Benefits and harms of breast cancer mammography screening for women at average risk of breast cancer: A systematic review for the European Commission Initiative on Breast Cancer
Por:
Canelo-Aybar, C, Ferreira, DS, Ballesteros, M, Posso, M, Montero, N, Sola, I, Saz-Parkinson, Z, Lerda, D, Rossi, PG, Duffy, SW, Follmann, M, Grawingholt, A, Alonso-Coello, P
Publicada:
1 dic 2021
Ahead of Print:
1 feb 2021
Resumen:
Objectives
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.
Methods
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.
Results
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, high certainty) and 70-74 (RR 0.77, 95%CI 0.54-1.09, high certainty), with smaller reductions in under 50s (RR 0.88, 95%CI 0.76-1.02, moderate certainty). Mammography reduced stage IIA+ in women 50-69 (RR 0.80, 95%CI 0.64-1.00, very low certainty) 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 (moderate certainty). Mammography was associated with 2.9% increased risk of invasive procedures with benign outcomes (low certainty).
Conclusions
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.
Filiaciones:
Canelo-Aybar, C:
CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain
Biomed Res Inst St Pau IIB Sant Pau, Iberoamerican Cochrane Ctr, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Ferreira, DS:
Biomed Res Inst St Pau IIB Sant Pau, Iberoamerican Cochrane Ctr, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Monash Univ, Sch Publ Hlth & Prevent Med, Dept Epidemiol & Prevent Med, Melbourne, Vic, Australia
Ballesteros, M:
Biomed Res Inst St Pau IIB Sant Pau, Iberoamerican Cochrane Ctr, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Posso, M:
Biomed Res Inst St Pau IIB Sant Pau, Iberoamerican Cochrane Ctr, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
IMIM Hosp del Mar Med Res Inst, Dept Epidemiol & Evaluat, Barcelona, Spain
Montero, N:
Biomed Res Inst St Pau IIB Sant Pau, Iberoamerican Cochrane Ctr, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Sola, I:
Biomed Res Inst St Pau IIB Sant Pau, Iberoamerican Cochrane Ctr, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
Saz-Parkinson, Z:
Joint Res Ctr JRC, European Commiss, Ispra, VA, Italy
Lerda, D:
Joint Res Ctr JRC, European Commiss, Ispra, VA, Italy
Rossi, PG:
AUSL IRCCS Reggio Emilia, Epidemiol Unit, Reggio Emilia, RE, Italy
Duffy, SW:
Queen Mary Univ London, Wolfson Inst Prevent Med, Ctr Canc Prevent, London, England
Follmann, M:
German Canc Soc, Berlin, Germany
Grawingholt, A:
Radiol Theater, Paderborn, Germany
Alonso-Coello, P:
CIBER Epidemiol & Salud Publ CIBERESP, Madrid, Spain
Biomed Res Inst St Pau IIB Sant Pau, Iberoamerican Cochrane Ctr, Dept Clin Epidemiol & Publ Hlth, Barcelona, Spain
hybrid, Green Published
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