Abstract

DO MAMMOGRAPHY’S BENEFITS JUSTIFY ITS HARMS FOR BREAST RANDOMIZED CANCER DETECTION? SYSTEMATIC REVIEW AND META-ANALYSIS OF LONG-TERM CONTROLLED TRIALS

Nura Nasser Alahmadi*, Thabat Abdullah Alfraidi, Nourah Ahmad Alsumairi, Abdulaziz Ali Saeed Al Shamlah, Ahmed Yahya Ahmed Mushari, Abdullah Ali Alqarni and Moustafa Radwan

Abstract

Mammography usefulness is questionable in terms of breast cancer over diagnosis and mortality, clinically subtle cancers which would not otherwise be detected. Therefore, we systematically reviewed the published randomized controlled trials (RCTs) about the benefits and harms of mammography for breast cancer detection. Methods: We searched SCOPUS, PubMed, Cochrane CENTRAL, and Web of Science for RCTs assessing the harms and benefits of mammography for breast cancer detection. We extracted and analyzed data by RevMan version 5.3 for windows. P value lower than 0.05 was considered statistically significant. Results: Eleven eligible RCTs were involved in the final analysis (Subjects n=673573). The overall effect estimates showed that mammography significantly reduced the breast cancer mortality rates, regardless of age group (RR=0·80(95%) CI [0·73–0·89], P <0.001). The absolute risk reduction showed that among 235 women invited to screening, the mammography prevented one cancer death. The overall percentage of the over diagnosis, defined as excess cancers as a rate of cancers diagnosed over long-term follow-up among invited women for screening, was 19% (95% CI [15·2– 22·7]). Conclusion: Mammography screening may modestly decrease mortality of breast cancer but with a high rate of over diagnosis occurs. The currently published trials have a lot of limitations and whose relevance to screening programs of present-day could be misbelieve.

Keywords: Mammography, Breast Cancer, Diagnostic Accuracy.