The impact of mammographic screening on breast cancer mortality in Europe: a review of observational studies
The impact of mammographic screening on breast cancer mortality in Europe: a review of observational studies
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DOI：
10.1258/jms.2012.012078
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发表时间：
2012-01-01
影响因子：
2.9
通讯作者：
Paci, Eugenio
中科院分区：
文献类型：
--
作者：
Broeders, Mireille;Moss, Sue;Paci, Eugenio
目的评估基于人群的乳房X光检查对欧洲乳腺癌死亡率的影响，考虑到不同的方法和数据的局限性。方法我们对欧洲趋势研究(n=17)、基于发病率的死亡率(IBM)研究(n=20)和病例对照(CC)研究(n=8)进行了系统的文献综述。获得了受邀妇女与未受邀妇女和/或接受筛查妇女与未筛查妇女的乳腺癌死亡率降低的估计。IBM研究和CC研究的结果分别使用随机效应荟萃分析。结果17项趋势研究中有12项量化了基于人群的筛查对乳腺癌死亡率的影响。在报告每年百分比变化的研究中，估计乳腺癌死亡率每年下降1%至9%，而在比较筛查后和筛查前时期的研究中，估计乳腺癌死亡率下降28%至36%。在IBM的研究中，受邀女性的综合死亡率降低了25%(相对风险[RR]0.75，95%可信区间[CI]0.69-0.81)，而实际筛查的女性降低了38%(相对风险0.62，95%可信区间0.56-0.69)。CC研究相应的合并估计为31%(优势比[OR]0.69，95%可信区间0.57~0.83)和经自行选择调整后的48%(优势比0.52，95%可信区间0.42~0.65)。结论有效的观察性设计是指有足够的纵向个体数据，将妇女的筛查历史与其死因直接联系起来的设计。从这样的研究中，对乳腺癌死亡率降低的最佳欧洲估计是，被邀请进行筛查的女性的死亡率降低25%-31%，而实际接受筛查的女性的死亡率降低38%-48%。目前关于乳腺癌筛查的大部分争议是由于使用了不适当的方法学方法，无法捕捉乳房X光检查的真实效果。
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.