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January 11, 1995, Vol 273, No. 2 >
Review | January 11, 1995

Efficacy of Screening Mammography: Title and subTitle BreakA Meta-analysis FREE

Karla Kerlikowske, MD; Deborah Grady, MD, MPH; Susan M. Rubin, MPH; Christian Sandrock; Virginia L. Ernster, PhD
[+] Author Affiliations

Reprint requests to San Francisco Veterans Affairs Medical Center, General Internal Medicine Section, 111A1, 4150 Clement St, San Francisco, CA 94121 (Dr Kerlikowske).


From the Department of Epidemiology and Biostatistics (Drs Kerlikowske, Grady, and Ernster, and Mr Sandrock) and the Division of General Internal Medicine, Department of Medicine (Ms Rubin), University of California, San Francisco, and the General Internal Medicine Section, Department of Veterans Affairs Medical Center, San Francisco, Calif (Drs Kerlikowske and Grady).


JAMA. 1995;273(2):149-154. doi:10.1001/jama.1995.03520260071035
Text Size: A A A
Published online
Article
References

Objective.  —To determine the efficacy of screening mammography by age, number of mammographic views per screen, screening interval, and duration of follow-up.

Design.  —Literature review and meta-analysis.

Data Identification and Analysis.  —Literature search of English-language studies reported from January 1966 to October 31, 1993, using MEDLINE, manual literature review, and consultation with experts. A total of 13 studies were selected, and their results were combined using meta-analytic techniques based on the assumption of fixed effects.

Main Results.  —The overall summary relative risk (RR) estimate for breast cancer mortality for women aged 50 to 74 years undergoing screening mammography compared with those who did not was 0.74 (95% confidence interval [CI], 0.66 to 0.83). The magnitude of the benefit in this age group was similar regardless of number of mammographic views per screen, screening interval, or duration of follow-up. In contrast, none of the summary RR estimates for women aged 40 to 49 years was significantly less than 1.0, irrespective of screening intervention or duration of follow-up. The overall summary RR estimate in women aged 40 to 49 years was 0.93 (95% CI, 0.76 to 1.13); the summary RR estimate for those studies that used two-view mammography was 0.87 (95% CI, 0.68 to 1.12) compared with 1.02 (95% CI, 0.73 to 1.44) for those studies that used one-view mammography, and for those studies with 7 to 9 years of follow-up, the summary RR estimate was 1.02 (95% CI, 0.82 to 1.27) compared with 0.83 (95% CI, 0.65 to 1.06) for those studies with 10 to 12 years of follow-up.

Conclusion.  —Screening mammography significantly reduces breast cancer mortality in women aged 50 to 74 years after 7 to 9 years of follow-up, regardless of screening interval or number of mammographic views per screen. There is no reduction in breast cancer mortality in women aged 40 to 49 years after 7 to 9 years of follow-up. Screening mammography may be effective in reducing breast cancer mortality in women aged 40 to 49 years after 10 to 12 years of follow-up, but the same benefit could probably be achieved by beginning screening at menopause or 50 years of age.(JAMA. 1995;273:149-154)

