Clinical guidelines for the management of mammographic density: a systematic review of breast screening guidelines worldwide.

IF 3.4 Q2 ONCOLOGY JNCI Cancer Spectrum Pub Date : 2024-11-01 DOI:10.1093/jncics/pkae103
Jennifer Marie Jacqueline Isautier, Nehmat Houssami, Claudia Hadlow, Michael Luke Marinovich, Serena Hope, Sophia Zackrisson, Meagan Elizabeth Brennan, Brooke Nickel
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Abstract

Background: High breast density is an independent risk factor for breast cancer and decreases the sensitivity of mammography. This systematic review synthesizes the international clinical guidelines and the evidence base for screening and supplemental screening recommendations in women with dense breasts.

Methods: A systematic search of CINHAL, Embase, and Medline databases was performed in August 2023 and grey literature searched in January 2024. Two authors independently assessed study eligibility and quality (Appraisal of Guidelines for Research and Evaluation II instrument).

Results: Of 3809 articles, 23 guidelines published from 2014 to 2024 were included. The content and quality varied between the guidelines; the average AGREE II total score was 58% (range = 23%-87%). Most guidelines recommended annual or biennial screening mammography for women more than 40 years old with dense breasts (n = 16). Other guidelines recommended breast tomosynthesis (DBT, n = 6) or magnetic resonance imaging (MRI, n = 1) as the preferred screening modality. One third of the guidelines (n = 8) did not recommend supplemental screening for women with dense breasts. Of those that recommended supplemental screening (n = 14), ultrasound was the preferred modality (n = 7), with MRI (n = 3), DBT (n = 3), and contrast-enhanced mammography (n = 2) also recommended.

Conclusions: Consensus on supplemental screening in women with dense breasts is lacking. The quality of the guidelines is variable, and recommendations are based largely on low-quality evidence. As evidence of the benefits versus harms of supplemental screening in women with dense breasts is evolving, it is imperative to improve the methodological quality of breast cancer screening and supplemental screening guidelines.

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乳腺造影密度管理的临床指南:全球乳腺筛查指南的系统回顾。
背景:高乳腺密度是乳腺癌的独立危险因素,会降低乳腺X光检查的灵敏度。本系统综述综合了国际临床指南和证据基础,为致密乳房女性提供筛查和补充筛查建议:方法:于 2023 年 8 月对 CINHAL、Embase 和 Medline 数据库进行了系统检索,并于 2024 年 1 月检索了灰色文献。两位作者独立评估了研究的资格和质量(研究和评估指南评估工具 II):在 3 809 篇文章中,共纳入了 23 份 2014 年至 2024 年出版的指南。不同指南的内容和质量各不相同;AGREE II 总分的平均值为 58%(范围从 23% 到 87%)。大多数指南建议40岁以上、乳房致密的女性每年或每两年进行一次乳腺X光筛查(n = 16)。其他指南建议首选乳腺断层扫描(DBT,n = 6)或磁共振成像(MRI,n = 1)作为筛查方式。三分之一的指南(8 份)不建议对致密乳房女性进行补充筛查。在建议进行补充筛查的指南中(14 份),超声波是首选筛查方式(7 份),此外还建议进行核磁共振成像(3 份)、DBT(3 份)和对比增强乳腺 X 光检查(2 份):结论:对于致密乳房女性的补充筛查还缺乏共识。指南的质量参差不齐,建议大多基于低质量的证据。由于有关致密乳房女性补充筛查利弊的证据在不断变化,因此提高乳腺癌筛查和补充筛查指南的方法学质量势在必行。
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来源期刊
JNCI Cancer Spectrum
JNCI Cancer Spectrum Medicine-Oncology
CiteScore
7.70
自引率
0.00%
发文量
80
审稿时长
18 weeks
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