Is there excess mortality in women screened with mammography: a meta-analysis of non-breast cancer mortality

BACKGROUND: The objective of our meta-analysis and systematic review was to analyze non-breast cancer mortality in women screened with mammography versus non-screened women to determine whether there is excess mortality caused by screening. METHODS: We searched PubMed and the Web of Science up to 30 November 2010. We included randomized controlled trials with non-breast cancer mortality as the main endpoint. Two authors independently assessed trial quality and extracted data. RESULTS: There was no significant difference between groups at 13-year follow-up (odds ratio = 1.00 (95% CI 0.98 to 1.03) with average heterogeneity I(2) = 61%) regardless of the age and the methodological quality of the included studies. The meta-analysis did not reveal excess non-breast cancer mortality caused by screening. If screening does have an effect on excess mortality, it is possible to provide an estimate of its maximum value through the upper confidence interval in good-quality methodological studies: up to 3% in the screened women group (12 deaths per 100,000 women). CONCLUSIONS: The all-cause death rate was not significantly reduced by screening when compared to the rate observed in unscreened women. However, mammography screening does not seem to induce excess mortality. These findings improve information given to patients. Finding more comprehensive data is now going to be difficult given the complexity of the studies. Individual modeling should be used because the studies fail to include all the aspects of a complex situation. The risk/benefit analysis of screening needs to be regularly and independently reassessed.