Løberg Magnus, Lousdal Mette Lise, Bretthauer Michael, Kalager Mette
Institute of Health and Society, University of Oslo, N-0317, Oslo, Norway.
Department of Transplantation Medicine, Oslo University Hospital, 0424, Oslo, Norway.
Breast Cancer Res. 2015 May 1;17(1):63. doi: 10.1186/s13058-015-0525-z.
Mammography screening for breast cancer is widely available in many countries. Initially praised as a universal achievement to improve women's health and to reduce the burden of breast cancer, the benefits and harms of mammography screening have been debated heatedly in the past years. This review discusses the benefits and harms of mammography screening in light of findings from randomized trials and from more recent observational studies performed in the era of modern diagnostics and treatment. The main benefit of mammography screening is reduction of breast-cancer related death. Relative reductions vary from about 15 to 25% in randomized trials to more recent estimates of 13 to 17% in meta-analyses of observational studies. Using UK population data of 2007, for 1,000 women invited to biennial mammography screening for 20 years from age 50, 2 to 3 women are prevented from dying of breast cancer. All-cause mortality is unchanged. Overdiagnosis of breast cancer is the main harm of mammography screening. Based on recent estimates from the United States, the relative amount of overdiagnosis (including ductal carcinoma in situ and invasive cancer) is 31%. This results in 15 women overdiagnosed for every 1,000 women invited to biennial mammography screening for 20 years from age 50. Women should be unpassionately informed about the benefits and harms of mammography screening using absolute effect sizes in a comprehensible fashion. In an era of limited health care resources, screening services need to be scrutinized and compared with each other with regard to effectiveness, cost-effectiveness and harms.
在许多国家，乳腺癌的乳腺钼靶筛查已广泛普及。乳腺钼靶筛查最初被誉为改善女性健康、减轻乳腺癌负担的一项普遍成就，但在过去几年中，其利弊一直备受激烈争论。本综述根据随机试验以及现代诊断和治疗时代进行的最新观察性研究结果，探讨了乳腺钼靶筛查的利弊。乳腺钼靶筛查的主要益处是降低与乳腺癌相关的死亡风险。相对降低幅度在随机试验中约为15%至25%，在观察性研究的荟萃分析中，最新估计为13%至17%。利用2007年英国的人口数据，对于1000名从50岁开始接受为期20年的两年一次乳腺钼靶筛查的女性，有2至3名女性可避免死于乳腺癌。全因死亡率没有变化。乳腺癌的过度诊断是乳腺钼靶筛查的主要危害。根据美国最近的估计，过度诊断（包括导管原位癌和浸润性癌）的相对比例为31%。这意味着，对于每1000名从50岁开始接受为期20年的两年一次乳腺钼靶筛查的女性，有15名女性会被过度诊断。应该以一种易于理解的方式，使用绝对效应大小，让女性冷静地了解乳腺钼靶筛查的利弊。在医疗资源有限的时代，需要对筛查服务进行审查，并在有效性、成本效益和危害方面相互比较。