REFERENCES

1 +
O'Maley M, Fletcher S, Morrison B. Does Screening for Breast Cancer Save Lives? Effectiveness of Treatment After Breast Cancer Detection Following Screening by Clinical Breast Examination, Mammography and Breast Self-examination . New York, NY: Springer-Verlag New York Inc; 1990;.
2 +
Tabar L, Fagerberg G, Duffy S, Day N, Gas A, Grontoft O.  Update of the Swedish two county program of mammographic screening trial. Radiol Clin North Am . 1992;;30:187-210.
3 +
Andersson I, Aspegren K, Janzon L, et al.  Mammographic screening and mortality from breast cancer: the Malmo mammographic screening trial. BMJ . 1988;;297:943-948.
4 +
Roberts MM, Alexander FE, Anderson TJ, et al.  Edinburgh trial of screening for breast cancer: mortality at seven years. Lancet . 1990;;335:241-246.
5 +
Frisell J, Eklund G, Hellstrom L, Lidbrink E, Rutqvist LE, Somell A.  Randomized study of mammography screening: preliminary report on mortality in the Stockholm trial. Breast Cancer Res Treat . 1991;;18:49-56.
6 +
Shapiro S. Periodic Screening for Breast Cancer: The Health Insurance Plan Project and Its Sequelae, 1963-1986 . Baltimore, Md: Johns Hopkins University Press; 1988;.
7 +
Miller AB, Baines CJ, To T, Wall C.  Canadian National Breast Screening Study, 1: breast cancer detection death rates among women aged 40 to 49 years. Can Med Assoc J . 1992;;147:1459-1476.
8 +
Nystrom L, Rutquvist LE, Wall S, et al.  Breast cancer screening with mammography: overview of Swedish randomized trials. Lancet . 1993;;341:973-978.
9 +
Fletcher SW, Black W, Harris R, Rimer BK, Shapiro S.  Report of the International Workshop on Screening for Breast Cancer. J Natl Cancer Inst . 1993;;85:1644-1656.
10 +
Sickles EA, Kopans DB.  Deficiencies in the analysis of breast cancer screening data. J Natl Cancer Inst . 1993;;85:1621-1624.
11 +
Bulpitt CJ.  Meta-analysis. Lancet . 1988;;2:93-94.
12 +
Smart CR, Hartmann WH, Beahrs OH, Garfinkel L.  Insights into breast cancer screening of younger women. Cancer . 1993;;72:1449-1456.
13 +
Letton AH, Mason EM.  Five-year survival of breast screenees. Cancer . 1981;;48:404-406.
14 +
Letton AH, Wilson JP, Mason EM.  The value of breast screening in women less than fifty years of age. Cancer . 1977;;40:1-3.
15 +
Seidman H, Gelb SK, Silverberg E, LaVerda N, Lubera JA.  Survival experience in the breast cancer detection demonstration project. CA Cancer J Clin . 1987;;37:258-290.
16 +
Baker LH.  Breast cancer detection demonstration project: five-year summary report. CA Cancer J Clin . 1982;;32:194-225.
17 +
Verbeek ALM, Hendriks JHCL, Holland R, Mravunac M, Sturmans F.  Mammographic screening and breast cancer mortality: age-specific effects in Nijmegen project, 1975-82. Lancet . 1985;;1:865-866.
18 +
Miller AB, Baines CJ, To T, Wall C.  Canadian National Breast Screening Study, 2: breast cancer detection and death rates among women aged 50 to 59 years. Can Med Assoc J . 1992;;147:1477-1488.
19 +
Collette HJA, de Waard F, Collette C, Day NE.  Further evidence of benefits of a (non-randomized) breast cancer screening programme: the DOM project. J Epidemiol Community Health . 1992;;46: 382-386.
20 +
Palli D, Del Turco MR, Buiatti E, Ciatto S, Crocetti E, Paci E.  Time interval since last test in a breast cancer screening programme: a case-control study in Italy. J Epidemiol Community Health . 1989;;43:241-248.
21 +
Moss SM, Summerley ME, Thomas BT, Ellman R, Chamberlain JOP.  A case-control evaluation of the effect of breast cancer screening in the United Kingdom Trial of Early Detection of Breast Cancer. J Epidemiol Community Health . 1992;;46:362-364.
22 +
