Recommendations on screening for breast cancer in women aged 40–74 years who are not at increased risk for breast cancer

Klarenbach, Scott; Sims‐Jones, Nicki; Lewin, Gabriela; Singh, Harminder; Thériault, Guylène; Tonelli, Marcello; Doull, Marion; Courage, Susan; Garcia, Alejandra Jaramillo; Thombs, Brett D.

doi:10.1503/cmaj.180463

Cited by 159 publications

(186 citation statements)

References 75 publications

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“…Young age at diagnosis is generally defined as a diagnosis before age 40 [2,7], but can be stratified by other ages. Current Canadian screening guidelines do not recommend screening for breast cancer until age 50, unless the patient is at increased risk for breast cancer [8]. Young age at diagnosis is linked to later stage of tumour progression at diagnosis, and worse clinical outcomes [2,7,[9][10][11][12][13][14].…”

Section: Young-onset Breast Cancermentioning

confidence: 99%

Mutational landscape differences between young-onset and older-onset breast cancer patients

et al. 2020

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Background: The incidence of breast cancer among young women (aged ≤40 years) has increased in North America and Europe. Fewer than 10% of cases among young women are attributable to inherited BRCA1 or BRCA2 mutations, suggesting an important role for somatic mutations. This study investigated genomic differences between young-and older-onset breast tumours.Methods: In this study we characterized the mutational landscape of 89 young-onset breast tumours (≤40 years) and examined differences with 949 older-onset tumours (> 40 years) using data from The Cancer Genome Atlas. We examined mutated genes, mutational load, and types of mutations. We used complementary R packages "deconstructSigs" and "SomaticSignatures" to extract mutational signatures. A recursively partitioned mixture model was used to identify whether combinations of mutational signatures were related to age of onset.Results: Older patients had a higher proportion of mutations in PIK3CA, CDH1, and MAP3K1 genes, while youngonset patients had a higher proportion of mutations in GATA3 and CTNNB1. Mutational load was lower for youngonset tumours, and a higher proportion of these mutations were C > A mutations, but a lower proportion were C > T mutations compared to older-onset tumours. The most common mutational signatures identified in both age groups were signatures 1 and 3 from the COSMIC database. Signatures resembling COSMIC signatures 2 and 13 were observed among both age groups. We identified a class of tumours with a unique combination of signatures that may be associated with young age of onset. Conclusions:The results of this exploratory study provide some evidence that the mutational landscape and mutational signatures among young-onset breast cancer are different from those of older-onset patients. The characterization of young-onset tumours could provide clues to their etiology which may inform future prevention. Further studies are required to confirm our findings.

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Section: Young-onset Breast Cancermentioning

confidence: 99%

Mutational landscape differences between young-onset and older-onset breast cancer patients

et al. 2020

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“…Care's 2018 recommendations on mammography screening for women at average risk recommends that women aged 50-74 years be screened every 2-3 years. 1 Women at average risk are defined as those without a personal or family history of breast cancer who are not (and whose first-degree relatives are not) carriers of specific gene mutations (e.g., BRAC1, BRAC2) and who did not have chest radiation before age 30 years or in the previous 8 years. Unlike previous recommendations, the new recommendation is now "conditional on the relative value that a woman places on the possible benefits and harms from screening," which suggests that there is no "right" decision; rather, decisions should fit with women's values and preferences.…”

Section: T He Canadian Task Force On Preventive Healthmentioning

confidence: 99%

“…Unlike previous recommendations, the new recommendation is now "conditional on the relative value that a woman places on the possible benefits and harms from screening," which suggests that there is no "right" decision; rather, decisions should fit with women's values and preferences. 1 To make informed decisions about mammography that align with their values and preferences, women need sufficient information about risks, benefits and available alternatives. 2 Educational materials are one tool to share this information.…”

Section: T He Canadian Task Force On Preventive Healthmentioning

confidence: 99%

Supporting women at average risk to make informed decisions about mammography when there is no “right” answer: a qualitative citizen deliberation study

Tripp

Abelson

2019

cmajo

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Background:Women are encouraged to make informed choices about mammography screening that align with their values and preferences, yet information materials developed by screening programs rarely provide complete, balanced information about screening. Through a series of deliberations with Ontario citizens, we elicited perspectives on materials developed by screening programs to support informed decision-making. Methods:We held 4 deliberative engagement events with citizens to discuss the current evidence about mammography and informed decision-making for the general population (i.e., women not at high risk) in the context of organized screening programs. Participants reviewed and provided feedback on the educational materials currently produced by screening programs in 8 provinces (British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia and Newfoundland and Labrador) and 2 territories (Yukon Territory and Northwest Territory) and identified the key features that should guide the design of these materials to optimally support informed decision-making. Results:In general, participants viewed the educational materials as insufficient to support informed decision-making. They identified the following key features of optimal educational materials: they should be accessible, complete and accurate, and provide information on both benefits and risks of screening in a comprehensive, easy-to-understand manner. Information materials should evoke the trust of the reader, and they should be consistent across Canada.Interpretation: Canadian women have insufficient access to reliable information sources and complete evidence about mammography screening, and, without this information, they are unable to make fully informed decisions. Canadian breast screening programs must take steps to improve the information shared with women to support informed decision-making that aligns with women's values and preferences. AbstractResearch OPEN CMAJ OPEN, 7(4) E731

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“…10 It is critical that clinical guidance is based on systematic review of evidence that uses accepted methods to minimize bias and considers the totality of evidence, 11 which the task force did in developing its recommendations on breast cancer screening. 12 Third, Dr. Yaffe suggested that observational data on breast cancer screening make a clear and strong case that benefits outweigh the harms. In 2016, the United States Preventive Services Task Force did a systematic review of the types of observational studies on breast cancer screening that Dr. Yaffe used to provide evidence that supported his position.…”

mentioning

confidence: 99%

The authors respond to: “Revamp governance of Canadian Task Force on Preventive Health Care”

Klarenbach

Moore

Thombs

2020

CMAJ

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Recommendations on screening for breast cancer in women aged 40–74 years who are not at increased risk for breast cancer

Abstract: KEY POINTS• Low-certainty evidence indicates that screening for breast cancer with mammography results in a modest reduction in breast cancer mortality for women aged 40 to 74 years; the absolute benefit is lowest for women younger than 50 years.

Cited by 159 publications

References 75 publications

Mutational landscape differences between young-onset and older-onset breast cancer patients

Mutational landscape differences between young-onset and older-onset breast cancer patients

Supporting women at average risk to make informed decisions about mammography when there is no “right” answer: a qualitative citizen deliberation study

The authors respond to: “Revamp governance of Canadian Task Force on Preventive Health Care”

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