انجام غربالگری ماموگرافی برای سرطان پستان : بررسی به عمل آمده از سود و زیان

Mammographic screening is a proven method for reducing breast cancer mortality for women 40 years of age and older, but the best method for implementation of mammographic screening, particularly in the age group 40–49, remains controversial. The author, in an invited review, summarizes the data and offers guidance based on the best information available for women at risk for breast cancer, and their care providers, with particular emphasis on costs and benefits.

There is no denying the fact that after more than 40 years of experience,1 systematic screening with mammograms reduces breast cancer mortality for women over 40 years of age. A key point of the most recent update of the breast cancer screening recommendations by the United States Preventive Services Task Force (USPSTF),2 that caused a veritable media frenzy,3 was not that there was new data, or even new analyses of the existing data that might question that fact, but only that the costs of arriving at the reduction in mortality might be higher than previously imagined, and might extend into areas that are not generally considered. In fact, the most recent Cochrane Analysis of the existing literature for mammographic screening,4 finds that when the 600,000 women in 7 eligible randomized controlled trials were randomized to a program offering regular mammographic screening or no regular mammographic screening, the group offered the regular screening had a statistically significant reduction in breast cancer mortality of 19% (RR = 0.81 with 95% confidence intervals of 0.74–0.87). A recent study from Cady et al.5 also demonstrated that in a large cohort of women followed for a median of 12.5 (8–17) years, 75% of all breast cancer deaths occurred in the 20% of women not participating in regular mammography screening. The purpose of this paper is to explore the costs of breast cancer screening, compare them to the benefits, and hopefully provide assistance to women considering this screening examination, and to the physicians advising them.

Breast cancer is a global public health problem and the reader can decide for him or her self if the costs and benefits outweigh the risks associated with breast health screening programs. Many governments will continue to debate the costs and the pros and cons; however without population based screening, many women will continue to suffer needlessly throughout the world. Thus, I would like to offer the following conclusions based on one surgeon’s analysis of the literature regarding the benefits and costs of mammographic screening for breast cancer: 1. Women invited to participate in a regular program of mammographic screening, beginning at age 40 and ontinuing annually for as long as a woman is healthy can be expected to have a 19% reduction in breast cancer mortality compared with women not invited to participate in systematic mammographic breast cancer screening. In fact, 75% of all breast cancer deaths occur in the 20% of women not undergoing periodic screening mammography. Breast cancer screening saves lives, and, when considering the monetary costs to society of treating advanced breast cancer, may actually save money. 2. Screening mammography is less than 100% sensitive or 100% specific for detection of breast cancer, and so there will be false negatives and false positives. Following rigorous quality control guidelines will minimize the incidence of false negatives and false positives. Combining annual screening mammography with annual professional clinical breast exams and encouraging women to become familiar with their breasts through monthly breast self exam are likely also to reduce the impact of the falsely negative mammogram, and should be encouraged. 3. It may be desirable to examine alternatives to current screening strategies, but, hopefully, this does not translate into less effective breast cancer screening strategies that aim to simply reduce costs in the future. Improving efficiency in mammographic screening practices may be a successful cost saving strategy that does not sacrifice benefit. 4.The perfect breast cancer screening tool would be 100% sensitive and 100% specific, inexpensive and not harmful. Mammography is not that perfect tool, but, for now, is a very satisfactory and evidence-based procedure which can save lives, and should be made accessible to all women at risk for developing this dreaded disease.