Efficacy of screening mammography: A meta-analysis

Karla Kerlikowske, Deborah Grady, Susan M. Rubin, Christian E Sandrock, Virginia L. Ernster

Research output: Contribution to journalArticle

919 Citations (Scopus)

Abstract

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 (96% 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.

Original languageEnglish (US)
Pages (from-to)149-154
Number of pages6
JournalJournal of the American Medical Association
Volume273
Issue number2
DOIs
StatePublished - Jan 11 1995
Externally publishedYes

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Mammography
Meta-Analysis
Confidence Intervals
Breast Neoplasms
Mortality
Menopause
MEDLINE
Language
Referral and Consultation
Age Groups

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Efficacy of screening mammography : A meta-analysis. / Kerlikowske, Karla; Grady, Deborah; Rubin, Susan M.; Sandrock, Christian E; Ernster, Virginia L.

In: Journal of the American Medical Association, Vol. 273, No. 2, 11.01.1995, p. 149-154.

Research output: Contribution to journalArticle

Kerlikowske, Karla ; Grady, Deborah ; Rubin, Susan M. ; Sandrock, Christian E ; Ernster, Virginia L. / Efficacy of screening mammography : A meta-analysis. In: Journal of the American Medical Association. 1995 ; Vol. 273, No. 2. pp. 149-154.
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abstract = "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 (96{\%} 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.",
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