CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Department of Clinical Epidemiology and Public Health, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
J Med Screen. 2021 Dec;28(4):389-404. doi: 10.1177/0969141321993866. Epub 2021 Feb 25.
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.
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.
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, ) and 70-74 (RR 0.77, 95%CI 0.54-1.09, ), with smaller reductions in under 50s (RR 0.88, 95%CI 0.76-1.02, ). Mammography reduced stage IIA+ in women 50-69 (RR 0.80, 95%CI 0.64-1.00, ) 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 (). Mammography was associated with 2.9% increased risk of invasive procedures with benign outcomes ().
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.
乳腺 X 线筛查通常适用于 50-69 岁的女性，但在其他年龄段，其收益与危害之间的平衡仍存在争议。本研究系统地评估了这些影响，为欧洲乳腺癌指南提供了信息。
我们检索了 PubMed、EMBASE 和 Cochrane Library 中的随机临床试验 (RCT) 或缺乏 RCT 的观察性研究系统评价，这些研究比较了在平均乳腺癌 (BC) 风险的女性中邀请进行乳腺 X 线筛查与不邀请进行乳腺 X 线筛查的效果。我们提取了死亡率、BC 分期、乳房切除术率、化疗提供情况、过度诊断和假阳性相关不良影响的数据。我们对三个年龄组（<50 岁、50-69 岁和 70-74 岁）的相对风险进行了汇总分析，应用了逆方差随机效应模型。使用 GRADE（推荐评估、制定与评价）方法评估证据的确定性。
我们确定了 10 项 RCT，共纳入 616641 名 38-75 岁的女性。乳腺 X 线摄影降低了 50-69 岁（相对风险 (RR) 0.77，95%置信区间 (CI) 0.66-0.90，）和 70-74 岁（RR 0.77，95%CI 0.54-1.09，）女性的 BC 死亡率，而在 50 岁以下女性中降低幅度较小（RR 0.88，95%CI 0.76-1.02，）。乳腺 X 线摄影降低了 50-69 岁女性的 IIA+期（RR 0.80，95%CI 0.64-1.00，），但导致过度诊断的概率为 23%（95%CI 18-27%）和 17%（95%CI 15-20%），分别在 50 岁以下和 50-69 岁的女性中（）。乳腺 X 线摄影与 2.9%的侵袭性操作良性结局风险增加相关（）。
对于 50-69 岁的女性，有高质量证据表明乳腺 X 线筛查降低了 BC 死亡率风险，这将支持决策者制定强有力的建议。在其他年龄段，其效果的净平衡不太明确，因此更有可能是有条件的建议，并结合共同决策。