Tabar L, Fagerberg G, Duffy SW, Day NE.  The Swedish two county trial of mammographic screening for breast cancer: recent results and calculation of benefit. J Epidemiol Community Health . 1989;; 43:107-114.
23 +
Shapiro S.  Evidence on screening for breast cancer from a randomized trial. Cancer . 1977;;39: 2772-2782.
24 +
Wald N, Chamberlain J, Hackshaw A, and EUSOMA Evaluation Committee.  Report of the European Society for Mastology Breast-Cancer Screening Evaluation Committee. J Eur Soc Mastology . 1993;;13:1-25.
25 +
Greenland S.  Quantitative methods in the review of epidemiologic literature. Epidemiol Rev . 1987;;9:1-30.
26 +
Elwood JM, Cox B, Richardson AK.  The effectiveness of breast cancer screening by mammography in younger women. Online J Curr Clin Trials [Serial on line]. 1993;;2:Doc NR 32.
27 +
van Dijck JAAM, Verbeek ALM, Hendriks JHCL, Holland R.  One-view versus two-view mammography in baseline screening for breast cancer: a review. Br J Radiol . 1992;;65:971-976.
28 +
Peeters PHM, Verbeek ALM, Hendriks JHCL, van Bon MJH.  Screening for breast cancer in Nijmegen: report of 6 screening rounds, 1975-1986. Int J Cancer . 1989;;43:226-230.
29 +
Sickles EA, Weber WN, Galvin HB, Ominsky SH, Sollitto RA.  Baseline screening mammography: one vs two views per breast. AJR Am J Roentgenol . 1986;;147:1149-1153.
30 +
Bassett LW, Bunnell DH, Jahanshahi R, Gold RH, Arndt RD, Linsman J.  Breast cancer detection: one versus two views. Radiology . 1987;;165: 95-97.
31 +
Frisell J, Glas U, Hellstrom L, Somell A.  Randomized mammographic screening for breast cancer in Stockholm. Breast Cancer Res Treat . 1986;; 8:45-54.
32 +
Andersson I, Janzon L, Sigfusson BF.  Mammographic breast cancer screening: a randomized trial in Malmo, Sweden. Maturitas . 1985;;7:21-9.
33 +
Moskowitz M.  Breast cancer: age-specific growth rates and screening strategies. Radiology . 1986;; 161:37-41.
34 +
Tabar L, Faberberg G, Day NE, Holmberg L.  What is the optimum interval between mammographic screening examinations? an analysis based on the latest results of the Swedish two-county breast cancer screening trial. Br J Cancer . 1987;; 55:547-551.
35 +
Chu KC, Smart CR, Tarone RE.  Analysis of breast cancer mortality and stage distribution by age for the Health Insurance Plan clinical trial. J Natl Cancer Inst . 1988;;80:1125-1132.
36 +
Stanford JL, Hartge P, Brinton LA, Hoover RN, Brookmeyer R.  Factors influencing the age at natural menopause. J Chronic Dis . 1987;;40:995-1002.
37 +
Whelan EA, Sandler DP, McConnaughey DR, Weinberg CR.  Menstrual and reproductive characteristics and age at natural menopause. Am J Epidemiol . 1990;;131:625-632.
38 +
Shapiro S, Venet W, Strax P, Venet L, Roeser R.  Ten- to fourteen-year effect of screening on breast cancer mortality. J Natl Cancer Inst . 1982;;69:349-355.
39 +
Peer PGM, Holland R, Hendriks JHCL, Mravunac M, Berbeek ALM.  Age-specific effectiveness of the Nijmegen population-based breast cancer screening program: assessment of early indicators of screening effectiveness. J Natl Cancer Inst . 1994;; 89:436-441.
40 +
Muir BB, Kirkpatrick AE, Roberts MM, Duffy SW.  Oblique-view mammography: adequacy for screening. Radiology . 1984;;151:39-41.
41 +
Andersson I, Hildell J, Muhlow A, Pettersson H.  Number of projections in mammography: influence on detection of breast disease. AJR Am J Roentgenol . 1978;;130:349-351.
42 +
UK Trial of Early Detection of Breast Cancer Group.  Sensitivity and specificity of screening in the UK Trial of Early Detection of Breast Cancer.  In: Miller AB, Chamberlain J, Day NE, Hakama M, Prorok PC, eds. Cancer Screening . New York, NY: University Press; 1991;:3-17.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
