Journal List > J Korean Soc Radiol > v.74(3) > 1087628

Kim and Kim: Benefits and Harms of Breast Screening: Focused on Updated Korean Guideline for Breast Cancer Screening


Breast cancer is the second most common malignancy among Korean women. The incidence of breast cancer has increased since 1999, which is when the national screening program involving mammography started. Until now, the benefits of screening mammography have been emphasized, but information about its benefits and harms should be provided in a comprehensive fashion, in order to guide people toward making informed decisions. Although the main benefit of screening is reduction of breast cancer mortality, harms such as overdiagnosis, overtreatment, false positive and false negative diagnoses, and radiation-induced breast cancer, can all occur as a result of screening. The 2015 Korean guideline for breast cancer screening recommends biennial screening mammography for asymptomatic women aged 40 to 69 years. This review discusses the benefits and harms of screening mammography in light of evidence-based approaches obtained from randomized trials, meta-analysis, and guidelines.

Figures and Tables

Table 1

The Korean Guideline for Breast Cancer Screening

Recommendations Grade Quality of Evidence
Mammography 40–69 years Every 2 year B
≥ 70 years Recommend against routine screening. Individual decision and patient context C
Breast ultrasound Alone or combination with mammography Insufficient evidence I
Clinical Breast Examination Alone or combination with mammography Insufficient evidence I

Grade B: Recommend routine screening mammography based on the moderate evidence for mortality reduction of screening mammography. Grade C: Recommend against routine screening mammography based on the low evidence for mortality reduction of screening mammography, but selectively recommend according to the individual decision and patient context. Grade I: No recommendation nor recommend against, based on the insufficient evidence for benefits and harm.

Table 2

Randomized Controlled Trials of Mammography Screening: Protocols and Results

Trial Baseline Trial Year Country Enrollment Age (Year) Mammography Clinical Breast Examination Follow-Up (Year) Relative Risk (95% Confidence Interval) Mortality Reduction (%)
Interval (Month) Round (Number) View (Number)
HIP (11) 1963 USA 40–64 12 4 2 Yes 18 0.78
Malmö (13) 1976 Sweden 45–69 18–24 5 1–2 No 20 0.78
Two-country (12) 1977 Sweden 40–74 23–33 4 1 No 30 0.68
Edinburgh (10) 1978 Scotland 45–64 24 4 1–2 Yes 14 0.78
Canadian (5) 1980 Canada 40–49 12 5 2 Yes 25 1.05
Stockholm (16) 1981 Sweden 40–64 28 2 1 No 16 0.90
Göthenborg (15) 1982 Sweden 40–59 18 4 2 No 14 0.79
Age (14) 1991 England, Scotland, and Wales 39–41 12 8 1–2 No 10 0.83
Table 3

Performances of Hand-Held Screening Ultrasound in Women with Negative but Dense Breasts on Mammography

Study Country Number of Examinations Cancer Detection Rate (Per 1000 Examinations) Biopsy Rate
(Per 1000 Examinations)
Kaplan (33) USA 1862 3.0 30.1
Crystal et al. (34) Israel 1517 4.6 25.0
De Felice et al. (35) Italy 1754 6.8 106.6
Brancato et al. (36) Italy 5227 0.3 11.9
Corsetti et al. (37) Italy 9157 4.0 56.1
Berg et al. (38) USA 2501 4.4 68.0
 ACRIN 6666
Leong et al. (39) Singapore 141 14 99.3
Hooley et al. (40) USA 648 4.6 71.0
Weigert and Steenbergen (41) USA 8647 3.2 48.3
Parris et al. (42) USA 5519 1.8 32.8
Girardi et al. (43) Italy 9960 2.2 Not reported
Chang et al. (44) Korea 990 5.1 Not reported
Moon et al. (45) Korea 1656 1.8 Not reported
Table 4

Comparison of Recommendations for Breast Cancer Screening

Organization Mammography, Age Range, Yr Breast Self-Examination Clinical Breast Examination
40–49 50–69 ≥ 70
Korean Medical Association, Korea (9) Every 2 yr Every 2 yr Recommend against routine screening. Individual decision Insufficient evidence Insufficient evidence
US Preventive Services Task Force, USA (52) Recommend against routine screening. Individual decision Every 2 yr for women 50–74 yr Insufficient evidence for women > 75 yr Recommend against teaching to women Insufficient evidence
Canadian Task Force on Preventive Health care, Canada (50) Recommend against routine screening Every 2–3 yr for women 50–74 yr No recommendation Recommend against Recommend against
National Health Service breast cancer screening program, UK (53) No active recruitment* Every 3 yr for women 50–70 yr No routine recruitment for women > 70 yr* Not recommended Not recommended

*Program is expanding to extend screening mammography every 3 years to women aged 47–73 yr.

Table 5

Meta-Analysis Results of the Benefits in Reduction of Breast Cancer Mortality According to the Age

Relative Risk (95% Confidence Interval) Grade Quality of Evidence
Breast cancer mortality for ages 40–49 yr
 The Canadian Task Force Review (50) 0.85 (0.75–0.96) Moderate
 Cochrane review (4)* 0.84 (0.73–0.96) Moderate
Breast cancer mortality for ages 50–69 yr
 The Canadian Task Force Review (50) 0.79 (0.68–0.90) Moderate
 Cochrane review (4)* 0.77 (0.69–0.86) Moderate
Breast cancer mortality for ages at least 70 yr
 The Canadian Task Force Review (50) 0.68 (0.45–1.01) Low

*In Cochrane review (4), meta-analysis was not performed for women aged at least 70 yr.


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