Breast Cancer Screening in the US and Canada

Preventative Recommendations

The health and vitality of a nation are directly related to the quality of prevention services provided by its healthcare professionals (Hogan-Quigley, Palm, & Bickley, 2012). The aim of this paper is to discuss the United States Preventive Services Task Force (USPSTF) and its recommendations for breast cancer screening. The paper will also compare the task force’s recommendations to those provided by Canadian Task Force on Preventative Health Care (CTFPHC).

Discussion

The USPSTF is a panel of prevention experts funded by the US Department of Health and Human Services (“About the USPSTF,” n.d.). The sole aim of the panel is the development of evidence-based preventative recommendations that can be used by the country’s healthcare professionals for the improvement of patient outcomes. The task force consists of sixteen volunteer professionals from a wide-range of healthcare fields (“Our members,” n.d.). The task force is governed by a chairperson and two vice-chairpersons (“Our members,” n.d.). The members of the USPSTF are appointed by the Agency for Healthcare Research and Quality (AHRQ) whose term of office is restricted to four years (“Our members,” n.d.). Currently, David Grossman presides over the task force’s meetings.

The USPSTF uses a five-point scale for its screening recommendations (“Grade definitions,” n.d.). In addition to grading suggestions for practice, the scale describes their strengths, thereby making it easier for healthcare practitioners to understand their importance. Furthermore, the USPSTF grade recognizes three tiers of evidence quality.

The final recommendation statement on breast cancer screening was released in 2016 (“Final recommendation,” 2016). The task force’s suggestions for self-breast examination and clinical breast examination (CBE) have not changed since the previous edition of recommendations for care practice issued in 2009 (“Final recommendation,” 2016). According to the USPSTF recommendations for CBE, the procedure allows detecting a significant portion of cancers if it is a sole screening test that is available for women (“Final recommendation,” 2016). The task force does not identify potential harms of CBE apart from false-positives. However, it is graded as a procedure that cannot be properly assessed due to the lack of evidence. Despite the fact that the USPSTF supports women who are willing to keep track of changes in their bodies, it recommends against self-examinations (“Breast cancer,” 2009). The recommended scale for the procedure is D, which presupposes high certainty that the practice’s harms are not outweighed by its benefits.

Mammography is recommended for women prior to the age of 50 and those between 50 and 74 years (“Final recommendation,” 2016). However, the use of mammography for cancer screening is graded as C for the first group of women and as B for the second group. When it comes to women who are 75 years or older, the USPSTF maintains that the current evidence on the safety and efficiency of the procedure is lacking; therefore, it is graded as I (“Final recommendation,” 2016). It should be mentioned that changes of the recommendations for mammography introduced in 2009 raised controversy among women (Pickert, 2011).

Recommendations of the CTFPHC for mammography and breast self-examination are identical to those provided by the USPSTF. Recommendations are also not different for CBE. However, the task force approves a moderate use of the procedure in combination with mammography (CTFPHC et al., 2011).

This minor difference in the two task force’s recommendations can lower the risk of breast cancer among young Canadian women. Even though high-quality evidence confirming benefits of the procedure is currently lacking, it is worth to perform CBE until evidence of increased harm emerges.

Conclusion

The paper has reviewed the recent USPSTF recommendations for breast cancer screening. Upon comparing the recommendations of the task force to those issued by the CTFPHC, it has been argued that the recommendation to engage in occasional CBE proposed by the latter body has significant implications for patient outcomes.

References

About the USPSTF. (n.d.). Web.

Breast cancer: Screening. (2009). Web.

CTFPHC, Tonelli, M., Gorber, C., Dickinson, S., Birthwhistle, R., Fitzpatrick-Lewis, D., & Liu, Y. (2011). Recommendations on screening for breast cancer in average-risk women aged 40-74 years. CMAJ, 183(17), 19-45.

Final recommendation statement: Breast cancer: Screening. (2016). Web.

Grade definitions. (n.d.). Web.

Hogan-Quigley, B., Palm, M. L., & Bickley, L. (2012). Bates’ nursing guide to physical examination and history taking. Philadelphia, PA: Lippincott Williams & Wilkins.

Our members. (n.d.). Web.

Pickert, K. (2011). The screening dilemma: Are some cancers better left undiscovered? Time, 177(24), 60-64.