O'Maley M, Fletcher S, Morrison B. Does Screening for Breast Cancer Save Lives? Effectiveness of Treatment After Breast Cancer Detection Following Screening by Clinical Breast Examination, Mammography and Breast Self-examination . New York, NY: Springer-Verlag New York Inc; 1990;.
2 +
Tabar L, Fagerberg G, Duffy S, Day N, Gas A, Grontoft O.  Update of the Swedish two county program of mammographic screening trial. Radiol Clin North Am . 1992;;30:187-210.
3 +
Andersson I, Aspegren K, Janzon L, et al.  Mammographic screening and mortality from breast cancer: the Malmo mammographic screening trial. BMJ . 1988;;297:943-948.
4 +
Roberts MM, Alexander FE, Anderson TJ, et al.  Edinburgh trial of screening for breast cancer: mortality at seven years. Lancet . 1990;;335:241-246.
5 +
Frisell J, Eklund G, Hellstrom L, Lidbrink E, Rutqvist LE, Somell A.  Randomized study of mammography screening: preliminary report on mortality in the Stockholm trial. Breast Cancer Res Treat . 1991;;18:49-56.
6 +
Shapiro S. Periodic Screening for Breast Cancer: The Health Insurance Plan Project and Its Sequelae, 1963-1986 . Baltimore, Md: Johns Hopkins University Press; 1988;.
7 +
Miller AB, Baines CJ, To T, Wall C.  Canadian National Breast Screening Study, 1: breast cancer detection death rates among women aged 40 to 49 years. Can Med Assoc J . 1992;;147:1459-1476.
8 +
Nystrom L, Rutquvist LE, Wall S, et al.  Breast cancer screening with mammography: overview of Swedish randomized trials. Lancet . 1993;;341:973-978.
9 +
Fletcher SW, Black W, Harris R, Rimer BK, Shapiro S.  Report of the International Workshop on Screening for Breast Cancer. J Natl Cancer Inst . 1993;;85:1644-1656.
10 +
Sickles EA, Kopans DB.  Deficiencies in the analysis of breast cancer screening data. J Natl Cancer Inst . 1993;;85:1621-1624.
11 +
Bulpitt CJ.  Meta-analysis. Lancet . 1988;;2:93-94.
12 +
Smart CR, Hartmann WH, Beahrs OH, Garfinkel L.  Insights into breast cancer screening of younger women. Cancer . 1993;;72:1449-1456.
13 +
Letton AH, Mason EM.  Five-year survival of breast screenees. Cancer . 1981;;48:404-406.
14 +
Letton AH, Wilson JP, Mason EM.  The value of breast screening in women less than fifty years of age. Cancer . 1977;;40:1-3.
15 +
Seidman H, Gelb SK, Silverberg E, LaVerda N, Lubera JA.  Survival experience in the breast cancer detection demonstration project. CA Cancer J Clin . 1987;;37:258-290.
16 +
Baker LH.  Breast cancer detection demonstration project: five-year summary report. CA Cancer J Clin . 1982;;32:194-225.
17 +
Verbeek ALM, Hendriks JHCL, Holland R, Mravunac M, Sturmans F.  Mammographic screening and breast cancer mortality: age-specific effects in Nijmegen project, 1975-82. Lancet . 1985;;1:865-866.
18 +
Miller AB, Baines CJ, To T, Wall C.  Canadian National Breast Screening Study, 2: breast cancer detection and death rates among women aged 50 to 59 years. Can Med Assoc J . 1992;;147:1477-1488.
19 +
Collette HJA, de Waard F, Collette C, Day NE.  Further evidence of benefits of a (non-randomized) breast cancer screening programme: the DOM project. J Epidemiol Community Health . 1992;;46: 382-386.
20 +
Palli D, Del Turco MR, Buiatti E, Ciatto S, Crocetti E, Paci E.  Time interval since last test in a breast cancer screening programme: a case-control study in Italy. J Epidemiol Community Health . 1989;;43:241-248.
21 +
Moss SM, Summerley ME, Thomas BT, Ellman R, Chamberlain JOP.  A case-control evaluation of the effect of breast cancer screening in the United Kingdom Trial of Early Detection of Breast Cancer. J Epidemiol Community Health . 1992;;46:362-364.
22 +
