Individual Preventive Screening on Breast Cancer

Mammography for breast cancer is one of the key preventive measures in the USA, as it is based on the rationale of early identification and subsequent prevention of the disease to decrease mortality and morbidity rates. Breast cancer screening guidelines by the United States Preventive Service Task Force (USPSTF) have gone through an evidence-based process to inform practice patterns and population health (Reeves & Kaufman, 2023). This paper explores the evidential data regarding current epidemiologic principles, methods, and critical data regarding current screening guidelines alongside disparities and potential for better patient-centered care: Individual Preventive Screening on Breast Cancer.

Condition and Screening

Breast cancer is a form of cancer that affects the tissue of the breasts; it is a malignant neoplasm with the ability to spread to other organs of the body in case the disease progresses. The first stage recommended by the USPSTF is mammography, a type of X-ray imaging that enables the detection of breast disorders when they are not yet evident clinically. Digital breast tomosynthesis (DBT), also known as 3D mammography, is an advanced screening method that has proved more effective than traditional 2D imaging (Reeves & Kaufman, 2023).

Epidemiology of Breast Cancer

Analyzing the epidemiological situation of breast cancer in the USA, it is possible to notice certain tendencies and differences. The annual incidence rate is 130 per 100000 women, though the number of newly diagnosed breast cancer cases in 2023 is approximately 264000 (Giaquinto et al., 2024). Death rates have demonstrated an average decline of 1.3% per annum for the past decade, which can be attributed to achievements in screening techniques and management strategies (Giaquinto et al., 2024). Three key statistical comparisons illuminate substantial disparities: for example, unequal outcomes such as blacks dying at a 40% higher rate than whites even though both groups are diagnosed at the same rate.

For black women, the survival rate is 83% after 5 years, while for white women, the rate is 92% (Wilson & Sule, 2022). Second, the age distribution reveals that 43% of women with breast cancer are between the ages of 55 and 74, with the median age at diagnosis being 62 (Hewitt et al., 2004). Women under 45 typically have more advanced illnesses, even though they only account for 9% of cases (Hewitt et al., 2004).

Consistently, women with the lowest socioeconomic status have a 31% higher likelihood of receiving a diagnosis later on and a 20% lower chance of being screened than women with the highest socioeconomic status (Giaquinto et al., 2024). These comparisons correlate to huge gaps in terms of care provision as well as access to screening or early detection programs. Screening benefits can be evidenced by mammography, where reduced mortality from breast cancer was observed by 20% among the women who had undergone screening regularly, the best findings being among the ages 50-74 years.

Methodology

The USPSTF employed a comprehensive, methodological review to formulate breast cancer screening recommendations. The methodology involved three key processes: systematic evidence integration, systematic review, and meta-analytical integration of published data from control trials or large cohort studies (Davidson et al., 2020).

A risk-benefit Assessment looks at the benefits of the screening process and the risks that are associated with the process, such as having a positive screening test yet being healthy or being diagnosed with a disease they had no sign of. Finally, the population stratification analysis was conducted, which aimed at determining the optimal age breakdown of the participants for screening the individuals and the best age categories to involve in the particular study.

Regarding the current breast cancer screening, it is recommended that women aged 50–74 years should undergo screening mammography every two years, which is a B recommendation. For women aged 40-49 years, the prescription of a statin should be according to the patient’s risk factors and his/her lifestyle and other factors that may have an impact on the patient’s health (C).

Some of the risk factors that need to be taken into consideration include a family history of breast cancer, the presence of BRCA1/2 gene mutations, a history of chest irradiation, breast density by mammography examination, and previous breast lesions. Next, the primary one is the Breast Cancer Risk Assessment Tool (BCRAT) or Gail Model, which is the most recognized and aims at assessing the five-year and lifetime risks associated with the development of breast cancer connected to several factors (Pruitt et al., 2024).

Literature Analysis

Four pivotal studies significantly influenced guideline development. For instance, the benefits and possible risks of mammography screening for breast cancer in women between the ages of 40 and 49 are thoroughly examined in the paper “Benefits and Risks of Mammography Screening in Women Ages 40 to 49 Years” by Grimm et al. (2022).

In order to inform patients about their screening options and to influence clinical decision-making, the authors stress the significance of comprehending both the risks and the benefits. Secondly, the UK Age Trial (2015) offered valuable information on screening women below 50 years and evidenced a mere 12% decline in breast cancer mortality, which supports the notion of personalized screening for the 40-49 age group (Moss et al., 2015).

Third, the TMIST trial (2015) investigated the performance of digital versus film mammography, indicating the superiority of digital mammography in women with dense breasts and those aged below 50 years when guiding screening methods (National Cancer Institute, 2017). Lastly, The Breast Cancer Surveillance Consortium study conducted in 2015 looked at the over-diagnosis rates at 11% and false-positive rates at 61% in a decade of screening, which is useful in assessing the benefit-risk ratio, which is core to screening advice (Hewitt et al., 2004).

Currently, most of the published work aligns with these conclusions, even pointing to areas of improvement. A meta-analysis conducted in 2022 also supported the idea of risk stratification because it might help to minimize unnecessary investigations and save resources for higher-risk patients, including young women (Siddiqi et al., 2022).

