Objectives: Mammography screening is generally accepted in women aged 50–69, but the balance between benefits and harms
remains controversial in other age groups. This study systematically reviews these effects to inform the European Breast
Cancer Guidelines.
Methods: We searched PubMed, EMBASE and Cochrane Library for randomised clinical trials (RCTs) or systematic reviews of
observational studies in the absence of RCTs comparing invitation to mammography screening to no invitation in women at
average breast cancer (BC) risk. We extracted data for mortality, BC stage, mastectomy rate, chemotherapy provision, overdiagnosis and false-positive-related adverse effects. We performed a pooled analysis of relative risks, applying an inversevariance random-effects model for three age groups (<50, 50–69 and 70–74). GRADE (Grading of Recommendations
Assessment, Development and Evaluation) was used to assess the certainty of evidence.
Results: We identified 10 RCTs including 616,641 women aged 38–75. Mammography reduced BC mortality in women aged
50–69 (relative risk (RR) 0.77, 95%CI (confidence interval) 0.66–0.90, high certainty) and 70–74 (RR 0.77, 95%CI 0.54–1.09, high
certainty), with smaller reductions in under 50s (RR 0.88, 95%CI 0.76–1.02, moderate certainty). Mammography reduced stage
IIAþ in women 50–69 (RR 0.80, 95%CI 0.64–1.00, very low certainty) but resulted in an overdiagnosis probability of 23% (95%CI
18–27%) and 17% (95%CI 15–20%) in under 50s and 50–69, respectively (moderate certainty). Mammography was associated
with 2.9% increased risk of invasive procedures with benign outcomes (low certainty).
Conclusions: For women 50–69, high certainty evidence that mammography screening reduces BC mortality risk would
support policymakers formulating strong recommendations. In other age groups, where the net balance of effects is less clear,
conditional recommendations will be more likely, together with shared decision-making.
CANELO-AYBAR Carlos;
SERAPHIN Diogenes;
BALLESTEROS Monica;
POSSO Margarita;
MONTERO Nadia;
SOLÀ Ivan;
SAZ PARKINSON Zuleika Esther;
LERDA Donata;
GIORGI ROSSI Paolo;
DUFFY Stephen;
FOLLMANN Markus;
GRÄWINGHOLT Axel;
ALONSO COELLO Pablo;
2022-03-25
SAGE PUBLICATIONS LTD
JRC117891
0969-1413 (online),
https://journals.sagepub.com/doi/10.1177/0969141321993866,
https://publications.jrc.ec.europa.eu/repository/handle/JRC117891,
10.1177/0969141321993866 (online),
