Review of age limits in the mammography screening programme extract
The possible benefit with regard to breast cancer-specific mortality, which is, however, quite questionable in this age group, is likely to be countered by harm expected from overdiagnosis and consequences of false-positive screening results
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| Format: | eBook |
| Language: | English |
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Köln, Germany
Institute for Quality and Efficiency in Health Care
2022, 16 August 2022
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| Edition: | Version 1.1 |
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| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | The possible benefit with regard to breast cancer-specific mortality, which is, however, quite questionable in this age group, is likely to be countered by harm expected from overdiagnosis and consequences of false-positive screening results It is assumed that the overall effect of reduced breast cancer mortality through screening was too small to have an impact on all-cause mortality. However, mammography screening leads to negative consequences (indication of harm) through false-positive screening results. In addition, overdiagnosis occurs (hint of harm). However, the extent of harm is not so great that it outweighs the mortality advantage. With regard to mastectomies, the data provide no hint of a benefit or harm from mammography screening. No data were available for adverse events and health-related quality of life, so no hint of a benefit or harm was shown for these outcomes. However, the effect of screening on the rate of adverse events and on health-related quality of life is likely to be essentially captured by the outcome of overdiagnosis. This is no argument against a benefit of mammography screening, because with increasing age, breast cancer accounts for a smaller and smaller proportion of all deaths, and all-cause mortality is greatly influenced by competing causes of death. It is therefore assumed that the overall effect of reduced breast cancer mortality through screening was too small to have an impact on all-cause mortality. Mammography screening leads to overdiagnosis and to negative consequences of false-positive screening results (in each case a hint of harm in women aged 70 and older). It is assumed that the expected mortality advantage outweighs the expected harm. No data were available for mastectomies, adverse events and health-related quality of life, so no hint of a benefit or harm was shown for these outcomes. In summary, the data provide a hint of a benefit of mammography screening versus no screening in women aged 70 to 74 years; the benefit of mammography screening thus outweighs harm. RESEARCH QUESTION: The aims of the present investigation are to assess the benefit of mammography screening for breast cancer versus no screening (or breast palpation alone) - in women aged 45 to 49 years with no signs of breast cancer and no specifically increased risk of breast cancer (Question 1) and - in women aged 70 years and older with no signs of breast cancer and no specifically increased risk of breast cancer (Question 2) with regard to patient-relevant outcomes. CONCLUSION: QUESTION 1: AGE GROUP 45 TO 49 YEARS: For breast cancer-specific mortality, the data provide a hint of a benefit of mammography screening versus no screening in women aged 45 to 49 years. With regard to all-cause mortality, there was no statistically significant result. The result on all-cause mortality is no argument against a benefit of mammography screening, because all-cause mortality is considerably influenced by other causes of death. In summary, the data provide a hint of a benefit of mammography screening for women aged 45 to 49 years versus no screening; the benefit of mammography screening thus outweighs harm. However, an individual assessment and weighing of benefits and harms is still essential in view of the very small mortality advantage in this age group. Therefore, all conditions must be fulfilled to enable women to make an informed decision. QUESTION 2: AGE GROUP 70 YEARS AND OLDER: For breast cancer-specific mortality, the data provide a hint of a benefit of mammography screening versus no screening in women aged 70 to 74 years. This is based on the results for this age group, the transferability of effects from adjacent younger age groups, and the confirmatory results of the modelling performed. With regard to all-cause mortality, there was no statistically significant result. However, an individual assessment and weighing of benefits and harms, considering the individual health status and life expectancy, is still essential in view of the very small mortality advantage, harm observed from overdiagnosis and the consequences of false-positive results, as well as the uncertainties regarding the quantification of effects. Therefore, all conditions must be fulfilled to enable women to make an informed decision. An ongoing randomized controlled trial (AgeX) is expected to provide meaningful data for both questions of this report in the near future. As soon as the study results are available, it should therefore be examined whether the results are in line with the recommendations to extend the age limits. Mammography screening for women aged 75 and older currently offers neither a benefit nor a potential versus no screening due to a lack of informative data. |
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| Item Description: | Translation of Chapters 1 to 6 of the final report S21-01 Überprüfung der Altersgrenzen im MammografieScreening-Programmem (Version 1.1; Status: 16 August 2022 [German original], 25 November 2022 [English translation]) |
| Physical Description: | 1 PDF file (viii, 49 pages) |