Benefits and harms of breast cancer mammography screening for women at average risk of breast cancer : A systematic review for the European Commission Initiative on Breast Cancer
Canelo Aybar, Carlos Gilberto (Institut d'Investigació Biomèdica Sant Pau)
Ferreira, Diogenes S. (Monash University. Department of Epidemiology and Preventive Medicine)
Ballesteros Silva, Mónica Patricia (Institut d'Investigació Biomèdica Sant Pau)
Posso, Margarita (Institut Hospital del Mar d'Investigacions Mèdiques)
Montero, Nadia (Iberoamerican Cochrane Centre)
Solà, Ivan (Institut d'Investigació Biomèdica Sant Pau)
Saz-Parkinson, Zuleika (European Commission. Joint Research Centre (JRC))
Lerda, Donata (European Commission. Joint Research Centre (JRC))
Giorgi Rossi, Paolo (Epidemiology Unit. AUSL - IRCCS di Reggio Emilia)
Duffy, Stephen W (Queen Mary University of London. Centre for Cancer Prevention)
Follmann, Markus (German Cancer Society)
Gräwingholt, Axel (Radiologie am Theater)
Alonso-Coello, Pablo (Institut d'Investigació Biomèdica Sant Pau)

Data:	2021
Resum:	Objectives: Mammography screening is generally accepted in women aged 50-69, but the balance between benefits and harms remains controversial in other age groups. This study systematically reviews these effects to inform the European Breast Cancer Guidelines. Methods: We searched PubMed, EMBASE and Cochrane Library for randomised clinical trials (RCTs) or systematic reviews of observational studies in the absence of RCTs comparing invitation to mammography screening to no invitation in women at average breast cancer (BC) risk. We extracted data for mortality, BC stage, mastectomy rate, chemotherapy provision, overdiagnosis and false-positive-related adverse effects. We performed a pooled analysis of relative risks, applying an inverse-variance random-effects model for three age groups (<50, 50-69 and 70-74). GRADE (Grading of Recommendations Assessment, Development and Evaluation) was used to assess the certainty of evidence. Results: We identified 10 RCTs including 616,641 women aged 38-75. Mammography reduced BC mortality in women aged 50-69 (relative risk (RR) 0. 77, 95%CI (confidence interval) 0. 66-0. 90, high certainty) and 70-74 (RR 0. 77, 95%CI 0. 54-1. 09, high certainty), with smaller reductions in under 50s (RR 0. 88, 95%CI 0. 76-1. 02, moderate certainty). Mammography reduced stage IIA+ in women 50-69 (RR 0. 80, 95%CI 0. 64-1. 00, very low certainty) but resulted in an overdiagnosis probability of 23% (95%CI 18-27%) and 17% (95%CI 15-20%) in under 50s and 50-69, respectively (moderate certainty). Mammography was associated with 2. 9% increased risk of invasive procedures with benign outcomes (low certainty). Conclusions: For women 50-69, high certainty evidence that mammography screening reduces BC mortality risk would support policymakers formulating strong recommendations. In other age groups, where the net balance of effects is less clear, conditional recommendations will be more likely, together with shared decision-making.
Ajuts:	European Commission 443094
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article de revisió ; recerca ; Versió publicada
Matèria:	Guidelines ; Breast cancer ; Mass screening ; Mammography
Publicat a:	Journal of Medical Screening, 2021 , ISSN 1475-5793

DOI: 10.1177/0969141321993866
PMID: 33632023

16 p, 9.6 MB

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