Mammography is the primary and the most effective method for breast cancer screening. Due to a high mortality rate among patients with late diagnosis and the asymptomatic nature of the condition, the U.S. Preventive Services Task Force (USPSTF, 2016) recommends biennial mammography tests for decreasing mortality and morbidity associated with breast cancer among women aged 50-74.
The method is considered to be uncomplicated and cost-efficient which is a crucial characteristic for the condition to be included in preventative care. At the same time, the primary concerns of breast cancer screening are cases of overdiagnosis and an elevated number of false-positive results. While the harms of mammography are evident, the virtues of breast cancer screening outweigh the associated risks.
Epidemiology
The current situation with epidemiology in the United States concerning breast cancer is disturbing. According to Fletcher, Fletcher, and Fletcher (2012), one in 69 women in their 40s in the US is recognized to have the condition. The risk of developing breast cancer in females aged 50-74 increases by 250% (USPSTF, 2016). In 2015, almost 232,000 women were diagnosed with the condition, and 40,000 of them died (USPSTF, 2016). Breast cancer is the second leading cause of cancer deaths of women in the United States, and it is the most frequently diagnosed noncutaneous cancer (Pace & Keating, 2014). Due to the situation described above, addressing breast cancer is a priority for health care authorities both in the US and worldwide.
Patient Population and Risk Factors
Breast cancer is most frequent in women from 50 to 74 years, and the median age of death from the illness is 68. While the condition is also diagnosed in women under 50, preventative screening for this population may be associated with more harm than benefit. Women younger than 40 or older than 75 are less likely to be affected by the illness (USPSTF, 2016). In short, the primary risk factor for breast cancer is age, and preventative screening tests should be ordered with this information in mind.
While a woman’s age is considered the most important criterion for estimating the chance of breast cancer, other risks should be considered to decrease mortality and morbidity among the population. First, women who have close relatives suffering from the condition are more likely to be exposed to the illness. Patients with a family history of breast cancer in their siblings, children, or mother are in greater danger of developing the condition (USPSTF, 2016).
Second, Pace and Keating (2014) acknowledge that women having dense breasts in their forties have twice the average risk of death from breast cancer. However, USPSTF (2016) fails to support the matter, as it states that the notion is “weak or inconsistent and would not likely influence how women value the tradeoffs of the potential benefits and harms of screening” (para. 27). In short, healthcare providers are to consider all the risk factors mentioned above before ordering preventative screening.
Preventative Screening Guideline
Guidelines for health care organizations should be based on balancing possible harms and benefits of preventative screening. According to Fletcher et al. (2012), before deciding whether the condition should be included in preventative care, physicians are to consider all the risk factors and evaluate the burden of suffering, screening test effectiveness, and further treatment efficiency. The possible harms of mammography as the primary test for breast cancer diagnosis are to be described to measure the potential risks. Overdiagnosis is a fundamental concern for the test, as tumors that would have otherwise never threatened health can be detected (USPSTF, 2016).
This fact leads to unnecessary expenses, discomfort, and dissatisfaction in patients. Moreover, the possibility of false-positive results also contributes to the decision-making process, as 49.7% – 61.3% of women were falsely diagnosed with breast cancer at least once (Pace and Keating, 2014). In brief, health care providers should order preventative screening considering possible harms and risk factors.
The preventative screening guideline provided by USPSFT summarizes all the recent research evidence and is recommended for implementation nationwide. First, USPSTF (2016) recommends the mammography test every two years for women aged 50-74. The screening pattern is expected to prevent up to 32 deaths in every 10,000 women of the patient group (USPSTF, 2016). Second, physicians are advised to make individualized mammography screening decisions for females aged 40-49 after informing the patient about possible risks (USPSTF, 2016). Physicians may also consider annual mammography, especially in women aged 60-69 with the family history of breast cancer (USPSTF, 2016). In short, the US authorities offer a comprehensive and adherent guideline for addressing the matter that is confirmed by recent evidence.
Conclusion
As there is no reliable treatment for late stages of breast cancer, the primary method for decreasing the number of deaths from the condition is preventative screening. The introduction of biennial mammography tests is associated with a significant breast cancer mortality decrease in women aged 50-74. However, the test has possible adverse outcomes that should be considered before ordering the procedure. Decisions concerning the matter should be made after measuring all the harms and benefits of the process.
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References
Fletcher, R. H., Fletcher, S. W., & Fletcher, G. S. (2012). Clinical epidemiology: The essentials (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins.
Pace, L., & Keating, N. (2014). A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA, 311(13), 1327. Web.
U.S. Preventive Services Task Force. (2016) Final recommendation statement. Breast cancer: Screening. Web.