乳腺钼靶筛查的有效性。一项荟萃分析。

Efficacy of screening mammography. A meta-analysis.

作者信息

Kerlikowske K, Grady D, Rubin S M, Sandrock C, Ernster V L

机构信息

Department of Epidemiology and Biostatistics, University of California, San Francisco.

出版信息

JAMA. 1995 Jan 11;273(2):149-54.

PMID:7799496

Abstract

OBJECTIVE

To determine the efficacy of screening mammography by age, number of mammographic views per screen, screening interval, and duration of follow-up.

DESIGN

Literature review and meta-analysis. DATA IDENTIFICATION AND ANALYSIS: Literature search of English-language studies reported from January 1966 to October 31, 1993, using MEDLINE, manual literature review, and consultation with experts. A total of 13 studies were selected, and their results were combined using meta-analytic techniques based on the assumption of fixed effects.

MAIN RESULTS

The overall summary relative risk (RR) estimate for breast cancer mortality for women aged 50 to 74 years undergoing screening mammography compared with those who did not was 0.74 (95% confidence interval [CI], 0.66 to 0.83). The magnitude of the benefit in this age group was similar regardless of number of mammographic views per screen, screening interval, or duration of follow-up. In contrast, none of the summary RR estimates for women aged 40 to 49 years was significantly less than 1.0, irrespective of screening intervention or duration of follow-up. The overall summary RR estimate in women aged 40 to 49 years was 0.93 (95% CI, 0.76 to 1.13); the summary RR estimate for those studies that used two-view mammography was 0.87 (95% CI, 0.68 to 1.12) compared with 1.02 (95% CI, 0.73 to 1.44) for those studies that used one-view mammography, and for those studies with 7 to 9 years of follow-up, the summary RR estimate was 1.02 (95% CI, 0.82 to 1.27) compared with 0.83 (95% CI, 0.65 to 1.06) for those studies with 10 to 12 years of follow-up.

CONCLUSION

Screening mammography significantly reduces breast cancer mortality in women aged 50 to 74 years after 7 to 9 years of follow-up, regardless of screening interval or number of mammographic views per screen. There is no reduction in breast cancer mortality in women aged 40 to 49 years after 7 to 9 years of follow-up. Screening mammography may be effective in reducing breast cancer mortality in women aged 40 to 49 years after 10 to 12 years of follow-up, but the same benefit could probably be achieved by beginning screening at menopause or 50 years of age.

摘要

目的

确定按年龄、每次筛查的乳房X光片数量、筛查间隔和随访时间进行乳腺钼靶筛查的效果。

设计

文献综述和荟萃分析。数据识别与分析：检索1966年1月至1993年10月31日期间报道的英文研究文献，使用医学文献数据库（MEDLINE）、手工文献综述并咨询专家。共选取13项研究，并基于固定效应假设采用荟萃分析技术合并其结果。

主要结果

与未接受乳腺钼靶筛查的女性相比，接受筛查的50至74岁女性乳腺癌死亡率的总体汇总相对风险（RR）估计值为0.74（95%置信区间[CI]，0.66至0.83）。该年龄组的获益程度与每次筛查的乳房X光片数量、筛查间隔或随访时间无关。相比之下，无论筛查干预措施或随访时间如何，40至49岁女性的汇总RR估计值均无显著低于1.0。40至49岁女性的总体汇总RR估计值为0.93（95%CI，0.76至1.13）；使用双侧乳房X光片检查的研究的汇总RR估计值为0.87（95%CI，0.68至1.12），而使用单侧乳房X光片检查的研究的汇总RR估计值为1.02（95%CI，0.73至1.44）；随访7至9年的研究的汇总RR估计值为1.02（95%CI，0.82至1.27），而随访10至12年的研究的汇总RR估计值为0.83（95%CI，0.65至1.06）。