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Article
Meta-analysis of breast cancer mortality benefit and overdiagnosis adjusted for adherence: Improving information on the effects of attending screening mammography
British Journal of Cancer
  • Gemma Jacklyn, University of Sydney
  • Paul P. Glasziou, Bond University
  • Petra Macaskill, University of Sydney
  • Alexandra Barratt, University of Sydney
Date of this Version
4-28-2016
Document Type
Journal Article
Grant Number
NHMRC Grant No. 633003
Publication Details

Citation only

Jacklyn, G., Glasziou, P., Macaskill, P., & Barratt, A. (2016). Meta-analysis of breast cancer mortality benefit and overdiagnosis adjusted for adherence: Improving information on the effects of attending screening mammography. British Journal of Cancer, 114(11), 1269-1276.

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© 2016 Cancer Research UK.

Abstract

Background:

Women require information about the impact of regularly attending screening mammography on breast cancer mortality and overdiagnosis to make informed decisions. To provide this information we aimed to meta-analyse randomised controlled trials adjusted for adherence to the trial protocol.

Methods:

Nine screening mammography trials used in the Independent UK Breast Screening Report were selected. Extending an existing approach to adjust intention-to-treat (ITT) estimates for less than 100% adherence rates, we conducted a random-effects meta-analysis. This produced a combined deattenuated prevented fraction and a combined deattenuated percentage risk of overdiagnosis.

Results:

In women aged 39-75 years invited to screen, the prevented fraction of breast cancer mortality at 13-year follow-up was 0.22 (95% CI 0.15-0.28) and it increased to 0.30 (95% CI 0.18-0.42) with deattenuation. In women aged 40-69 years invited to screen, the ITT percentage risk of overdiagnosis during the screening period was 19.0% (95% CI 15.2-22.7%), deattenuation increased this to 29.7% (95% CI 17.8-41.5%).

Conclusions:

Adjustment for nonadherence increased the size of the mortality benefit and risk of overdiagnosis by up to 50%. These estimates are more appropriate when developing quantitative information to support individual decisions about attending screening mammography

Citation Information
Gemma Jacklyn, Paul P. Glasziou, Petra Macaskill and Alexandra Barratt. "Meta-analysis of breast cancer mortality benefit and overdiagnosis adjusted for adherence: Improving information on the effects of attending screening mammography" British Journal of Cancer Vol. 114 Iss. 11 (2016) p. 1269 - 1276 ISSN: 0007-0920
Available at: http://works.bepress.com/paul_glasziou/192/