Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force.
OBJECTIVE
To synthesize new data on breast cancer screening for the U.S. Preventive Services Task Force.


METHODS
MEDLINE; the Cochrane Controlled Trials Registry; and reference lists of reviews, editorials, and original studies.


METHODS
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.


METHODS
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.


RESULTS
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.
Oregon Health & Science University and Portland Veterans Affairs Medical Center, Mailcode BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098, USA.
Linda L
LL
Humphrey
Mark
M
Helfand
Benjamin K S
BK
Chan
Steven H
SH
Woolf
D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control*; D016504:Breast Self-Examination; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008327:Mammography / Q000009:adverse effects / Q000191:economics; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D012107:Research Design; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology