Breast cancer screening: Conflicting guidelines and medicolegal risk
Ces deux articles analysent divers enjeux de la controverse relative aux programmes de dépistage organisé du cancer du sein
Consider the decision about how to best manage a healthy, 52-year-old woman who has no risk factors for breast cancer and presents for routine screening. Guidelines issued by 4 highly respected organizations provide conflicting recommendations about the appropriate interval for screening mammography of women aged 40 to 74 years at average risk of breast cancer, and whether clinical breast examination (CBE) should be performed. The 2008 American College of Radiology and 2003 American Cancer Society guidelines recommend annual screening mammography for asymptomatic, average risk women aged 40 years and older. The American Cancer Society also recommends periodic CBE, “preferably annually.” In contrast, 2009 US Preventive Services Task Force (USPSTF) guidelines recommend biennial mammography for women aged 50 to 74 years and deem existing evidence insufficient to support a conclusion about the benefit of CBE. The 2011 American College of Obstetricians and Gynecologists guidelines state that CBE should be performed annually and that although mammography should be offered annually, biennial mammography may be “more appropriate or acceptable” for some women.
JAMA , commentaire en libre accès, 2012