ImportanceBreast 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.ObjectiveTo review studies comparing different breast cancer screening strategies for the US Preventive Services Task Force.Data SourcesMEDLINE, Cochrane Library through August 22, 2022; literature surveillance through March 2024.Study SelectionEnglish-language publications; randomized clinical trials and nonrandomized studies comparing screening strategies; expanded criteria for screening harms.Data Extraction and SynthesisTwo reviewers independently assessed study eligibility and quality; data extracted from fair- and good-quality studies.Main Outcomes and MeasuresMortality, morbidity, progression to advanced cancer, interval cancers, screening harms.ResultsSeven 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 RelevanceEvidence 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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乳腺癌筛查

重要性乳腺癌是美国女性癌症死亡的主要原因。试验已证实筛查乳房 X 光检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清楚。目的回顾比较美国预防服务工作组不同乳腺癌筛查策略的研究。数据来源MEDLINE、Cochrane 图书馆2022 年 8 月 22 日；截至 2024 年 3 月的文献监测。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；扩大了筛查危害的标准。数据提取和合成两位评审员独立评估了研究的资格和质量；从公平和高质量的研究中提取的数据。主要结果和测量死亡率、发病率、晚期癌症进展、间期癌症、筛查危害。结果纳入了 7 项随机临床试验和 13 项非随机研究； 2 项非随机研究报告了死亡率结果。一项非随机试验模拟研究估计 74 岁以上筛查的死亡率没有差异（调整后的风险比，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后，晚期癌症检测没有差异。三项试验将数字乳房断层合成 (DBT) 乳房 X 光检查与单独的数字乳房 X 光检查进行了比较。与数字乳房 X 光检查相比，DBT 在第一轮筛查中检测到更多浸润性癌症，但间期癌症没有统计学上的显着差异（汇总相对风险，0.87 [95% CI，0.64-1.17]；3 项研究 [n = 130] 196]；我2= 0%）。在各个试验中，DBT 与数字乳房 X 光检查相比，在随后的筛查中晚期癌症（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。一项随机对照试验将乳房致密的个体随机邀请进行磁共振成像补充筛查，报告称干预措施降低了间期癌症风险（相对风险，0.47 [95% CI，0.29-0.77]），并出现了额外的假阳性召回和活检结果；没有长期晚期乳腺癌的发病率或发病率和死亡率结果。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结果，并且间期癌症没有差异。结论和相关性比较不同乳腺癌筛查策略有效性的证据尚无定论，因为关键研究尚未完成，而且很少有研究报告了乳腺癌筛查策略的有效性。评估相对效益所需的阶段转移或死亡率结果。