Isautier Jennifer Marie Jacqueline, Houssami Nehmat, Hadlow Claudia, Marinovich Michael Luke, Hope Serena, Zackrisson Sophia, Brennan Meagan Elizabeth, Nickel Brooke
Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
Wiser Healthcare, School of Public Health, The University of Sydney, NSW, Australia.
JNCI Cancer Spectr. 2024 Nov 1;8(6). doi: 10.1093/jncics/pkae103.
High breast density is an independent risk factor for breast cancer and decreases the sensitivity of mammography. This systematic review synthesizes the international clinical guidelines and the evidence base for screening and supplemental screening recommendations in women with dense breasts.
A systematic search of CINHAL, Embase, and Medline databases was performed in August 2023 and grey literature searched in January 2024. Two authors independently assessed study eligibility and quality (Appraisal of Guidelines for Research and Evaluation II instrument).
Of 3809 articles, 23 guidelines published from 2014 to 2024 were included. The content and quality varied between the guidelines; the average AGREE II total score was 58% (range = 23%-87%). Most guidelines recommended annual or biennial screening mammography for women more than 40 years old with dense breasts (n = 16). Other guidelines recommended breast tomosynthesis (DBT, n = 6) or magnetic resonance imaging (MRI, n = 1) as the preferred screening modality. One third of the guidelines (n = 8) did not recommend supplemental screening for women with dense breasts. Of those that recommended supplemental screening (n = 14), ultrasound was the preferred modality (n = 7), with MRI (n = 3), DBT (n = 3), and contrast-enhanced mammography (n = 2) also recommended.
Consensus on supplemental screening in women with dense breasts is lacking. The quality of the guidelines is variable, and recommendations are based largely on low-quality evidence. As evidence of the benefits versus harms of supplemental screening in women with dense breasts is evolving, it is imperative to improve the methodological quality of breast cancer screening and supplemental screening guidelines.
乳腺组织密度高是乳腺癌的独立危险因素，会降低乳腺钼靶检查的敏感性。本系统评价综合了国际临床指南以及针对乳腺组织密度高的女性进行筛查和补充筛查建议的证据基础。
2023年8月对CINHAL、Embase和Medline数据库进行了系统检索，并于2024年1月检索了灰色文献。两名作者独立评估研究的纳入资格和质量（使用《研究与评价指南II工具》）。
在3809篇文章中，纳入了2014年至2024年发布的23项指南。各指南的内容和质量各不相同；AGREE II总分平均为58%（范围=23%-87%）。大多数指南建议对40岁以上乳腺组织密度高的女性进行每年或每两年一次的乳腺钼靶筛查（n=16）。其他指南建议将乳腺断层合成摄影（DBT，n=6）或磁共振成像（MRI，n=1）作为首选筛查方式。三分之一的指南（n=8）不建议对乳腺组织密度高的女性进行补充筛查。在建议进行补充筛查的指南中（n=14），超声是首选方式（n=7），也推荐使用MRI（n=3）、DBT（n=3）和对比增强乳腺钼靶检查（n=2）。
对于乳腺组织密度高的女性进行补充筛查缺乏共识。指南质量参差不齐，建议很大程度上基于低质量证据。随着乳腺组织密度高的女性补充筛查利弊证据的不断演变，提高乳腺癌筛查和补充筛查指南的方法学质量势在必行。
