Adverse effects of screening mammography
Section snippets
Discomfort from breast compression
The benefits from breast compression include sharper images with better exposure, more contrast, and reduction in radiation dose [3]. Improvements in breast compression devices and techniques over the past 30 years have allowed higher cancer detection rates and more comfortable examinations [4]. Most women tolerate compression well [5], [6]. Discomfort can be minimized by following some simple recommendations. Vigorous compression is not necessary [7]. Rather, the breast should be compressed
Screening recall rates
When screening mammography is “batch interpreted” the patient leaves the imaging center right after her standard two-view per breast screening mammogram is performed and checked for image quality by the technologist. Examinations are placed on rotating film viewer and are batch interpreted by the radiologist at a later time. Patients receive their results by mail. If mammographic findings indicate that supplementary views or ultrasound are needed, the patient must return on another day.
Because
False-positive biopsies
False-positive biopsies result in patient anxiety, discomfort, pain, and increased cost and decreased use of screening mammography. The American College of Radiology and the Agency for Health Care Research and Quality recommend that the PPV when biopsy is recommended (PPV2) should be 25% to 40% [15], [16]. PPV results are affected by patient age, risk factors, and presence of clinical signs and symptoms [35]. Results from several centers have found that PPV3 (cancers/biopsies performed) for
Relative risks for screening women ages 40 to 49
Breast cancer incidence increases with age and is 0.5, 1.8, 3.1, and 4 cases per 1000 women per year for ages 30 to 39, 40 to 49, 50 to 59, and 60 to 69 years, respectively [45]. Fewer than 0.5% of all breast cancers occur below age 40, compared with 18%, 23%, 18%, and 23% for women ages 40 to 49, 50 to 59, 60 to 69, and 70 to 79, respectively [45]. Moreover, because of the large representation of the 40- to 49-year-old age group in the American population and their longer life expectancy,
Detection of ductal carcinoma in situ: benefit or harm?
Coincident with the increasing use of mammography there has also been a marked increase in the incidence of DCIS. Before the mammographic screening era, DCIS represented less than 5% of all malignancies of the breast [45]. DCIS now accounts for 20% to 40% of all nonpalpable cancers detected at screening [13], [36], [56]. With appropriate treatment the survival rate for DCIS should be 99.5% [57], [58]. DCIS may be considered a frequent but nonobligate precursor of fatal breast cancer. All cases
Radiation exposure
Misperceptions regarding radiation risk from mammography persist despite the fact that no woman has ever been shown to have developed breast cancer as a result of mammography, not even from multiple examinations over many years time at doses much higher than the current dose of 3 to 4 mGy (0.3–0.40 rad) per two-view per breast examination [85], [86], [87], [88]. Such concern is based on the observation that some groups of women (eg, Japanese A-bomb survivors and North American women treated
Psychologic effects of screening
Although no increase in the level of anxiety or depression could be found by Bull and Campbell [113] among women undergoing screening, many women become understandably anxious before their mammography examination according to Rimer and Bluman [114]. Women receiving normal screening results feel relieved and free of stress according to Lowe et al [115]. Most women prefer online interpretation of their screening studies according to Wilson et al [116]. Women advised to return after screening for
Summary
The main risks and other adverse consequences from screening include pain and discomfort from breast compression, patient recall for additional imaging, and false-positive biopsies. Although these risks affect a larger number of women than those who benefit from screening, the risks are less consequential than the life-sparing benefits from early detection. Detection of DCIS is a benefit rather than a risk from screening. Radiation risk, even for multiple screenings, is negligible at current
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