{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T07:17:23Z","timestamp":1781939843169,"version":"3.54.5"},"reference-count":54,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,3,14]],"date-time":"2019-03-14T00:00:00Z","timestamp":1552521600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"publisher","award":["FP7 Marie Curie Actions \u2010People \u2010Co\u2010funding"],"award-info":[{"award-number":["FP7 Marie Curie Actions \u2010People \u2010Co\u2010funding"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2019,8,15]]},"abstract":"<jats:p>This systematic review, stimulated by inconsistency in secondary evidence, reports the benefits and harms of breast cancer (BC) screening and their determinants according to systematic reviews. A systematic search, which identified 9,976 abstracts, led to the inclusion of 58 reviews. BC mortality reduction with screening mammography was 15\u201325% in trials and 28\u201356% in observational studies in all age groups, and the risk of stage III+ cancers was reduced for women older than 49\u2009years. Overdiagnosis due to mammography was 1\u201360% in trials and 1\u201312% in studies with a low risk of bias, and cumulative false\u2010positive rates were lower with biennial than annual screening (3\u201317% <jats:italic>vs<\/jats:italic> 0.01\u201341%). There is no consistency in the reviews\u2019 conclusions about the magnitude of BC mortality reduction among women younger than 50\u2009years or older than 69\u2009years, or determinants of benefits and harms of mammography, including the type of mammography (digital <jats:italic>vs<\/jats:italic> screen\u2010film), the number of views and the screening interval. Similarly, there was no solid evidence on determinants of benefits and harms or BC mortality reduction with screening by ultrasonography or clinical breast examination (sensitivity ranges, 54\u201384% and 47\u201369%, respectively), and strong evidence of unfavourable benefit\u2010to\u2010harm ratio with breast self\u2010examination. The reviews\u2019 conclusions were not dependent on the quality of the reviews or publication date. Systematic reviews on mammography screening, mainly from high\u2010income countries, systematically disagree on the interpretation of the benefit\u2010to\u2010harm ratio. Future reviews are unlikely to clarify the discrepancies unless new original studies are published.<\/jats:p>","DOI":"10.1002\/ijc.32211","type":"journal-article","created":{"date-parts":[[2019,2,14]],"date-time":"2019-02-14T10:40:18Z","timestamp":1550140818000},"page":"994-1006","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["Systematic reviews as a \u2018lens of evidence\u2019: Determinants of benefits and harms of breast cancer screening"],"prefix":"10.1002","volume":"145","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3755-3031","authenticated-orcid":false,"given":"Olena","family":"Mandrik","sequence":"first","affiliation":[{"name":"Section of Early Detection and Prevention, International Agency for Research on Cancer  Lyon France"},{"name":"Erasmus School of Health Policy &amp; Management, Erasmus University Rotterdam  Rotterdam The Netherlands"},{"name":"Health Economic and Decision Science (HEDS), School of Health and Related Research (ScHARR) The University of Sheffield  Sheffield United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Zielonke","sequence":"additional","affiliation":[{"name":"Department of Public Health, Erasmus MC University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filip","family":"Meheus","sequence":"additional","affiliation":[{"name":"Section of Early Detection and Prevention, International Agency for Research on Cancer  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.L. 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