BACKGROUND: Mammography screening of women >50 years of age significantly reduces breast cancer mortality in randomized controlled trials (RCTs). We sought to evaluate the effectiveness of mammography screening in women aged 39–49 years in reducing breast cancer mortality and to discuss previously published meta-analyses. METHODS: PubMed/MEDLINE, OVID, COCHRANE, and Educational Resources Information Center (ERIC) databases were searched, and extracted references were reviewed. Dissertation abstracts and clinical trials databases available online were assessed to identify unpublished works. All assessments were independently done by two reviewers. All trials included were RCTs, published in English, included data on women aged 39–49, and reported relative risk (RR)/odds ratio (OR) or frequency data. RESULTS: Nine studies were identified: the Kopparberg, Ostergotland (The Two-County study), Health Insurance Plan (HIP), Canada, Stockholm, Gothenburg, Edinburgh, Age, and Malmo trials. The individual trials were quality assessed, and the data were extracted using predefined forms. Using the DerSimonian and Laird random effects model, the results from the seven RCTs with the highest quality score were combined, and a significant pooled RR estimate of 0.83 (95% confidence interval [CI] 0.72-0.97) was calculated. <i>Post hoc</i> sensitivity analyses excluding studies with randomization before 1980 caused a loss of statistical significance (RR 0.87, 95% CI: 0.56, 1.13). CONCLUSIONS: Mammography screenings are effective and generate a 17% reduction in breast cancer mortality in women 39–49 years of age. The quality of the trials varies, and providers should inform women in this age group about the positive and negative aspects of mammography screenings. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
BACKGROUND: This systematic review is an update of new evidence since the 2002 U.S. Preventive Services Task Force recommendation on breast cancer screening.
PURPOSE: To determine the effectiveness of mammography screening in decreasing breast cancer mortality among average-risk women age 40–49 years and 70 years and older; the effectiveness of clinical breast examination (CBE) and breast self examination (BSE) in decreasing breast cancer mortality among women of any age; and harms of screening with mammography, CBE, and BSE.
DATA SOURCES: The Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2008), MEDLINE(®) searches (January 2001 to December 2008), reference lists, and Web of Science(®) searches for published studies and Breast Cancer Surveillance Consortium for screening mammography data.
STUDY SELECTION: Randomized, controlled trials with breast cancer mortality outcomes for screening effectiveness, and studies of various designs and multiple data sources for harms.
DATA EXTRACTION: Relevant data were abstracted, and study quality was rated by using established criteria.
DATA SYNTHESIS: Mammography screening reduces breast cancer mortality by 15% for women age 39–49 (relative risk [RR] 0.85; 95% credible interval [CrI], 0.75–0.96; 8 trials). Results are similar to those for women age 50–59 years (RR 0.86; 95% CrI, 0.75–0.99; 6 trials), but effects are less than for women age 60–69 years (RR 0.68; 95% CrI, 0.54–0.87; 2 trials). Data are lacking for women age 70 years and older. Radiation exposure from mammography is low. Patient adverse experiences are common and transient and do not affect screening practices. Estimates of overdiagnosis vary from 1–10%. Younger women have more false-positive mammography results and additional imaging but fewer biopsies than older women. Trials of CBE are ongoing; trials of BSE showed no reductions in mortality but increases in benign biopsy results.
LIMITATIONS: Studies of older women, digital mammography, and magnetic resonance imaging are lacking.
CONCLUSIONS: Mammography screening reduces breast cancer mortality for women age 39–69 years; data are insufficient for women age 70 years and older. False-positive mammography results and additional imaging are common. No benefit has been shown for CBE or BSE.
BACKGROUND: The risks and benefits of mammography screening among women 40 to 49 years of age remain an important issue for clinical practice. PURPOSE: To evaluate the evidence about the risks and benefits of mammography screening for women 40 to 49 years of age. DATA SOURCES: English-language publications in MEDLINE (1966-2005), Pre-MEDLINE, and the Cochrane Central Register of Controlled Trials and references of selected studies through May 2005. STUDY SELECTION: Previous systematic reviews; randomized, controlled trials; and observational studies. DATA EXTRACTION: Two independent reviewers. DATA SYNTHESIS: In addition to publications from the original mammography trials, 117 studies were included in the review. Meta-analyses of randomized, controlled trials demonstrate a 7% to 23% reduction in breast cancer mortality rates with screening mammography in women 40 to 49 years of age. Screening mammography is associated with an increased risk for mastectomy but a decreased risk for adjuvant chemotherapy and hormone therapy. The risk for death due to breast cancer from the radiation exposure involved in mammography screening is small and is outweighed by a reduction in breast cancer mortality rates from early detection. Rates of false-positive results are high (20% to 56% after 10 mammograms), but false-positive results have little effect on psychological health or subsequent mammography adherence. Although many women report pain at the time of the mammography, few see pain as a deterrent to future screening. Evidence about the effect of negative screening mammography on psychological well-being or the subsequent clinical presentation of breast cancer is insufficient. LIMITATIONS: Few randomized, controlled trials assessed the risks of screening, and the literature search was completed in 2005. CONCLUSIONS: Although few women 50 years of age or older have risks from mammography that outweigh the benefits, the evidence suggests that more women 40 to 49 years of age have such risks.
Mammography screening of women >50 years of age significantly reduces breast cancer mortality in randomized controlled trials (RCTs). We sought to evaluate the effectiveness of mammography screening in women aged 39–49 years in reducing breast cancer mortality and to discuss previously published meta-analyses.
METHODS:
PubMed/MEDLINE, OVID, COCHRANE, and Educational Resources Information Center (ERIC) databases were searched, and extracted references were reviewed. Dissertation abstracts and clinical trials databases available online were assessed to identify unpublished works. All assessments were independently done by two reviewers. All trials included were RCTs, published in English, included data on women aged 39–49, and reported relative risk (RR)/odds ratio (OR) or frequency data.
RESULTS:
Nine studies were identified: the Kopparberg, Ostergotland (The Two-County study), Health Insurance Plan (HIP), Canada, Stockholm, Gothenburg, Edinburgh, Age, and Malmo trials. The individual trials were quality assessed, and the data were extracted using predefined forms. Using the DerSimonian and Laird random effects model, the results from the seven RCTs with the highest quality score were combined, and a significant pooled RR estimate of 0.83 (95% confidence interval [CI] 0.72-0.97) was calculated. Post hoc sensitivity analyses excluding studies with randomization before 1980 caused a loss of statistical significance (RR 0.87, 95% CI.: 0.56, 1.13).
CONCLUSIONS:
Mammography screenings are effective and generate a 17% reduction in breast cancer mortality in women 39–49 years of age. The quality of the trials varies, and providers should inform women in this age group about the positive and negative aspects of mammography screenings. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
