Evidence-based practice: recommendations for the early detection of breast cancer.

The American Cancer Society (ACS) estimates that in 2003, 211,300 women will be diagnosed with breast cancer and 39,800 women will die from the disease (Jemal et al., 2003). The mortality associated with breast cancer has decreased because of increased awareness of and participation in early detection methods. The three primary tools used for the early detection of breast cancer are breast self-examination (BSE), clinical breast examination (CBE) by a healthcare provider, and mammography. Each detection tool has it own inherent strengths and weaknesses. Recommendations for the early detection of breast cancer vary among agencies. Controversy continues about the choice of screening tests, recommended intervals for testing, and populations to be screened for cancer. This confusion stems from differences in populations considered (e.g., women of different ages), varying thresholds for acceptance of effectiveness of tests (e.g., sensitivity, specificity), costs, risks associated with screening tests, and the underlying mission of the recommending agency (Foltz, 2000). Many types of agencies issue guidelines, including governmental agencies, diseaserelated organizations, and organizations of health professionals. Table 1 provides an overview of some of the current recommendations from a variety of agencies for the early detection of breast cancer. Most of these recommendations do not include an upper age limit for when screening should be stopped. The decision to continue screening is individualized and usually based on the overall health of the woman.