Abstract
In 2012, the Euroscreen project published a review of incidence-based mortality evaluations of breast cancer screening programmes. In this paper, we update this review to October 2019 and expand its scope from Europe to worldwide. We carried out a systematic review of incidence-based mortality studies of breast cancer screening programmes, and a meta-analysis of the estimated effects of both invitation to screening and attendance at screening, with adjustment for self-selection bias, on incidence-based mortality from breast cancer. We found 27 valid studies. The results of the meta-analysis showed a significant 22% reduction in breast cancer mortality with invitation to screening, with a relative risk of 0.78 (95% CI 0.75–0.82), and a significant 33% reduction with actual attendance at screening (RR 0.67, 95% CI 0.61–0.75). Breast cancer screening in the routine healthcare setting continues to confer a substantial reduction in mortality from breast cancer.
Highlights
Reviews of randomised controlled trials (RCTs) of mammography screening estimate that invitation to screening reduces risk of death from breast cancer by around 20% [1,2]
The results may not be representative of the effectiveness of individual population mammography screening programmes [5], which are affected by factors such as varying round lengths, radiographer skill and technology [6]
One method is to use incidence-based mortality (IBM) [7], where deaths from breast cancer are only included in women diagnosed after screening has been introduced [8]
Summary
Reviews of randomised controlled trials (RCTs) of mammography screening estimate that invitation to screening reduces risk of death from breast cancer by around 20% [1,2]. While RCTs provide reliable evidence and proof of principle that mammography screening is likely to be beneficial, once population screening programmes have been introduced, randomisation to a non-interventional control is no longer ethical and it is necessary to measure the effectiveness of screening in practice through observational studies. One method is to use incidence-based mortality (IBM) [7], where deaths from breast cancer are only included in women diagnosed after screening has been introduced [8]. This avoids contamination of deaths in the screening period of women who were diagnosed prior to the start of screening, which would bias results against screening [9]. The aim of this review is to provide an overview of all IBM studies evaluating the impact of mammography
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