemiology, and control: reflections on the CISNET breast group experience. J Natl Cancer Inst Monogr. 2006;:122-6. [PMID: 17032902] CrossrefMedlineGoogle Scholar18. Ballard-Barbash R, Taplin SH, Yankaskas BC, Ernster VL, Rosenberg RD, Carney PA, et al. Breast Cancer Surveillance Consortium: a national mammography screening and outcomes database. AJR Am J Roentgenol. 1997;169:1001-8. [PMID: 9308451] CrossrefMedlineGoogle Scholar19. Nicholson BT, LoRusso AP, Smolkin M, Bovbjerg VE, Petroni GR, Harvey JA. Accuracy of assigned BI-RADS breast density category definitions. Acad Radiol. 2006;13:1143-9. [PMID: 16935726] CrossrefMedlineGoogle Scholar20. Hoskins LM, Roy KM, Greene MH. Toward a new understanding of risk perception among young female BRCA1/2 “previvors”. Fam Syst Health. 2012;30:32-46. [PMID: 22429077] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Otis W. Brawley, MDAffiliations: From American Cancer Society, Atlanta, GA 30303.Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0761.Corresponding Author: Otis W. Brawley, MD, American Cancer Society, 250 Williams Street, Atlanta, GA 30303; e-mail, otis.[email protected]org. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTipping the Balance of Benefits and Harms to Favor Screening Mammography Starting at Age 40 Years Nicolien T. van Ravesteyn , Diana L. Miglioretti , Natasha K. Stout , Sandra J. Lee , Clyde B. Schechter , Diana S.M. Buist , Hui Huang , Eveline A.M. Heijnsdijk , Amy Trentham-Dietz , Oguzhan Alagoz , Aimee M. Near , Karla Kerlikowske , Heidi D. Nelson , Jeanne S. Mandelblatt , and Harry J. de Koning Risk Factors for Breast Cancer for Women Aged 40 to 49 Years Heidi D. Nelson , Bernadette Zakher , Amy Cantor , Rongwei Fu , Jessica Griffin , Ellen S. O'Meara , Diana S.M. Buist , Karla Kerlikowske , Nicolien T. van Ravesteyn , Amy Trentham-Dietz , Jeanne S. Mandelblatt , and Diana L. Miglioretti Metrics Cited byImproving Performance of Breast Cancer Risk Prediction by Incorporating Optical Density Image Feature AnalysisFears and barriers: problems in breast cancer diagnosis and treatment in PakistanDeveloping global image feature analysis models to predict cancer risk and prognosisPersonalised and risk based cancer screeningAssessment of short-term breast cancer risk using a frequency domain correlation based imaging markerApplying a new maximum local asymmetry feature analysis method to improve near-term breast cancer risk predictionCancer screening issues in black and ethnic minority populationsExplaining the effects of a decision intervention on mammography intentions: The roles of worry, fear and perceived susceptibility to breast cancerApplying a new computer-aided detection scheme generated imaging marker to predict short-term breast cancer riskDeveloping a unique portable device to non-invasively detect bio-electrochemical characteristics of human tissuesApplying a new mammographic imaging marker to predict breast cancer riskImproving performance of breast cancer risk prediction using a new CAD-based region segmentation schemeAssociation between mammogram density and background parenchymal enhancement of breast MRIMammography screening: A major issue in medicinePrediction of breast cancer risk using a machine learning approach embedded with a locality preserving projection algorithmAssessment of global and local region-based bilateral mammographic feature asymmetry to predict short-term breast cancer riskApplying a new bilateral mammographic density segmentation method to improve accuracy of breast cancer risk predictionPrediction of near-term breast cancer risk using local region-based bilateral asymmetry features in mammographyExploring a new bilateral focal density asymmetry based image marker to predict breast cancer riskTensor based multichannel reconstruction for breast tumours identification from DCE-MRIsBreast and Cervical Cancer Screening among US and non US Born African American Muslim Women in New York CityAssociation Between Changes in Mammographic Image Features and Risk for Near-Term Breast Cancer DevelopmentA new paradigm of dielectric relaxation spectroscopy for non-invasive detection of breast abnormalities: a preliminary feasibility analysisAssessment of a Four-View Mammographic Image Feature Based Fusion Model to Predict Near-Term Breast Cancer RiskImproving the efficacy of mammography screening: the potential and challenge of developing new computer-aided detection approachesCandidate early detection protein biomarkers for ER+/PR+ invasive ductal breast carcinoma identified using pre-clinical plasma from the WHI observational studyA new approach to develop computer-aided detection schemes of digital mammogramsAssociations Between Religion-Related Factors and Breast Cancer Screening Among American MuslimsA new CAD approach for improving efficacy of cancer screeningScreening Mammography and Breast Cancer Reduction: Examining the EvidenceReduction of false-positive recalls using a computerized mammographic image feature analysis schemeAssociation between Computed Tissue Density Asymmetry in Bilateral Mammograms and Near-term Breast Cancer RiskPrediction of Near-term Breast Cancer Risk Based on Bilateral Mammographic Feature AsymmetryDo reproductive and hormonal risk factors for breast cancer associate with attendance at mammography screening?Ultrasonographic assessment of breast densityBreast-cancer screening with trained volunteers in a rural area of Sudan: a pilot studyThe Relationship between Individual Risk and Cost-Effectiveness in Screening InterventionsBilateral mammographic density asymmetry and breast cancer risk: A preliminary assessment 1 May 2012Volume 156, Issue 9Page: 662-663KeywordsBreast cancerCancer geneticsCancer risk factorsCancer screeningDeath ratesHealth surveysMammographyMedical risk factorsMortalityRelative risk ePublished: 1 May 2012 Issue Published: 1 May 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. 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