The Japanese Guidelines for Breast Cancer Screening Chisato Hamashima*on behalf of the Japanese Research Group for the Development of Breast Cancer Screening Guidelines

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 agestandardized 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 populationbased 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.