The Japanese Guidelines for Breast Cancer Screening.
Chisato Hamashima, Japanese Research Group for the Development of Breast Cancer Screening Guidelines, Chisato Hamashima C, Masakazu Hattori, Satoshi Honjo, Yoshio Kasahara, Takafumi Katayama, Masahiro Nakai, Tomio Nakayama, Takako Morita, Koji Ohta, Koji Ohnuki, Motoyasu Sagawa, Hiroshi Saito, Seiju Sasaki, Tomoyuki Shimada, Tomotaka Sobue, Akihiko Suto, Japanese Research Group for the Development of Breast Cancer Screening Guidelines
Author Information
Chisato Hamashima: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan chamashi@ncc.go.jp.
Chisato Hamashima C: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
Masakazu Hattori: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
Satoshi Honjo: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
Yoshio Kasahara: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
Takafumi Katayama: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
Masahiro Nakai: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
Tomio Nakayama: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
Takako Morita: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
Koji Ohta: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
Koji Ohnuki: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
Motoyasu Sagawa: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
Hiroshi Saito: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
Seiju Sasaki: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
Tomoyuki Shimada: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
Tomotaka Sobue: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
Akihiko Suto: Division of Cancer Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Chuo-ku, Tokyo, Japan.
OBJECTIVE: The incidence of breast cancer has progressively increased, making it the leading cause of cancer deaths in Japan. Breast cancer accounts for 20.4% of all new cancers with a reported age-standardized rate of 63.6 per 100 000 women. METHODS: The Japanese guidelines for breast cancer screening were developed based on a previously established method. The efficacies of mammography with and without clinical breast examination, clinical breast examination and ultrasonography with and without mammography were evaluated. Based on the balance of the benefits and harms, recommendations for population-based and opportunistic screenings were formulated. RESULTS: Five randomized controlled trials of mammographic screening without clinical breast examination were identified for mortality reduction from breast cancer. The overall relative risk for women aged 40-74 years was 0.75 (95% CI: 0.67-0.83). Three randomized controlled trials of mammographic screening with clinical breast examination served as eligible evidence for mortality reduction from breast cancer. The overall relative risk for women aged 40-64 years was 0.87 (95% confidence interval: 0.77-0.98). The major harms of mammographic screening were radiation exposure, false-positive cases and overdiagnosis. Although two case-control studies evaluating mortality reduction from breast cancer were found for clinical breast examination, there was no study assessing the effectiveness of ultrasonography for breast cancer screening. CONCLUSIONS: Mammographic screening without clinical breast examination for women aged 40-74 years and with clinical breast examination for women aged 40-64 years is recommended for population-based and opportunistic screenings. Clinical breast examination and ultrasonography are not recommended for population-based screening because of insufficient evidence regarding their effectiveness.
