Abstract：
OBJECTIVE: Film mammography has been replaced by digital mammography in breast screening programs globally. This led to a small increase in the rate of detection, but whether the detection of clinically important cancers increased is uncertain. We aimed to assess the impact on tumor characteristics of screen-detected and interval breast cancers.
METHODS: We searched seven databases from inception to October 08, 2023, for publications comparing film and digital mammography within the same population of asymptomatic women at population (average) risk of breast cancer. We recorded reported tumor characteristics and assessed risk of bias using the Risk Of Bias In Non-randomised Studies - of Interventions tool. We synthesized results using meta-analyses of random effects.
RESULTS: Eighteen studies were included in the analysis from 8 countries, including 11,592,225 screening examinations (8,117,781 film; 3,474,444 digital). There were no differences in tumor size, morphology, grade, node status, receptor status, or stage in the pooled differences for screen-detected and interval invasive cancer tumor characteristics. There were statistically significant increases in screen-detected ductal carcinoma in situ (DCIS) across all grades: 0.05 (0.00-0.11), 0.14 (0.05-0.22), and 0.19 (0.05-0.33) per 1000 screens for low, intermediate, and high-grade DCIS, respectively. There were similar (non-statistically significant) increases in screen-detected invasive cancer across all grades.
CONCLUSIONS: The increased detection of all grades of DCIS and invasive cancer may indicate both increased early detection of more aggressive disease and increased overdiagnosis.
METHODS: We searched seven databases from inception to October 08, 2023, for publications comparing film and digital mammography within the same population of asymptomatic women at population (average) risk of breast cancer. We recorded reported tumor characteristics and assessed risk of bias using the Risk Of Bias In Non-randomised Studies - of Interventions tool. We synthesized results using meta-analyses of random effects.
RESULTS: Eighteen studies were included in the analysis from 8 countries, including 11,592,225 screening examinations (8,117,781 film; 3,474,444 digital). There were no differences in tumor size, morphology, grade, node status, receptor status, or stage in the pooled differences for screen-detected and interval invasive cancer tumor characteristics. There were statistically significant increases in screen-detected ductal carcinoma in situ (DCIS) across all grades: 0.05 (0.00-0.11), 0.14 (0.05-0.22), and 0.19 (0.05-0.33) per 1000 screens for low, intermediate, and high-grade DCIS, respectively. There were similar (non-statistically significant) increases in screen-detected invasive cancer across all grades.
CONCLUSIONS: The increased detection of all grades of DCIS and invasive cancer may indicate both increased early detection of more aggressive disease and increased overdiagnosis.
摘要：
目的：在全球范围内的乳腺筛查计划中，胶片乳房X线照相术已取代数字乳房X线照相术。这导致检测率的小幅增加，但是临床上重要的癌症的检测是否增加是不确定的。我们旨在评估筛查和间隔乳腺癌对肿瘤特征的影响。
方法：从开始到2023年10月8日，我们搜索了七个数据库，以比较相同人群（平均）患乳腺癌风险的无症状女性中的电影和数字乳腺X线摄影。我们使用ROBINS-I工具记录报告的肿瘤特征并评估偏倚风险。我们使用随机效应的荟萃分析综合了结果。
结果：来自8个国家的18项研究被纳入分析，包括11,592,225项放映考试（8,117,781部电影；3,474,444部数字）。肿瘤大小没有差异，形态学,grade,节点状态,受体状态，或在筛选检测到的和间隔浸润性癌症肿瘤特征的合并差异中的阶段。在所有年级中，屏幕检测到的DCIS均有统计学上的显着增加：0.05（0.00-0.11），0.14（0.05-0.22），和0.19（0.05-0.33）每1000个屏幕低，中间,和高等级DCIS分别。在所有等级中，屏幕检测到的浸润性癌症都有相似（无统计学意义）的增加。
结论：对所有级别的DCIS和浸润性癌的检测增加可能表明对更具侵袭性疾病的早期检测增加和过度诊断增加。
背景：澳大利亚国家健康与医学研究委员会和国家乳腺癌基金会。
背景：PROSPERO2017：CRD42017070601。
方法：从开始到2023年10月8日，我们搜索了七个数据库，以比较相同人群（平均）患乳腺癌风险的无症状女性中的电影和数字乳腺X线摄影。我们使用ROBINS-I工具记录报告的肿瘤特征并评估偏倚风险。我们使用随机效应的荟萃分析综合了结果。
结果：来自8个国家的18项研究被纳入分析，包括11,592,225项放映考试（8,117,781部电影；3,474,444部数字）。肿瘤大小没有差异，形态学,grade,节点状态,受体状态，或在筛选检测到的和间隔浸润性癌症肿瘤特征的合并差异中的阶段。在所有年级中，屏幕检测到的DCIS均有统计学上的显着增加：0.05（0.00-0.11），0.14（0.05-0.22），和0.19（0.05-0.33）每1000个屏幕低，中间,和高等级DCIS分别。在所有等级中，屏幕检测到的浸润性癌症都有相似（无统计学意义）的增加。
结论：对所有级别的DCIS和浸润性癌的检测增加可能表明对更具侵袭性疾病的早期检测增加和过度诊断增加。
背景：澳大利亚国家健康与医学研究委员会和国家乳腺癌基金会。
背景：PROSPERO2017：CRD42017070601。
