Effectiveness of breast cancer screening: Systematic review and meta-analysis to update the 2009 U.S. Preventive services task force recommendation

Heidi Nelson, Rongwei (Rochelle) Fu, Amy Cantor, Miranda Pappas, Monica Daeges, Linda Humphrey

Research output: Contribution to journalArticle

174 Scopus citations

Abstract

Background: In 2009, the U.S. Preventive Services Task Force recommended biennial mammography screening for women aged 50 to 74 years and selective screening for those aged 40 to 49 years. Purpose: To review studies of the effectiveness of breast cancer screening in average-risk women. Data Sources: MEDLINE and Cochrane databases to 4 June 2015. Study Selection: English-language randomized, controlled trials and observational studies of screening with mammography, magnetic resonance imaging, and ultrasonography that reported breast cancer mortality, all-cause mortality, or advanced breast cancer outcomes. Data Extraction: Investigators extracted and confirmed data and dual rated study quality; discrepancies were resolved through consensus. Data Synthesis: Fair-quality evidence from a meta-analysis of mammography trials indicated relative risks (RRs) for breast cancer mortality of 0.92 for women aged 39 to 49 years (95% CI, 0.75 to 1.02) (9 trials; 3 deaths prevented per 10 000 women over 10 years); 0.86 for those aged 50 to 59 years (CI, 0.68 to 0.97) (7 trials; 8 deaths prevented per 10 000 women over 10 years); 0.67 for those aged 60 to 69 years (CI, 0.54 to 0.83) (5 trials; 21 deaths prevented per 10 000 women over 10 years); and 0.80 for those aged 70 to 74 years (CI, 0.51 to 1.28) (3 trials; 13 deaths prevented per 10 000 women over 10 years). Risk reduction was 25% to 31% for women aged 50 to 69 years in observational studies of mammography screening. All-cause mortality was not reduced with screening. Advanced breast cancer was reduced for women aged 50 years or older (RR, 0.62 [CI, 0.46 to 0.83]) (3 trials) but not those aged 39 to 49 years (RR, 0.98 [CI, 0.74 to 1.37]) (4 trials); less evidence supported this outcome. Limitations: Most trials used imaging technologies and treatments that are now outdated, and definitions of advanced breast cancer were heterogeneous. Studies of effectiveness based on risk factors, intervals, or other modalities were unavailable or methodologically limited. Conclusion: Breast cancer mortality is generally reduced with mammography screening, although estimates are not statistically significant at all ages and the magnitudes of effect are small. Advanced cancer is reduced with screening for women aged 50 years or older. Primary Funding Source: Agency for Healthcare Research and Quality.

Original languageEnglish (US)
Pages (from-to)244-255
Number of pages12
JournalAnnals of Internal Medicine
Volume164
Issue number4
DOIs
StatePublished - Feb 16 2016

ASJC Scopus subject areas

  • Internal Medicine

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