Summary of the evidence of breast cancer service screening outcomes in Europe and first estimate of the benefit and harm balance sheet
Summary of the evidence of breast cancer service screening outcomes in Europe and first estimate of the benefit and harm balance sheet
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DOI：
10.1258/jms.2012.012077
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发表时间：
2012-01-01
影响因子：
2.9
通讯作者：
Zorzi, M.
中科院分区：
文献类型：
--
作者：
Ancelle-Park, R.;Armaroli, P.;Zorzi, M.
目的构建基于人群的乳房x线摄影乳腺癌筛查关键结果的欧洲“资产负债表”，为决策者、利益相关者和受邀女性提供信息。方法将筛查的主要益处（降低乳腺癌死亡率）与筛查的主要危害（过度诊断和假阳性结果）进行比较。结果：在基于发病率的死亡率研究中，受邀女性的乳腺癌死亡率降低了25%，在病例对照研究中降低了31%（在实际接受筛查的女性中分别降低了38%和48%）。在没有筛查的情况下，过度诊断估计占预期发病率的1%至10%。根据提前期和潜在趋势正确调整后的欧洲研究，对接受筛查的妇女的过度诊断的综合估计为6.5%。对于接受10次两年一次筛查试验的妇女，经非侵入性评估后发生FPR的累积风险估计为17%，经侵入性评估的累积风险为3%。从50-51岁到68-69岁，每1000名妇女每两年接受一次筛查，并随访至79岁，估计有7至9人的生命得到挽救，4例被过度诊断，170名妇女至少有一次回忆，然后进行非侵入性评估，结果为阴性，30名妇女至少有一次回忆，然后进行侵入性手术，结果为阴性。结论以人群为基础的适当质量的乳房x线检查挽救妇女生命的机会大于过度诊断。欧洲的服务筛查在死亡率上的优势至少和随机对照试验一样大。这些结果应告知在欧洲接受服务筛查的妇女。
Objectives To construct a European 'balance sheet' of key outcomes of population-based mammographic breast cancer screening, to inform policy-makers, stakeholders and invited women.Methods From the studies reviewed, the primary benefit of screening, breast cancer mortality reduction, was compared with the main harms, over-diagnosis and false-positive screening results (FPRs).Results Pooled estimates of breast cancer mortality reduction among invited women were 25% in incidence-based mortality studies and 31% in case-control studies (38% and 48% among women actually screened). Estimates of over-diagnosis ranged from 1% to 10% of the expected incidence in the absence of screening. The combined estimate of over-diagnosis for screened women, from European studies correctly adjusted for lead time and underlying trend, was 6.5%. For women undergoing 10 biennial screening tests, the estimated cumulative risk of a FPR followed by non-invasive assessment was 17%, and 3% having an invasive assessment. For every 1000 women screened biennially from age 50-51 until age 68-69 and followed up to age 79, an estimated seven to nine lives are saved, four cases are over-diagnosed, 170 women have at least one recall followed by non-invasive assessment with a negative result and 30 women have at least one recall followed by invasive procedures yielding a negative result.Conclusions The chance of saving a woman's life by population-based mammographic screening of appropriate quality is greater than that of over-diagnosis. Service screening in Europe achieves a mortality benefit at least as great as the randomized controlled trials. These outcomes should be communicated to women offered service screening in Europe.