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APPENDIX B 137 new BSE teaching programs nor changing existing ones, appears to be a prudent interim approach pending new data.47 Clinical Intervention Annual clinical breast examination is recommended for all women aged 40 and above. Mammography every one to two years is recommended for all women beginning at age 50 and concluding at approximately age 75 unless pathology is detected. Obtaining "baseline" mammograms before age 50 is not recommended. For the special category of women at high risk because of a family history of premenopausally diagnosed breast cancer in first-degree relatives, it may be prudent to begin regular clinical breast examination and mammography at an earlier age (e.g., age 35). Clinicians should refer patients to mammographers who use low-dose equipment and adhere to high standards of quality control. Although teaching BSE is not specifically recommended at this time, there is insufficient evidence to recommend any change in current BSE practices. Note: See Appendix A for the U.S. Preventive Services Task Force Table of Ratings for this topic. See also the relevant Task Force background paper: O'Malley MS, Fletcher SW. U.S. Preventive Services Task Force: screening for breast cancer with breast self-examination: a critical review. JAMA 1987; 257:2196-203. REFERENCES 1. American Cancer Society. Cancer statistics, 1989. CA 1989; 39:3-20. 2. Leads from MMWR. Premature mortality due to breast cancer--United States, 1984. JAMA 1987; 3229-31. 3. McLellan GL. Screening and early diagnosis of breast cancer. J Fam Pract 1988: 26:561-8. 4. Kelsey JL, Hildreth NG, Thompson WD. Epidemiological aspects of breast cancer. Radiol Clin North Am 1983; 21:3-12. 5. Kelsey JL. A review of the epidemiology of human breast cancer. Epidemiol Rev 1979; 1:74-109. 6. Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med 1985; 312:146-51.
APPENDIX B 138 7. Seidman H, Stellman SD, Mushinski MH. A different perspective on breast cancer risk factors: some implications of nonattributable risk. CA 1982; 32:301-13. 8. O'Malley MS, Fletcher SW. Screening for breast cancer with breast self examination. JAMA 1987; 257:2197-293. 9. Haughey BP, Marshall JR, Mettlin C, et al. Nurses' ability to detect nodules in silicone breast models. Oncol Nurs Forum 1984; 1:37-42. 10. Fletcher SW, O'Malley MS, Bunce LA. Physicians' abilities to detect lumps in silicone breast models. JAMA 1985; 253:2224-8. 11. Baines CJ, McFarlane DV, Miller AB. Sensitivity and specificity of first screen mammography in 15 NBSS centres. Can Assoc Radiol J 1988; 39:273-6. 12. Eideiken S. Mammography and palpable cancer of the breast. Cancer 1988; 61:263-5. 13. Peeters PH, Verbeck AL, Hendricks JH, et al. The predictive value of positive test results in screening for breast cancer by mammography in the Nijmegen programme. Br J Cancer 1987; 56:667-71. 14. Wright CJ. Breast cancer screening: a different look at the evidence. Surgery 1986; 100:594-8. 15. Boyd NF, Wofson C, Moskowitz M, et al. Observer variation in the interpretation of xeromammograms. JNCI 1982; 68:357-63. 16. Baines CJ, McFarlane DV, Wall C. Audit procedures in the national breast screening study: mammography interpretation. J Can Assoc Radiol 1986; 37:256-60. 17. Gadkin BM, Feig SA, Muir HD. The technical quality of mammography in centers participating in a regional breast cancer awareness program. Radiographics 1988; 8:133-45. 18. Kimme-Smith C, Bassett LW, Gold RH. Evaluation of radiation dose, focal spot, and automatic exposure of newer film-screen mammography units. AJR 1987; 149:913-7. 19. Prado KL, Rakowski JT, Barragan F, et al. Breast radiation dose in film/screen mammography. Health Physics 1988; 55:81-3. 20. Gould-Martin K, Paganini-Hill A, Cassagrande C, et al. Behavioral and biological determinants of surgical stage of breast cancer. Prev Med 1982; 11:441-53. 21. Hall DC, Adams CK, Stein GH, et al. Improved detection of human breast lesions following experimental training. Cancer 1980; 46:408-11. 22. Shapiro S, Venet W, Strax P, et al., eds. Periodic screening for breast cancer. Baltimore, Md.: Johns Hopkins Press, 1988. 23. Tabar L, Fagerberg CJG, Gad A, et al. Reduction in mortality from breast cancer after mass screening with mammography: randomised
