SCREENING FOR BREAST CANCER // NGC - Compare - Comparison

NATIONAL GUIDELINE CLEARINGHOUSE™ (NGC)
GUIDELINE SYNTHESIS
SCREENING FOR BREAST CANCER
guidelines being compared
1.American College of Physicians (ACP). Screening mammography for women 40 to 49 years of age: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2007 Apr 3;146(7):511-5. [31 references]
2.U.S. Preventive Services Task Force (USPSTF). 1) Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. 2) December 2009 addendum. Ann Intern Med 2009 Nov 17;151(10):716-726. [32 references]


TABLE OF CONTENTS
AREAS OF AGREEMENT AND DIFFERENCE
COMPARISON OF RECOMMENDATIONS

•MAMMOGRAPHIC SCREENING IN WOMEN AGED 40 TO 49 YEARS
•MAMMOGRAPHIC SCREENING IN WOMEN OLDER THAN 49 YEARS OF AGE
•DIGITAL MAMMOGRAPHY AND MAGNETIC RESONANCE IMAGING (MRI)
•CLINICAL BREAST EXAMINATION (CBE) AND BREAST SELF-EXAMINATION (BSE)
STRENGTH OF EVIDENCE AND RECOMMENDATION GRADING SCHEMES
METHODOLOGY
SOURCE(S) OF FUNDING
BENEFITS AND HARMS
ABBREVIATIONS AREAS OF AGREEMENT AND DIFFERENCE
A direct comparison of the recommendations presented in the above guidelines for screening for breast cancer in asymptomatic women is provided in the tables below.

Areas of Agreement
Mammographic Screening In Women Aged 40 to 49 Years
Neither ACP nor USPSTF recommend routine screening mammography in women aged 40 to 49 years, with both groups recommending the decision to screen be an informed one made on a case-by-case basis. ACP recommends that clinicians: periodically (every 1 to 2 years) perform individualized assessment of risk for breast cancer to help guide decisions about screening mammography; inform women about the potential benefits and harms of screening mammography; and base screening mammography decisions on benefits and harms of screening, as well as on a woman's preferences and breast cancer risk profile. USPSTF similarly recommends that the decision to start regular, biennial screening mammography before the age of 50 years be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.

With regard to recommended screening intervals in women in this age group who choose to undergo screening, USPSTF recommends biennial screening, noting that the evidence reviewed indicates that a large proportion of the benefit of screening mammography is maintained by biennial screening, and changing from annual to biennial screening is likely to reduce the harms of mammography screening by nearly half. ACP does not present recommendations regarding the frequency with which women in this age group should undergo screening mammography. They do, however, address screening intervals in the context of women in this age group with certain circumstances. They note that for women who do not wish to discuss the screening decision, screening mammography every 1 to 2 years is reasonable. They also note that if a woman decides to forgo mammography, clinicians should readdress the decision to have screening every 1 to 2 years.

Areas of Difference
Mammographic Screening In Women Older Than 49 Years of Age
USPSTF is the only group to provide screening recommendations for women older than 49 years of age. In women aged 50 to 74 years it recommends biennial screening mammography. For women 75 years or older, it concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography, citing overdiagnosis and unnecessary earlier treatment as important potential harms of screening women in this age group.

Digital Mammography and Magnetic Resonance Imaging (MRI)
USPSTF is the only group to address screening using digital mammography and MRI, and concludes that the current evidence is insufficient to assess the additional benefits and harms of using either tool instead of film mammography as a screening modality for breast cancer.

Clinical Breast Examination (CBE) and Breast Self-Examination (BSE)
USPSTF is the only group to address CBE and BSE. It recommends against teaching BSE and concludes that the current evidence is insufficient to assess the additional benefits and harms of CBE beyond screening mammography in women 40 years or older.

abrir aquí para acceder al documento NGC AHRQ completo (muy extenso):
NGC - Compare - Comparison