Tabar L, Fagerberg G, Duffy SW, Day NE.  The Swedish two county trial of mammographic screening for breast cancer: recent results and calculation of benefit. J Epidemiol Community Health . 1989;; 43:107-114.
23 +
Shapiro S.  Evidence on screening for breast cancer from a randomized trial. Cancer . 1977;;39: 2772-2782.
24 +
Wald N, Chamberlain J, Hackshaw A, and EUSOMA Evaluation Committee.  Report of the European Society for Mastology Breast-Cancer Screening Evaluation Committee. J Eur Soc Mastology . 1993;;13:1-25.
25 +
Greenland S.  Quantitative methods in the review of epidemiologic literature. Epidemiol Rev . 1987;;9:1-30.
26 +
Elwood JM, Cox B, Richardson AK.  The effectiveness of breast cancer screening by mammography in younger women. Online J Curr Clin Trials [Serial on line]. 1993;;2:Doc NR 32.
27 +
van Dijck JAAM, Verbeek ALM, Hendriks JHCL, Holland R.  One-view versus two-view mammography in baseline screening for breast cancer: a review. Br J Radiol . 1992;;65:971-976.
28 +
Peeters PHM, Verbeek ALM, Hendriks JHCL, van Bon MJH.  Screening for breast cancer in Nijmegen: report of 6 screening rounds, 1975-1986. Int J Cancer . 1989;;43:226-230.
29 +
Sickles EA, Weber WN, Galvin HB, Ominsky SH, Sollitto RA.  Baseline screening mammography: one vs two views per breast. AJR Am J Roentgenol . 1986;;147:1149-1153.
30 +
Bassett LW, Bunnell DH, Jahanshahi R, Gold RH, Arndt RD, Linsman J.  Breast cancer detection: one versus two views. Radiology . 1987;;165: 95-97.
31 +
Frisell J, Glas U, Hellstrom L, Somell A.  Randomized mammographic screening for breast cancer in Stockholm. Breast Cancer Res Treat . 1986;; 8:45-54.
32 +
Andersson I, Janzon L, Sigfusson BF.  Mammographic breast cancer screening: a randomized trial in Malmo, Sweden. Maturitas . 1985;;7:21-9.
33 +
Moskowitz M.  Breast cancer: age-specific growth rates and screening strategies. Radiology . 1986;; 161:37-41.
34 +
Tabar L, Faberberg G, Day NE, Holmberg L.  What is the optimum interval between mammographic screening examinations? an analysis based on the latest results of the Swedish two-county breast cancer screening trial. Br J Cancer . 1987;; 55:547-551.
35 +
Chu KC, Smart CR, Tarone RE.  Analysis of breast cancer mortality and stage distribution by age for the Health Insurance Plan clinical trial. J Natl Cancer Inst . 1988;;80:1125-1132.
36 +
Stanford JL, Hartge P, Brinton LA, Hoover RN, Brookmeyer R.  Factors influencing the age at natural menopause. J Chronic Dis . 1987;;40:995-1002.
37 +
Whelan EA, Sandler DP, McConnaughey DR, Weinberg CR.  Menstrual and reproductive characteristics and age at natural menopause. Am J Epidemiol . 1990;;131:625-632.
38 +
Shapiro S, Venet W, Strax P, Venet L, Roeser R.  Ten- to fourteen-year effect of screening on breast cancer mortality. J Natl Cancer Inst . 1982;;69:349-355.
39 +
Peer PGM, Holland R, Hendriks JHCL, Mravunac M, Berbeek ALM.  Age-specific effectiveness of the Nijmegen population-based breast cancer screening program: assessment of early indicators of screening effectiveness. J Natl Cancer Inst . 1994;; 89:436-441.
40 +
Muir BB, Kirkpatrick AE, Roberts MM, Duffy SW.  Oblique-view mammography: adequacy for screening. Radiology . 1984;;151:39-41.
41 +
Andersson I, Hildell J, Muhlow A, Pettersson H.  Number of projections in mammography: influence on detection of breast disease. AJR Am J Roentgenol . 1978;;130:349-351.
42 +
UK Trial of Early Detection of Breast Cancer Group.  Sensitivity and specificity of screening in the UK Trial of Early Detection of Breast Cancer.  In: Miller AB, Chamberlain J, Day NE, Hakama M, Prorok PC, eds. Cancer Screening . New York, NY: University Press; 1991;:3-17.

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