To determine the best screening frequency the ECIBC's Guidelines Development Group (GDG) compared 3 different frequencies (annual, biennial and triennial) against each other for each age range.
Should annual vs. biennial mammography screening be used for early detection of breast cancer in women aged 45 to 49?
For asymptomatic women aged 45 to 49 with an average risk of breast cancer, the ECIBC's Guidelines Development Group (GDG) suggests against annual mammography screening over biennial mammography screening in the context of an organised screening programme.
Conditional recommendation against the intervention
Very low certainty of the evidence
The GDG noted that women with a strong family history may be considered for more frequent screening within screening programmes (United Kingdom). Other countries do more intensive surveillance for high-risk women.
Considerations for implementation and policy making
- The GDG notes that there is variability in the acceptability between countries and that the current practice will impact the ease of implementation and the acceptability of this intervention to key stakeholders.
- The GDG agreed that the possibility of using other imaging techniques in this subgroup of women may be relevant to consider.
- The GDG agreed that more research on the effectiveness of the different screening intervals, comparative studies, would be helpful due to the very low certainty of the evidence.
- Less information is available for certain outcomes in this age group (e.g. interval cancer).
- The GDG notes that cost-effectiveness research would be helpful to further assess this screening interval in women aged 45 to 49.
- The GDG notes that there is a lack of research on other imaging modalities between screening intervals with mammography for women of this age-group.
- There was discussion in the GDG whether women with dense breasts in this age group should be screened at different intervals.
- The GDG felt that increased cost effectiveness data, having more contextualised costs and cost-effectiveness analysis and from other settings would be helpful for future recommendations; this included checking the consistency of cost-effectiveness models with new research from trials on breast cancer screening and natural history of breast cancer disease. Also many member states have cost analysis but they are in the grey literature and not publicly available, and this should be shared with the scientific community. This priority may apply to all other screening interval recommendations.
Monitoring and evaluation
Careful monitoring of interval cancer rates in this age group is warranted.