APPENDIX B 139 trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet 1985; 1:829-32. 24. Andersson I, Aspegren K, Janzon L, et al. Mammographic screening and mortality from breast cancer: the Malmo Mammographic Screening Trial. Br Med J 1988; 297:943-8. 25. Verbeek ALM, Hendricks JHCL, Hollan PR, et al. Reduction of breast cancer mortality through mass screening with modern mammography: first results of the Nijmegen Project, 1975-1981. Lancet 1984; 1:1222-4. 26. Palli D, Del Turco MR, Buiatti E, et al. A case-control study of the efficacy of a non- randomized breast cancer screening program in Florence (Italy). Int J Cancer 1986; 38:501-4. 27. Seidman H, Gelb SK, Silverberg E, et al. Survival experience in the breast cancer detection demonstration project. CA 1987: 37:258-90. 28. Morrison AS, Brisson J, Khalid N. Breast cancer incidence and mortality in the Breast Cancer Detection Demonstration Project. JNCI 1988; 80:1540-7. 29. Bailar JC. Mammography before age 50 years? An editorial. JAMA 1988; 259:1548-9. 30. Eddy DM, Hasselblad V, McGivney W, et al. The value of mammography screening in women under age 50 years. JAMA 1988; 259:1512-9. 31. Dodd GS, Taplin S. Is screening mammography routinely indicated for women between 40 and 50 years of age? J Fam Pract 1988; 27:313-20. 32. Day NE, Baines CJ, Chamberlain J, et al. UICC project on screening for cancer: report of the workshop on screening for breast cancer. Int J Cancer 1986; 38:303-8. 33. Chu KC, Smart CR, Tarone RE. Analysis of breast cancer mortality and stage distribution by age for the Health Insurance Plan clinical trial . JNCI 1988; 80:1125-32. 34. Eddy DM. Breast cancer screening (letter). JNCI 1989; 81:234-5. 35. Tabar L, Faberberg G, Day NE, et al. What is the optimum interval between mammographic screening examinations? An analysis based on the latest results of the Swedish two-county breast cancer screening trial. Int J Cancer 1987; 55:547-51. 36. Hill D, White V, Jolley D, et al. Self examination of the breast: is it beneficial? Meta-analysis of studies investigating breast self examination and extent of disease in patients with breast cancer. Br Med J 1988; 297:271-5. 37. American Cancer Society. Summary of current guidelines for the cancer-related checkup: recommendations. New York: American Cancer Society, 1988.
APPENDIX B 140 38. National Cancer Institute. Working guidelines for early detection: rationale and supporting evidence to decrease mortality. Bethesda, Md.: National Cancer Institute, 1987. 39. American Medical Association. Mammography screening in asymptomatic women 40 years and older (Resolution 93, I-87). Report of the Council on Scientific Affairs, Report F (A-88). Chicago, Ill.: American Medical Association, 1988. 40. American College of Obstetricians and Gynecologists. Standards for obstetric-gynecologic services, 6th ed. Washington, D.C.: American College of Obstetricians and Gynecologists, 1985. 41. American College of Radiology. Policy statement: guidelines for mammography. Reston, Va.: American College of Radiology, 1982. 42. Dodd GD, American College of RAdiology. Personal communication, February 1989. 43. Canadian Task Force on the Periodic Health Examination. The periodic health examination: 2. 1985 update. Can Med Assoc J 1986; 134:724-9. 44. American College of Physicians. The use of diagnostic tests for screening and evaluating breast lesions. Ann Intern Med 1985; 103:147-51. 45. Baines CJ. Breast-cancer screening: current evidence on mammography and implications for practice. Can Fam Physician 1987; 33:915-22. 46. Frame PS. A critical review of adult health maintenance. Part 3. Prevention of cancer. J Fam Pract 1986; 22:511-20. 47. World Health Organization. Self-examination in the early detection of breast cancer. Bull WHO 1984; 62:861-9. 48. Miller AB. Screening for breast cancer. Breast Cancer Res Treat 1983; 3:143-56. 49. Sickles EA, Weber WN, Galvin HB, et al. Mammographic screening: how to operate successfully at low cost. Radiology 1986; 160:95-7. 50. Dodd GS. The history and present status of radiographic screening for breast carcinoma. Cancer [Suppl 7] 1987; 1:671-4. 51. Bassett LW, Diamond JJ, Gold RH, et al. Survey of mammography practices. AJR 1987; 149:1149.