Harms and benefits of mammographic screening for breast cancer in Brazil
Harms and benefits of mammographic screening for breast cancer in Brazil
Data
2024
Autores
Migowski, Arn
Nadanovsky, Paulo
Vianna, Cid Manso de Mello
Journal Title
Journal ISSN
Volume Title
Publisher
PLOS ONE
Resumo
Introduction
In the absence of evidence on the effect of mammographic screening on overall mortality,
comparing the number of deaths avoided with the number of deaths caused by screening
would be ideal, but the only existing models of this type adopt a very narrow definition of
harms. The objective of the present study was to estimate the number of deaths prevented
and induced by various mammography screening protocols in Brazil.
Methods
A simulation study of cohorts of Brazilian women screened, considering various age groups
and screening interval protocols, was performed based on life tables. The number of deaths
avoided and caused by screening was estimated, as was the absolute risk reduction, the
number needed to invite for screening—NNS, the net benefit of screening, and the ratio of
“lives saved” to “lives lost”. Nine possible combinations of balances between benefits and
harms were performed for each protocol, in addition to other sensitivity analyses.
Results and conclusions
The most efficient protocol was biennial screening from 60 to 69 years of age, with almost
three times more deaths avoided than biennial screening from 50 to 59 years of age, with a
similar number of deaths avoided by biennial screening from 50 to 69 years of age and with
the greatest net benefit. Compared with the best scenario of annual screening from 40 to 49
years of age, the NNS of the protocol with biennial screening from 60 to 69 years of age was
three-fold lower. Even in its best scenario, the addition of annual screening from 40 to 49
years of age to biennial screening from 50 to 69 years of age results in a decreased net ben-
efit. However, even in the 50–69 year age group, the estimated reduction in breast cancer
mortality for Brazil was half that estimated for the United Kingdom.
Description
Palavras-chave
Aged, Brazil / epidemiology, Breast, Breast Neoplasms* / diagnostic imaging, Early Detection of Cancer / adverse effects, Early Detection of Cancer / methods, Female, Humans, Mammography / adverse effects, Mammography / methods, Mass Screening / methods, Middle Aged.
Citação
Migowski A, Nadanovsky P, Manso de Mello Vianna C. Harms and benefits of mammographic screening for breast cancer in Brazil. PLoS One. 2024 Jan 25;19(1):e0297048. doi: 10.1371/journal.pone.0297048.