Meta-analysis of breast cancer mortality benefit and overdiagnosis adjusted for adherence: improving information on the effects of attending screening mammography

Br J Cancer. 2016 May 24;114(11):1269-76. doi: 10.1038/bjc.2016.90. Epub 2016 Apr 28.


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.

Publication types

  • Meta-Analysis

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / diagnostic imaging
  • Breast Neoplasms / mortality*
  • Canada / epidemiology
  • Clinical Trials as Topic
  • Early Detection of Cancer* / adverse effects
  • Female
  • Humans
  • Mammography* / adverse effects
  • Mammography* / statistics & numerical data
  • Mass Screening* / adverse effects
  • Mass Screening* / statistics & numerical data
  • Medical Overuse
  • Middle Aged
  • Models, Theoretical
  • Mortality / trends
  • Multicenter Studies as Topic
  • Patient Compliance
  • Risk Assessment
  • Sweden / epidemiology
  • United Kingdom / epidemiology