Canadian Task Force on Preventive Health Care, Recommendations on screening for breast cancer in average-risk women aged 40–74 years

Alberta Kidney Disease Network, University of Alberta, Edmonton, Alta.
Canadian Medical Association Journal (Impact Factor: 5.96). 11/2011; 183(17):1991-2001. DOI: 10.1503/cmaj.110334
Source: PubMed
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    • "Variable recommendations for breast cancer screening among countries and organizations demonstrate the complexity of translating evidence into recommendations, even in very well-studied conditions [1-4]. Disagreement can arise over a variety of issues, including which studies provide sufficiently valid evidence to be included in analysis, the relative value of various outcomes, and the degree to which personal preferences of patients and families should be considered [5-9]. "
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    ABSTRACT: Background We sought to determine the extent to which physicians agree about the appropriate decision threshold for recommending magnetic resonance imaging in a clinical practice guideline for children with recurrent headache. Methods We surveyed attending physicians in Canada practicing in community pediatrics, child neurology, pediatric radiology, and pediatric neurosurgery. For children in each of six risk categories, physicians were asked to determine whether they would recommend for or against routine magnetic resonance imaging of the brain in a clinical practice guideline for children with recurrent headache. Results Completed surveys were returned by 114 physicians. The proportion recommending routine neuroimaging for each risk group was 100% (50% risk), 99% (10% risk), 93% (4% risk), 54% (1% risk), 25% (0.4% risk), 4% (0.01% risk). Community pediatricians, physicians in practice >15 years, and physicians who believed they ordered neuroimaging less often than peers were less likely to recommend neuroimaging for the 1% risk group (all p < 0.05). Conclusions There is no consensus among pediatric specialists regarding the appropriate decision threshold for neuroimaging in a clinical practice guideline for children with recurrent headache. Because of the impact that individual threshold preferences may have on guidelines, these findings support the need for careful composition of guideline committees and consideration of the role of patient and family preferences. Our findings also support the need for transparency in guidelines regarding how evidence was translated into recommendations and how conflicts were resolved.
    Full-text · Article · Jun 2014 · BMC Pediatrics
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    • "A reduction in breast cancer mortality attributable to mammography among women aged 50 to 74 has been demonstrated [4] [5] [6]. In Canada, average-risk women aged 50 to 74 are recommended to undergo screening mammography every 2 to 3 years [7]. In Ontario, mammography is available to women aged 50 to 74 through the Ontario Breast Screening Program (OBSP), and with physician referral through imaging facilities outside of the screening program [8]. "
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    ABSTRACT: Evidence of the accuracy of self-reported mammography use among women with familial breast cancer risk is limited. This study examined the accuracy of self-reported screening mammography dates in a cohort of 1,114 female relatives of breast cancer cases, aged 26 to 73 from the Ontario site of the Breast Cancer Family Registry. Self-reported dates were compared to dates abstracted from imaging reports. Associations between inaccurate recall and subject characteristics were assessed using multinomial regression. Almost all women (95.2% at baseline, 98.5% at year 1, 99.8% at year 2) accurately reported their mammogram use within the previous 12 months. Women at low familial risk (OR = 1.77, 95% CI: 1.00-3.13), who reported 1 or fewer annual visits to a health professional (OR = 1.97, 95% CI: 1.15, 3.39), exhibited a lower perceived breast cancer risk (OR = 1.90, 95% CI: 1.15, 3.15), and reported a mammogram date more than 12 months previous (OR = 5.22, 95% CI: 3.10, 8.80), were significantly more likely to inaccurately recall their mammogram date. Women with varying levels of familial risk are accurate reporters of their mammogram use. These results present the first evidence of self-reported mammography recall accuracy among women with varying levels of familial risk.
    Full-text · Article · Aug 2013
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    • "In non-participants, the incidence remained stable along age with a small peak around 45 years old, which is similar to the patterns observed in Asian women (Lee et al. 2009; Tonelli et al. 2011). In the participants, conversely, the incidence increased with increasing age, which is very close to the patterns in western countries (Lee et al. 2009). "
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    ABSTRACT: To evaluate the screening performance of individual and combined use of clinical breast examination, ultrasonography and mammography in Chinese women, we conducted a biennial breast cancer screening program among 14,464 women aged 35 to 74 years old who lived in Qibao County, Minhang district of Shanghai, China, between May 2008 and Sept 2012. All participants were submitted to clinical breast examination, and then women with positive results and all women at age of 45-69 years old were preformed breast ultrasonography and mammography. The examination results were compared against pathological findings as the gold standard of reference. A total of 66 women were diagnosed with breast cancer in the two rounds of the screening, yielding an incident rate of 194 per 100,000 person-years. The sensitivity of clinical breast examination, ultrasonography and mammography alone were 61.4%, 53.7% and 67.3%, respectively. While mammography performed better in elder age groups and hormone receptor positive disease groups, ultrasonography had a higher sensitivity in younger age group and did not differ in sensitivity by estrogen receptor or progesterone receptor status. Combined use of the two imaging examinations increased the sensitivity in almost all age groups, but had a higher sensitivity in hormone receptor positive cancers than in those negative. Our results suggest that the Qibao modality is an effective strategy for breast cancer screening among Chinese women, especially for early detection of elder and hormone receptor positive breast cancer.
    Full-text · Article · Jun 2013 · SpringerPlus
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