Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA.
J Womens Health (Larchmt). 2011 Jun;20(6):845-52. doi: 10.1089/jwh.2010.2098. Epub 2011 Mar 17.
Mammography screening of women >50 years of age significantly reduces breast cancer mortality in randomized controlled trials (RCTs). We sought to evaluate the effectiveness of mammography screening in women aged 39-49 years in reducing breast cancer mortality and to discuss previously published meta-analyses.
PubMed/MEDLINE, OVID, COCHRANE, and Educational Resources Information Center (ERIC) databases were searched, and extracted references were reviewed. Dissertation abstracts and clinical trials databases available online were assessed to identify unpublished works. All assessments were independently done by two reviewers. All trials included were RCTs, published in English, included data on women aged 39-49, and reported relative risk (RR)/odds ratio (OR) or frequency data.
Nine studies were identified: the Kopparberg, Ostergotland (The Two-County study), Health Insurance Plan (HIP), Canada, Stockholm, Gothenburg, Edinburgh, Age, and Malmo trials. The individual trials were quality assessed, and the data were extracted using predefined forms. Using the DerSimonian and Laird random effects model, the results from the seven RCTs with the highest quality score were combined, and a significant pooled RR estimate of 0.83 (95% confidence interval [CI] 0.72-0.97) was calculated. Post hoc sensitivity analyses excluding studies with randomization before 1980 caused a loss of statistical significance (RR 0.87, 95% CI: 0.56, 1.13).
Mammography screenings are effective and generate a 17% reduction in breast cancer mortality in women 39-49 years of age. The quality of the trials varies, and providers should inform women in this age group about the positive and negative aspects of mammography screenings.
在随机对照试验（RCT）中，对 50 岁以上女性进行乳房 X 光筛查显著降低了乳腺癌死亡率。我们旨在评估对 39-49 岁女性进行乳房 X 光筛查在降低乳腺癌死亡率方面的有效性，并讨论之前发表的荟萃分析。
检索了 PubMed/MEDLINE、OVID、COCHRANE 和教育资源信息中心（ERIC）数据库，并对提取的参考文献进行了审查。评估了在线可用的论文摘要和临床试验数据库，以确定未发表的研究。所有评估均由两名独立的评审员进行。所有纳入的试验均为 RCT，发表于英文期刊，纳入了 39-49 岁女性的数据，并报告了相对风险（RR）/比值比（OR）或频率数据。
共确定了 9 项研究：Kopparberg、Ostergotland（两县研究）、健康保险计划（HIP）、加拿大、斯德哥尔摩、哥德堡、爱丁堡、年龄和马尔默试验。对各个试验进行了质量评估，并使用预定义的表格提取数据。使用 DerSimonian 和 Laird 随机效应模型，对质量评分最高的 7 项 RCT 的结果进行合并，计算出了显著的合并 RR 估计值 0.83（95%置信区间[CI] 0.72-0.97）。事后敏感性分析排除了 1980 年前进行随机分组的研究后，结果失去了统计学意义（RR 0.87，95%CI：0.56，1.13）。
乳房 X 光筛查对 39-49 岁女性有效，可降低 17%的乳腺癌死亡率。试验的质量存在差异，医务人员应向该年龄段的女性告知乳房 X 光筛查的积极和消极方面。
