本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2023.25844

摘要内容如下：

重要性

乳腺癌是美国女性癌症死亡的主要原因。试验已经证实，乳房X光筛查可以降低死亡风险，但人群筛查指南的最佳筛查年龄、间隔时间和方式仍不明确。

目的

回顾美国预防服务工作组比较不同乳腺癌筛查策略的研究。

数据源

MEDLINE，Cochrane图书馆至2022年8月22日；文献监测至2024年3月。

研究选择

英文出版物；比较筛查策略的随机临床试验和非随机研究；扩大了危害筛查标准。

数据提取与合成

两名评价者独立评估研究的合格性和质量；从质量良好的研究中提取的数据。

主要成果和措施

死亡率，发病率，进展到晚期癌症，间期癌症，筛查危害。

结果

纳入7个随机临床试验和13个非随机研究。2项非随机研究报告了死亡率结果。一项非随机试验仿真研究估计，年龄超过74岁的筛查无死亡率差异（校正风险比，1.00[95%CI，0.83至1.19]）。在一项非随机研究中，每年或每两年一次的筛查间隔对晚期癌症的检测没有影响。三项试验比较了数字乳腺断层合成（DBT）乳房X线摄影筛查与单独的数字乳房X线摄影。与数字乳腺摄影相比，DBT在第一轮筛查中检测到更多的侵袭性癌症，但在间期癌症中没有统计学上的显著差异（合并相对风险，0.87[95%CI，0.64-1.17]；3项研究[N=130196]；I2=0%）。在个体试验中，DBT与数字乳腺摄影相比，在随后的筛查轮次中，晚期癌症（II期或更高）的风险没有统计学意义。来自试验和非随机研究的有限证据表明，DBT的召回率较低。一项随机对照试验（RCT）将致密型乳腺患者随机分为两组，一组接受磁共振成像的补充筛查，另一组接受干预的患者报告了降低的间期癌症风险（相对风险，0.47[95%CI，0.29-0.77]）和额外的假阳性回忆和活检结果。没有长期的晚期乳腺癌发病率或发病率和死亡率结果可用。一项随机对照试验和一项补充超声筛查的非随机研究报告了额外的假阳性，并且在间期癌症中没有差异。

结论和相关性

比较不同乳腺癌筛查策略的有效性的证据尚无定论，因为关键研究尚未完成，并且很少有研究报告评估相对益处所必需的分期转移或死亡率结果。

英文原文如下：

Abstracts

Importance  Breast cancer is a leading cause of cancer mortality for US women. Trials have established that screening mammography can reduce mortality risk, but optimal screening ages, intervals, and modalities for population screening guidelines remain unclear.

Objective  To review studies comparing different breast cancer screening strategies for the US Preventive Services Task Force.

Data Sources  MEDLINE, Cochrane Library through August 22, 2022; literature surveillance through March 2024.

Study Selection  English-language publications; randomized clinical trials and nonrandomized studies comparing screening strategies; expanded criteria for screening harms.

Data Extraction and Synthesis  Two reviewers independently assessed study eligibility and quality; data extracted from fair- and good-quality studies.

Main Outcomes and Measures  Mortality, morbidity, progression to advanced cancer, interval cancers, screening harms.

Results  Seven randomized clinical trials and 13 nonrandomized studies were included; 2 nonrandomized studies reported mortality outcomes. A nonrandomized trial emulation study estimated no mortality difference for screening beyond age 74 years (adjusted hazard ratio, 1.00 [95% CI, 0.83 to 1.19]). Advanced cancer detection did not differ following annual or biennial screening intervals in a nonrandomized study. Three trials compared digital breast tomosynthesis (DBT) mammography screening with digital mammography alone. With DBT, more invasive cancers were detected at the first screening round than with digital mammography, but there were no statistically significant differences in interval cancers (pooled relative risk, 0.87 [95% CI, 0.64-1.17]; 3 studies [n = 130 196]; I2 = 0%). Risk of advanced cancer (stage II or higher) at the subsequent screening round was not statistically significant for DBT vs digital mammography in the individual trials. Limited evidence from trials and nonrandomized studies suggested lower recall rates with DBT. An RCT randomizing individuals with dense breasts to invitations for supplemental screening with magnetic resonance imaging reported reduced interval cancer risk (relative risk, 0.47 [95% CI, 0.29-0.77]) and additional false-positive recalls and biopsy results with the intervention; no longer-term advanced breast cancer incidence or morbidity and mortality outcomes were available. One RCT and 1 nonrandomized study of supplemental ultrasound screening reported additional false-positives and no differences in interval cancers.

Conclusions and Relevance  Evidence comparing the effectiveness of different breast cancer screening strategies is inconclusive because key studies have not yet been completed and few studies have reported the stage shift or mortality outcomes necessary to assess relative benefits.

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