CLINICAL STRATEGIES FOR BREAST-CANCER SCREENING - WEIGHING AND USING THE EVIDENCE

被引:62
作者
HARRIS, R [1 ]
LEININGER, L [1 ]
机构
[1] UNIV N CAROLINA, SCH MED, LINEBERGER COMPREHENS CANC CTR, CHAPEL HILL, NC USA
关键词
D O I
10.7326/0003-4819-122-7-199504010-00011
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
When balancing the benefits of screening women for breast cancer against the harms and costs of such screening, one needs to consider the risk far dying of breast cancer, the relative reduction in that risk that will result from screening women in different age groups, and the harms and costs associated with screening. Seven randomized controlled trials provide evidence of the relative risk reduction that results from screening women in different age groups; other studies estimate the harms and costs of screening. These studies indicate that the benefit of screening, expressed as the absolute number of lives extended per 1000 women screened, increases with age and that the harm of screening, expressed as the number of follow-up procedures per cancer detected, decreases with age. Thus, the tradeoff between the benefits and the harms and costs of screening is better for older than for younger women. Because there is no clear cut-point for determining when benefits outweigh harms and costs, it is important to involve women in discussions of breast cancer screening. The women who most need to be involved are those for whom the benefits of screening clearly outweigh the harms and costs and those for whom the benefits and the harms and costs constitute a ''close call.'' For women in both groups, the physician should routinely raise the issue of screening, first eliciting the patient's perceptions and then providing information and discussion about the risk for breast cancer and about the benefits and the harms and costs of screening. Furthermore, the physician should encourage the patient to use her own values to weigh the benefits against the harms and costs, pointing out biases in reasoning and minimizing socioeconomic barriers. Finally, when the benefits obviously outweigh the harms and costs, the physician should make a clear recommendation for screening.
引用
收藏
页码:539 / 547
页数:9
相关论文
共 51 条
  • [21] 2-8
  • [22] CURRENT PRACTICE OF SCREENING MAMMOGRAPHY IN THE UNITED-STATES - DATA FROM THE NATIONAL SURVEY OF MAMMOGRAPHY FACILITIES
    HOUN, F
    BROWN, ML
    [J]. RADIOLOGY, 1994, 190 (01) : 209 - 215
  • [23] POSITIVE PREDICTIVE VALUE OF SCREENING MAMMOGRAPHY BY AGE AND FAMILY HISTORY OF BREAST-CANCER
    KERLIKOWSKE, K
    GRADY, D
    BARCLAY, J
    SICKLES, EA
    EATON, A
    ERNSTER, V
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1993, 270 (20): : 2444 - 2450
  • [24] KEUTER MW, 1995, IN PRESS HLTH PSYCHO
  • [25] OBSERVATIONS ON MAMMOGRAPHIC SCREENING AND FALSE-POSITIVE MAMMOGRAMS
    KOPANS, DB
    SWANN, CA
    [J]. AMERICAN JOURNAL OF ROENTGENOLOGY, 1988, 150 (04) : 785 - 786
  • [26] THE CANADIAN NATIONAL BREAST SCREENING STUDY - A CRITICAL-REVIEW
    KOPANS, DB
    FEIG, SA
    [J]. AMERICAN JOURNAL OF ROENTGENOLOGY, 1993, 161 (04) : 755 - 760
  • [27] KOTTKE TE, 1995, IN PRESS JAMA
  • [28] LANNIN DR, 1993, SURG GYNECOL OBSTET, V177, P457
  • [29] PSYCHOLOGICAL AND BEHAVIORAL-IMPLICATIONS OF ABNORMAL MAMMOGRAMS
    LERMAN, C
    TROCK, B
    RIMER, BK
    BOYCE, A
    JEPSON, C
    ENGSTROM, PF
    [J]. ANNALS OF INTERNAL MEDICINE, 1991, 114 (08) : 657 - 661
  • [30] A BEDSIDE DECISION INSTRUMENT TO ELICIT A PATIENTS PREFERENCE CONCERNING ADJUVANT CHEMOTHERAPY FOR BREAST-CANCER
    LEVINE, MN
    GAFNI, A
    MARKHAM, B
    MACFARLANE, D
    [J]. ANNALS OF INTERNAL MEDICINE, 1992, 117 (01) : 53 - 58