In conclusion, the USPSTF breast cancer screening guidelines can be considered a prudent approach founded on sound epidemiology and strict methodological standards. Current screening practices show that disparities still need to be addressed, as evidenced by the observed mortality rate. Subsequent guidelines should take into account new technologies and risk stratification techniques and the social justice gaps that contribute to inequalities in screening. Undeniably, guidelines for breast cancer screening are essential for personal health because they enable early identification and efficient treatment, which eventually improves health outcomes and increases survival rates.

References

Davidson, K. W., Kemper, A. R., Doubeni, C. A., Tseng, C., Simon, M. A., Kubik, M., Curry, S. J., Mills, J., Krist, A., Ngo-Metzger, Q., & Borsky, A. (2020). Developing primary care–based recommendations for social determinants of health: Methods of the U.S. preventive services task force. Annals of Internal Medicine, 173(6), 461–467. https://doi.org/10.7326/m20-0730

Giaquinto, A. N., Sung, H., Newman, L. A., Freedman, R. A., Smith, R. A., Star, J., Jemal, A., & Siegel, R. L. (2024). Breast cancer statistics 2024. CA: A Cancer Journal for Clinicians, 74(6). https://doi.org/10.3322/caac.21863

Grimm, L. J., Avery, C. S., Hendrick, E., & Baker, J. A. (2022). Benefits and risks of mammography screening in women ages 40 to 49 years. Journal of Primary Care & Community Health, 13. https://doi.org/10.1177/21501327211058322

Hewitt, M., Herdman, R., & Holland, J. (Eds.). (2004). Epidemiology of breast cancer. Meeting Psychosocial Needs of Women With Breast Cancer – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK215952/

Moss, S. M., Wale, C., Smith, R., Evans, A., Cuckle, H., & Duffy, S. W. (2015). Effect of mammographic screening from age 40 years on breast cancer mortality in the UK Age trial at 17 years’ follow-up: A randomised controlled trial. The Lancet Oncology, 16(9), 1123–1132. https://doi.org/10.1016/s1470-2045(15)00128-x

National Cancer Institute. (2017, September 26). TMIST trial compares 2-D and 3-D mammography. Cancer.gov. https://www.cancer.gov/news-events/press-releases/2017/tmist-mammography-trial

Pruitt, W. R., Samuels, B., & Cunningham, S. (2024). The GAIL model and its use in preventive screening: A comparison of the Corbelli study. Cureus. https://doi.org/10.7759/cureus.56290

Reeves, R. A., & Kaufman, T. (2023, July 24). Mammography. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK559310/

Siddiqi, T. J., Ahmed, A., Greene, S. J., Shahid, I., Usman, M. S., Oshunbade, A., Alkhouli, M., Hall, M. E., Murad, M. H., Khera, R., Jain, V., Van Spall, H. G. C., & Khan, M. S. (2022). Performance of current risk stratification models for predicting mortality in patients with heart failure: A systematic review and meta-analysis. European Journal of Preventive Cardiology, 29(15), 2027–2048. https://doi.org/10.1093/eurjpc/zwac148

Wilson, J., & Sule, A. A. (2022, October 24). Disparity in early detection of breast cancer. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK564311/

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Review the clinician provider guidelines and recommendations from the United States Preventive Services Task Force A and B Recommendations.

For the master’s-prepared nurse, knowledge of epidemiology and its application to preventive screening guidelines is important in many clinical areas: administrative, education, and nurse practitioner fields. Individual patient preventive screenings are ordered as a secondary measure before symptoms occur. Preventive screenings are recommended based on outcome data from epidemiological studies, that the test is beneficial; based on risk and characteristics of the identified population in the screening guideline.

Select one screening below from the United States Preventive Services Task Force guidelines.

• Abdominal aortic aneurysm
• Breast cancer
• Cervical cancer
• Colon cancer
• Diabetes mellitus II
• Lung cancer

Condition and Screening

• Define the condition and type of screening

Epidemiology of Condition

• Discuss the epidemiology of the condition in the United States, via three statistical terms. Include the mortality and related morbidity statistics in numerical format and address trends. Include 3 comparisons: related disparities, such as race, sex, age, etc. Clearly state an analysis of the data, identifying gaps and inequities in care. Provide trends and outcomes related to screening benefits in numerical statistics.

Methodology

• Incorporate the described USPSTF guideline development methodology process, (How the guideline was developed).
• Discuss the preventive guideline criteria, the population, and provide details on the screening tool.
• Include detailed risk factors. If there is a risk prediction tool, include this.

Critical Analysis

• Conduct a literature review of the guideline’s support used for its development. You may include alternative studies found in more recent literature supporting or offering alternative views.
• Identify and discuss four studies used in the guideline development clearly relating the impact on the guideline criteria for screening, tool, or population etc.
• Identify each study clearly in the paper and cite.

Summary

Provide a summary conclusion of the screening guideline, general benefit to the individual, and why it is important.

Format expectations:

• Follow all assessment directions.
• Introduction and conclusion are included.
• Information in paragraphs and paper organized to convey the content to the reader.
• Paper length paper should be 3 pages of content.
• Follows APA in paper format, reference page, in-text citations, or headings.
• Uses four or more credible peer-reviewed sources.