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• W2079667970 abstract "Editorials3 April 2007Breast Cancer Screening for Women in Their 40s: Moving from Controversy about Data to Helping Individual WomenJoann Elmore, MD, MPH and John Choe, MD, MPHJoann Elmore, MD, MPHFrom University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington.Search for more papers by this author and John Choe, MD, MPHFrom University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-146-7-200704030-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail We should move beyond a discussion of the quality of the evidence for breast cancer screening for women in their 40s. Instead, we should learn to live with smaller absolute benefits and higher risks than those we had originally hoped for. In the face of continuing controversy about the evidence, our priority now should be to help women make informed decisions.Three articles in this issue (1–3) can help us make the transition from controversy to action. The first is a succinct clinical practice guideline from the American College of Physicians (ACP) that advises clinicians on how to approach breast ...References1. Qaseem A, Snow V, Sherif K, Aronson M, Weiss KB, Owens DK. Screening mammography in women 40 to 49 years of age: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007;146:511-5. LinkGoogle Scholar2. Armstrong K, Moye E, Williams S, Berlin JA, Reynolds EE. Screening mammography in women 40 to 49 years of age: a systematic review for the American College of Physicians. Ann Intern Med. 2007;146:516-26. LinkGoogle Scholar3. Brewer NT, Salz T, Lillie SE. Systematic review: the long-term effects of false-positive mammograms. Ann Intern Med. 2007;146:502-10. LinkGoogle Scholar4. Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2006;:CD001877. [PMID: 17054145] MedlineGoogle Scholar5. Moss SM, Cuckle H, Evans A, Johns L, Waller M, Bobrow L, et al. Effect of mammographic screening from age 40 years on breast cancer mortality at 10 years' follow-up: a randomised controlled trial. Lancet. 2006;368:2053-60. [PMID: 17161727] CrossrefMedlineGoogle Scholar6. Elmore JG, Fletcher SW. The risk of cancer risk prediction: “What is my risk of getting breast cancer”? [Editorial]. J Natl Cancer Inst. 2006;98:1673-5. [PMID: 17148763] CrossrefMedlineGoogle Scholar7. Gigerenzer G. Calculated Risks: How to Know When Numbers Deceive You. New York: Simon & Schuster; 2002. Google Scholar8. Humphrey LL, Helfand M, Chan BK, Woolf SH. Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;137:347-60. [PMID: 12204020] LinkGoogle Scholar9. Carney PA, Miglioretti DL, Yankaskas BC, Kerlikowske K, Rosenberg R, Rutter CM, et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med. 2003;138:168-75. [PMID: 12558355] LinkGoogle Scholar10. Elmore JG, Nakano CY, Koepsell TD, Desnick LM, D'Orsi CJ, Ransohoff DF. International variation in screening mammography interpretations in community-based programs. J Natl Cancer Inst. 2003;95:1384-93. [PMID: 13130114] CrossrefMedlineGoogle Scholar11. Smith-Bindman R, Chu PW, Miglioretti DL, Sickles EA, Blanks R, Ballard-Barbash R, et al. Comparison of screening mammography in the United States and the United Kingdom. JAMA. 2003;290:2129-37. [PMID: 14570948] CrossrefMedlineGoogle Scholar12. 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 Scholar13. Welch HG. Should I Be Tested for Cancer? Maybe Not and Here's Why. Berkeley, CA: Univ of California Pr; 2006. Google Scholar14. Burke W, Olsen AH, Pinsky LE, Reynolds SE, Press NA. Misleading presentation of breast cancer in popular magazines. Eff Clin Pract. 2001;4:58-64. [PMID: 11329986] MedlineGoogle Scholar15. Black WC, Nease RF, Tosteson AN. Perceptions of breast cancer risk and screening effectiveness in women younger than 50 years of age. J Natl Cancer Inst. 1995;87:720-31. [PMID: 7563149] CrossrefMedlineGoogle Scholar16. Egger JR, Cutter GR, Carney PA, Taplin SH, Barlow WE, Hendrick RE, et al. Mammographers' perception of women's breast cancer risk. Med Decis Making. 2005;25:283-9. [PMID: 15951455] CrossrefMedlineGoogle Scholar17. Fletcher SW. Whither scientific deliberation in health policy recommendations? Alice in the Wonderland of breast-cancer screening. N Engl J Med. 1997;336:1180-3. [PMID: 9099666] CrossrefMedlineGoogle Scholar18. Physician Insurers Association of America. Breast Cancer Study. 3rd ed. Washington, DC: Physician Insurers Assoc of America; 2002. Google Scholar19. Merenstein D. A piece of my mind. Winners and losers. JAMA. 2004;291:15-6. [PMID: 14709561] CrossrefMedlineGoogle Scholar20. Elmore JG, Taplin SH, Barlow WE, Cutter GR, D'Orsi CJ, Hendrick RE, et al. Does litigation influence medical practice? The influence of community radiologists' medical malpractice perceptions and experience on screening mammography. Radiology. 2005;236:37-46. [PMID: 15987961] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington.Acknowledgments: The authors thank Raymond Harris, PhD, and Suzanne Fletcher, MD, for their helpful editorial suggestions.Grant Support: Dr. Elmore is supported by grant K05-CA104699 from the National Cancer Institute.Disclosures: Dr. Elmore has served as an expert witness on the topic of risk communication.Corresponding Author: Joann G. Elmore, MD, MPH, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359780, Seattle, WA 98104-2499; e-mail, [email protected]washington.edu.Current Author Addresses: Dr. Elmore: University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359780, Seattle, WA 98104-2499.Dr. Choe: University of Washington, 325 Ninth Avenue, Box 359780, Seattle, WA 98104. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSystematic Review: The Long-Term Effects of False-Positive Mammograms Noel T. Brewer , Talya Salz , and Sarah E. Lillie Screening Mammography for Women 40 to 49 Years of Age: A Clinical Practice Guideline from the American College of Physicians Amir Qaseem , Vincenza Snow , Katherine Sherif , Mark Aronson , Kevin B. Weiss , Douglas K. Owens , and Screening Mammography in Women 40 to 49 Years of Age: A Systematic Review for the American College of Physicians Katrina Armstrong , Elizabeth Moye , Sankey Williams , Jesse A. Berlin , and Eileen E. Reynolds Metrics Cited ByScreening Mammography and Breast Cancer Reduction: Examining the EvidenceBreast cancer risk scores in a standard screening populationProgram-Specific Cost-Effectiveness Analysis: Breast Cancer Screening Policies for a Safety-Net ProgramUpdate on mammography trendsBreast-cancer early detection in low-income and middle-income countries: do what you can versus one size fits allScreening Results, Controversies, and GuidelinesStage of breast cancer at diagnosis among low-income women with access to mammographyA Monte Carlo tool to simulate breast cancer screening programmesEffect of Previous Benign Breast Biopsy on the Interpretive Performance of Subsequent Screening MammographyDecreased accuracy in interpretation of community-based screening mammography for women with multiple clinical risk factorsEpidemiology of CancerBreast Cancer Screening for Women 40 to 49 Years of Age 3 April 2007Volume 146, Issue 7Page: 529-531KeywordsBreast cancerBreast cancer screeningCancer treatmentDecision makingMammographyResearch designSystematic reviewsTreatment guidelines ePublished: 3 April 2007 Issue Published: 3 April 2007 CopyrightCopyright © 2007 by American College of Physicians. 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