Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening

Smith, Robert A.; Andrews, Kimberly S.; Brooks, Durado; Fedewa, Stacey A.; Manassaram‐Baptiste, Deana; Saslow, Debbie; Wender, Richard C.

doi:10.3322/caac.21557

Cited by 533 publications

(448 citation statements)

References 152 publications

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“…For the population at large, a meta‐analysis of randomized control trials from the US and Sweden estimated that to prevent one breast cancer death per 1000 screened women, the women should have a remaining life expectancy of at least 10 years 28 . Some US screening guidelines, for instance from the American Cancer Society, 29 recommend stopping screening in women with a remaining life expectancy of less than 10 years, while Europe screening guidelines are based solely on age 2 . In any case, assessing the remaining life expectancy of a woman is challenging.…”

Section: Discussionmentioning

confidence: 99%

Impact of chronic diseases on effect of breast cancer screening

et al. 2020

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Background Although breast cancer screening reduces breast cancer mortality at the population level, subgroups of women may benefit differently. We investigated the impact of health status on the effect of breast cancer screening. Methods The study included 181 299 women invited in two population‐based screening programs in Denmark and 1 526 446 control subjects, followed from April 1981 to December 2014. Poisson regressions were used to compare the observed breast cancer mortality rate in women invited to screening with the expected rate in the absence of screening among women with and without chronic diseases. Chronic diseases were defined as any diagnosis in the Charlson Comorbidity Index during 4 years before the first invitation to screening. Results Almost 10% of women had chronic diseases before first invitation to screening. Whereas we observed a reduction in breast cancer mortality following invitation to screening of 28% (95% CI, 20% to 35%) among women without chronic diseases, only a 7% (95% CI, −39% to 37%) reduction was seen for women with chronic diseases (P‐value for interaction = .22). For participants, the reduction, corrected for selection bias, was 35% (95% CI 16% to 49%) for women without, and 4% (95% CI −146% to 62%) for women with chronic diseases (P‐value for interaction = .43). Conclusion Our data indicate a marginal effect of mammography screening on breast cancer mortality in women with chronic diseases. If our results are confirmed in other populations, the presence of chronic diseases will be an important factor to take into consideration in personalized screening.

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Section: Discussionmentioning

confidence: 99%

Impact of chronic diseases on effect of breast cancer screening

et al. 2020

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“…2 Guidelines support screening for these cancers for adults up to age 75 for breast cancer and CRC and adults up to age 65 for cervical cancer. 3 However, recommendations become less clear for older adults beyond those ages for breast, CRC, and cervical cancers. 3 The U.S. Preventive Services Task Force (USPSTF) guidelines do not give a recommendation for breast cancer screening for women 75 years of age or older due to insufficient evidence of the benefits and harms of screening in this population.…”

Section: Introductionmentioning

confidence: 99%

Examining Older Adults’ Attitudes and Perceptions of Cancer Screening and Overscreening: A Qualitative Study

Roy

Moss

Rodríguez-Colón

et al. 2020

J Prim Care Community Health

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Introduction/Objectives: Screening guidelines for breast, cervical, and colorectal cancer (CRC) are less clear for older adults due to the potential harms that may result from screening. Understanding older adults’ attitudes and perceptions, especially racial/ethnic minority and underserved adults, of cancer screening can help health care providers determine how best to communicate with older adults about cancer screening and screening cessation. The objective of this study was to determine how older adults primarily from minority/underserved backgrounds perceive cancer screening and overscreening. Methods: Four focus groups (n = 39) were conducted with adults (>=65 years of age) in 3 community settings in south-central Pennsylvania. Two focus groups were conducted in Spanish and translated to English upon transcription. Focus group data was managed and analyzed using QSR NVivo 12. Inductive thematic analysis was used to analyze the data where themes emerged following the coding process. Results: The focus group participants had an average age of 74 years and were primarily female (74%) and Hispanic (69%), with 69% reporting having less than a high school degree. Four key themes were identified from the focus groups: (1) importance of tailored and targeted education/information; (2) impact of physician/patient communication; (3) impact of barriers and facilitators to screening on cancer screening cessation; and (4) awareness of importance of screening. Participants were more likely to be agreeable to screening cessation if they received specific information regarding their health status and previous medical history from their physician as to why screening should be stopped and told by their physician that the screening decision is up to them. Conclusions: Older adults prefer individualized information from their physician in order to justify screening cessation but are against incorporating life expectancy into the discussion. Future research should focus on developing interventions to test the effectiveness of culturally tailored screening cessation messages for older adults.

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“…Breast cancer is the most widely diagnosed type of cancer, and the second leading cause of cancerrelated deaths, among women in the United States (Siegel et al 2019). Early radiographic detection by mammography is currently the best available means for reducing breast cancer mortality (Smith et al 2019, Van Ourti et al 2020. Microcalcifications (µcals) are the most common abnormality detected by mammography, coincident with 30-50% of all breast lesions and 85-95% of all cases of ductal carcinoma in situ (Cheng et al 2003, Gülsün et al 2003, Henrot et al 2014, Millis et al 1976.…”

Section: Introductionmentioning

confidence: 99%

Quantitative Molecular Imaging of Breast Microcalcification Composition using Photon-Counting Spectral Computed Tomography

Curtis

Roeder

2020

Preprint

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Mammographic screening for breast cancer is unable to distinguish molecular differences between hydroxyapatite (HA) microcalcifications (μcals) that are associated with malignancy and calcium oxalate (CaOx) μcals that are benign. Therefore, the objective of this study was to investigate quantitative material decomposition of model breast μcals of clinically-relevant composition and size using spectral photon-counting computed tomography (PCCT). Model μcals composed of HA, CaOx, and dicalcium phosphate (DCP) were treated as materials containing spatially coincident elemental compositions of calcium (Ca), phosphorus (P), and oxygen (O). Elemental decomposition was performed using constrained maximum-likelihood estimation in the image domain. Images were acquired with a commercial, preclinical PCCT system (MARS Bioimaging) with five energy bins selected to maximize counts at low photon energies and spectral differences between Ca and P. Elemental concentrations of Ca and P within the each μcal composition were accurately identified and quantified with a root-mean-squared error < 12%. HA and CaOx μcals, < 1 mm is size, were accurately discriminated by the measured P content with an area under the receiver operating characteristic curve (AUC) > 0.9. The mole fraction of P, P/(Ca+P), was able to discriminate all three μcal compositions with AUC > 0.8 for μcals < 1 mm is size and AUC = 1 for μcals > 2 mm in size. The overall accuracy for the classification of μcal types and quantification of P was robust against different assumptions in the elemental decomposition calibration, but quantification of Ca was improved with assumptions that most accurately accounted for the molar volume of each element within μcal compositions. Thus, PCCT enabled quantitative molecular imaging of breast μcal composition, which is not possible with current clinical molecular imaging modalities.

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Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening

Cited by 533 publications

References 152 publications

Impact of chronic diseases on effect of breast cancer screening

Impact of chronic diseases on effect of breast cancer screening

Examining Older Adults’ Attitudes and Perceptions of Cancer Screening and Overscreening: A Qualitative Study

Quantitative Molecular Imaging of Breast Microcalcification Composition using Photon-Counting Spectral Computed Tomography

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