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QUESTION: How effective is breast cancer screening with mammography, clinical breast examination (CBE), and breast self examination (BSE) in preventing breast cancer mortality?
Studies were identified by searching Medline (1994–2001), Premedline (December 2001 to February 2002), and the Cochrane Controlled Trials Register; reviewing the reference lists of previous reviews, commentaries, and meta-analyses; and contacting experts in the field.
Studies were selected if they were randomised controlled trials (RCTs) of breast cancer screening and had a relevant clinical outcome (advanced breast cancer, breast cancer mortality, or all cause mortality).
Data were extracted on patient population, study design, potential flaws, missing information, analysis, and length of follow up. US Preventive Services Task Force (USPSTF) criteria were used to assess study quality (good, fair, or poor). The primary endpoint was breast cancer mortality.
8 RCTs (479 987 women) (154 publications) met the selection criteria: 4 evaluated mammography, and 4 evaluated mammography plus CBE. 7 trials were rated fair quality, and 1 was rated poor quality. The mean follow up was 14 years. Meta-analysis of the 7 fair trials showed that mammography screening led to …
For correspondence: Dr L L Humphrey, Oregon Health & Science University, Portland, OR, USA.
Abstract and commentary also appear in ACP Journal Club.
Source of funding: Agency for Healthcare Research and Quality.