TY - JOUR
T1 - The impact of mammographic screening on breast cancer mortality in Europe
T2 - a review of observational studies
AU - Broeders, Mireille
AU - Moss, Sue
AU - Nyström, Lennarth
AU - Njor, Sisse Helle
AU - Jonsson, Håkan
AU - Paap, Ellen
AU - Massat, Nathalie
AU - Duffy, Stephen
AU - Lynge, Elsebeth
AU - Paci, Eugenio
AU - EUROSCREEN Working Group
PY - 2012/9
Y1 - 2012/9
N2 - 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 1/4 17), incidencebased mortality (IBM) studies (n 1/4 20) and case-control (CC) studies (n 1/4 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 womans 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.
AB - 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 1/4 17), incidencebased mortality (IBM) studies (n 1/4 20) and case-control (CC) studies (n 1/4 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 womans 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.
KW - Breast Neoplasms
KW - Early Detection of Cancer
KW - Europe
KW - Female
KW - Humans
KW - Mammography
KW - Mass Screening
U2 - 10.1258/jms.2012.012078
DO - 10.1258/jms.2012.012078
M3 - Journal article
C2 - 22972807
SN - 0969-1413
VL - 19 Suppl 1
SP - 14
EP - 25
JO - Journal of Medical Screening
JF - Journal of Medical Screening
ER -
