The impact of mammographic screening on breast cancer mortality in Europe: a review of observational studies

被引:328
作者
Broeders, Mireille [1 ,2 ]
Moss, Sue [3 ]
Nystrom, Lennarth [4 ]
Njor, Sisse [5 ]
Jonsson, Hakan [6 ]
Poop, Ellen [1 ,2 ]
Massat, Nathalie
Duffy, Stephen [3 ]
Lynge, Elsebeth [7 ]
Paci, Eugenio [8 ]
机构
[1] Radboud Univ Nijmegen, Dept Epidemiol Biostat & HTA, Med Ctr, NL-6500 HB Nijmegen, Netherlands
[2] Natl Expert & Training Ctr Breast Canc Screening, Nijmegen, Netherlands
[3] Queen Mary Univ London, Wolfson Inst Prevent Med, Ctr Canc Prevent, London, England
[4] Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden
[5] Univ Copenhagen, Ctr Epidemiol & Screening, DK-1168 Copenhagen, Denmark
[6] Umea Univ, Dept Radiat Sci, S-90187 Umea, Sweden
[7] Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark
[8] ISPO Canc Res & Prevent Inst, Clin & Descript Epidemiol Unit, Florence, Italy
关键词
ALL-CAUSE MORTALITY; CONTROLLED-TRIALS; TREND ANALYSIS; PROGRAM; WOMEN; DEATH; REDUCTION; DESIGN; BIAS; OVERDIAGNOSIS;
D O I
10.1258/jms.2012.012078
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Objectives To assess the impact of population-based mammographic screening on breast cancer mortality in Europe, considering different methodologies and limitations of the data. Methods We conducted a systematic literature review of European trend studies (n = 17), incidence-based mortality (IBM) studies (n = 20) and case-control (CC) studies (n = 8). Estimates of the reduction in breast cancer mortality for women invited versus not invited and/or for women screened versus not screened were obtained. The results of IBM studies and CC studies were each pooled using a random effects meta-analysis. Results Twelve of the 17 trend studies quantified the impact of population-based screening on breast cancer mortality. The estimated breast cancer mortality reductions ranged from 1% to 9% per year in studies reporting an annual percentage change, and from 28% to 36% in those comparing post- and prescreening periods. In the IBM studies, the pooled mortality reduction was 25% (relative risk [RR] 0.75, 95% confidence interval [CI] 0.69-0.81) among invited women and 38% (RR 0.62, 95% CI 0.56-0.69) among those actually screened. The corresponding pooled estimates from the CC studies were 31% (odds ratio [OR] 0.69, 95% CI 0.57-0.83), and 48% (OR 0.52, 95% CI 0.42-0.65) adjusted for self-selection. Conclusions Valid observational designs are those where sufficient longitudinal individual data are available, directly linking a woman's screening history to her cause of death. From such studies, the best 'European' estimate of breast cancer mortality reduction is 25-31% for women invited for screening, and 38-48% for women actually screened. Much of the current controversy on breast cancer screening is due to the use of inappropriate methodological approaches that are unable to capture the true effect of mammographic screening.
引用
收藏
页码:14 / 25
页数:12
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