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.
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.
Authors: Jeanne S Mandelblatt; Natasha K Stout; Clyde B Schechter; Jeroen J van den Broek; Diana L Miglioretti; Martin Krapcho; Amy Trentham-Dietz; Diego Munoz; Sandra J Lee; Donald A Berry; Nicolien T van Ravesteyn; Oguzhan Alagoz; Karla Kerlikowske; Anna N A Tosteson; Aimee M Near; Amanda Hoeffken; Yaojen Chang; Eveline A Heijnsdijk; Gary Chisholm; Xuelin Huang; Hui Huang; Mehmet Ali Ergun; Ronald Gangnon; Brian L Sprague; Sylvia Plevritis; Eric Feuer; Harry J de Koning; Kathleen A Cronin Journal: Ann Intern Med Date: 2016-01-12 Impact factor: 25.391
Authors: Alejandro Rodriguez-Ruiz; Kristina Lång; Albert Gubern-Merida; Mireille Broeders; Gisella Gennaro; Paola Clauser; Thomas H Helbich; Margarita Chevalier; Tao Tan; Thomas Mertelmeier; Matthew G Wallis; Ingvar Andersson; Sophia Zackrisson; Ritse M Mann; Ioannis Sechopoulos Journal: J Natl Cancer Inst Date: 2019-09-01 Impact factor: 13.506
Authors: S Heywang-Koebrunner; K Bock; W Heindel; G Hecht; L Regitz-Jedermann; A Hacker; V Kaeaeb-Sanyal Journal: Geburtshilfe Frauenheilkd Date: 2013-10 Impact factor: 2.915