Faculty of Medicine, Wessex Institute, University of Southampton, Southampton SO16 7PX, UK.
BMJ. 2011 Dec 8;343:d7627. doi: 10.1136/bmj.d7627.
To assess the claim in a Cochrane review that mammographic breast cancer screening could be doing more harm than good by updating the analysis in the Forrest report, which led to screening in the United Kingdom.
Development of a life table model, which replicated Forrest's results before updating and extending them with data from relevant systematic reviews, trials, and other models based on purposive literature searches.
Women aged 50 and over invited for breast cancer screening.
Quality adjusted life years (QALYs), combining life years gained from screening with losses of quality of life from false positive diagnoses and surgery.
Inclusion of the effects of harms reduced the updated estimate of net cumulative QALYs gained after 20 years from 3301 to 1536 or by more than half. The best estimates from the Cochrane review generated negative QALYs for the first seven years of screening, 70 QALYs after 10 years, and 834 QALYs after 20 years. Sensitivity analysis showed these results were robust to a range of assumptions, particularly up to 10 years. It also indicated the importance of the level and duration of harms from surgery.
This analysis supports the claim that the introduction of breast cancer screening might have caused net harm for up to 10 years after the start of screening.
通过更新福雷斯特报告中的分析来评估 Cochrane 综述中提出的乳房 X 线筛查可能弊大于利的说法，该报告导致了英国开始进行筛查。
开发寿命表模型，该模型复制了福雷斯特的结果，然后使用来自相关系统评价、试验和其他基于有针对性文献搜索的模型的数据对其进行更新和扩展。
邀请 50 岁及以上的女性进行乳腺癌筛查。
质量调整生命年（QALYs），将筛查获得的生命年与假阳性诊断和手术导致的生活质量损失结合起来。
纳入危害影响后，更新后的 20 年后净累积 QALYs 获益估计值从 3301 减少到 1536，降幅超过一半。 Cochrane 综述的最佳估计值在前 7 年的筛查中产生了负 QALYs，10 年后为 70 QALYs，20 年后为 834 QALYs。敏感性分析表明，这些结果对各种假设具有稳健性，尤其是在前 10 年。它还表明手术危害的程度和持续时间的重要性。
这项分析支持了这样一种说法，即乳腺癌筛查的引入可能在筛查开始后长达 10 年内造成净危害。
