Systematic reviews as a 'lens of evidence': Determinants of benefits and harms of breast cancer screening
Systematic reviews as a 'lens of evidence': Determinants of benefits and harms of breast cancer screening
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DOI：
10.1002/ijc.32211
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发表时间：
2019-08-15
影响因子：
6.4
通讯作者：
Murillo, Raul
中科院分区：
文献类型：
--
作者：
Mandrik, Olena;Zielonke, Nadine;Murillo, Raul
这篇系统性综述，由于次要证据的不一致性，根据系统性综述报告了乳腺癌（BC）筛查的益处和危害及其决定因素。系统检索识别出9，976篇摘要，纳入58篇综述。在所有年龄组的试验和观察性研究中，筛查性乳房X光检查使BC死亡率降低了15-25%，并且降低了49岁以上女性的III+期癌症风险。在试验中，由于乳房X线摄影导致的过度诊断为1-60%，在偏倚风险较低的研究中为1-12%，两年一次筛查的累积假阳性率低于每年一次筛查（3-17% vs 0.01-41%）。关于50岁以下或69岁以上妇女的BC死亡率降低幅度，或乳房X线摄影的益处和危害的决定因素，包括乳房X线摄影的类型（数字与屏幕胶片），视图数量和筛查间隔，审查结论不一致。同样，没有确凿的证据表明超声筛查或临床乳腺检查（敏感性范围分别为54-84%和47- 69%）的益处和危害或BC死亡率降低的决定因素，也没有有力的证据表明乳房自我检查的不利益处与危害比。审查的结论并不取决于审查的质量或出版日期。主要来自高收入国家的乳房X光检查筛查系统性评论对利害比的解释存在系统性分歧。除非发表新的原始研究，否则未来的综述不太可能澄清这些差异。
This systematic review, stimulated by inconsistency in secondary evidence, reports the benefits and harms of breast cancer (BC) screening and their determinants according to systematic reviews. A systematic search, which identified 9,976 abstracts, led to the inclusion of 58 reviews. BC mortality reduction with screening mammography was 15-25% in trials and 28-56% in observational studies in all age groups, and the risk of stage III+ cancers was reduced for women older than 49 years. Overdiagnosis due to mammography was 1-60% in trials and 1-12% in studies with a low risk of bias, and cumulative false-positive rates were lower with biennial than annual screening (3-17% vs 0.01-41%). There is no consistency in the reviews' conclusions about the magnitude of BC mortality reduction among women younger than 50 years or older than 69 years, or determinants of benefits and harms of mammography, including the type of mammography (digital vs screen-film), the number of views and the screening interval. Similarly, there was no solid evidence on determinants of benefits and harms or BC mortality reduction with screening by ultrasonography or clinical breast examination (sensitivity ranges, 54-84% and 47-69%, respectively), and strong evidence of unfavourable benefit-to-harm ratio with breast self-examination. The reviews' conclusions were not dependent on the quality of the reviews or publication date. Systematic reviews on mammography screening, mainly from high-income countries, systematically disagree on the interpretation of the benefit-to-harm ratio. Future reviews are unlikely to clarify the discrepancies unless new original studies are published.