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

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• dc.contributor.author Canelo Aybar, Carlos
• dc.contributor.author Ferreira, Diogenes S.
• dc.contributor.author Ballesteros, Mónica
• dc.contributor.author Posso, Margarita
• dc.contributor.author Montero, Nadia
• dc.contributor.author Solà, Ivan
• dc.contributor.author Saz Parkinson, Zuleika
• dc.contributor.author Lerda, Donata
• dc.contributor.author Rossi, Paolo G.
• dc.contributor.author Duffy, Stephen
• dc.contributor.author Follmann, Markus
• dc.contributor.author Gräwingholt, Axel
• dc.contributor.author Alonso Coello, Pablo
• dc.date.accessioned 2021-07-01T07:36:56Z
• dc.date.available 2021-07-01T07:36:56Z
• dc.date.issued 2021
• dc.description.abstract 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.
• dc.format.mimetype application/pdf
• dc.identifier.citation Canelo-Aybar C, Ferreira DS, Ballesteros M, Posso M, Montero N, Solà I, Saz-Parkinson Z, Lerda D, Rossi PG, Duffy SW, Follmann M, Gräwingholt A, Alonso-Coello P. 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. J Med Screen. 2021;28(4):389-404. DOI: 10.1177/0969141321993866
• dc.identifier.doi http://dx.doi.org/10.1177/0969141321993866
• dc.identifier.issn 0969-1413
• dc.identifier.uri http://hdl.handle.net/10230/48035
• dc.language.iso eng
• dc.publisher SAGE Publications
• dc.relation.ispartof Journal of Medical Screening. 2021;28(4):389-404
• dc.rights © The Author(s) 2021. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri https://creativecommons.org/licenses/by-nc/4.0/
• dc.subject.keyword Guidelines
• dc.subject.keyword Breast cancer
• dc.subject.keyword Mammography
• dc.subject.keyword Mass screening
• dc.title 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
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion