Breast cancer screening: A summary of the evidence for the US Preventive Services Task Force
Breast cancer screening: A summary of the evidence for the US Preventive Services Task Force
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DOI：
10.7326/0003-4819-137-5_part_1-200209030-00012
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发表时间：
2002-09-03
影响因子：
39.2
通讯作者：
Woolf, SH
中科院分区：
文献类型：
--
作者：
Humphrey, LL;Helfand, M;Woolf, SH
目的：为美国预防服务工作组综合有关乳腺癌筛查的新数据，数据来源：MEDLINE;科克伦对照试验登记处;以及综述、社论和原始研究的参考列表。研究选择：纳入了8项乳腺X线摄影的随机对照试验和2项评估乳房自我检查的试验。154出版物的结果，这些试验，以及选定的文章有关的测试特性和危害与screening.Data提取：预定义的标准被用来评估每个研究的质量。使用贝叶斯随机效应模型进行荟萃分析，以提供乳腺X线摄影筛查在降低乳腺癌死亡率方面的有效性的汇总相对风险估计和可信区间（CrIs）。对于质量一般或更好的研究，汇总相对风险为0.84（95%CrI，0.77至0.91），在大约14年的观察后，为防止一例乳腺癌死亡而需要进行筛查的人数为1224人（CrI，665至2564）。在50岁以下的女性中，与乳房X线摄影相关的汇总相对风险为0.85（CrI，0.73至0.99），在观察14年后，为防止一例乳腺癌死亡而需要筛查的人数为1792（CrI，764至10540）。对于临床乳房检查和乳房自我检查，随机试验的证据是inconclusive.Conclusions：在随机对照试验中，乳房X光检查降低了40至74岁女性的乳腺癌死亡率。老年妇女的绝对风险降低幅度更大。由于这些结果包含了几轮筛查，因此防止一例乳腺癌死亡所需的乳房X光检查的实际数量更高。此外，每次筛查都有相关的风险和成本。
Purpose: To synthesize new data on breast cancer screening for the U.S. Preventive Services Task Force.Data Sources: MEDLINE; the Cochrane Controlled Trials Registry; and reference lists of reviews, editorials, and original studies.Study Selection: Eight randomized, controlled trials of mammography and 2 trials evaluating breast self-examination were included. One hundred fifty-four publications of the results of these trials, as well as selected articles about the test characteristics and harms associated with screening, were examined.Data Extraction: Predefined criteria were used to assess the quality of each study. Meta-analyses using a Bayesian random-effects model were conducted to provide summary relative risk estimates and credible intervals (CrIs) for the effectiveness of screening with mammography in reducing death from breast cancer.Data Synthesis: For studies of fair quality or better, the summary relative risk was 0.84 (95% CrI, 0.77 to 0.91) and the number needed to screen to prevent one death from breast cancer after approximately 14 years of observation was 1224 (CrI, 665 to 2564). Among women younger than 50 years of age, the summary relative risk associated with mammography was 0.85 (CrI, 0.73 to 0.99) and the number needed to screen to prevent one death from breast cancer after 14 years of observation was 1792 (CrI, 764 to 10 540). For clinical breast examination and breast self-examination, evidence from randomized trials is inconclusive.Conclusions: in the randomized, controlled trials, mammography reduced breast cancer mortality rates among women 40 to 74 years of age. Greater absolute risk reduction was seen among older women. Because these results incorporate several rounds of screening, the actual number of mammograms needed to prevent one death from breast cancer is higher. In addition, each screening has associated risks and costs.