The screening value of mammography for breast cancer: an overview of 28 systematic reviews with evidence mapping.

Background: The effectiveness of mammography screening in reducing breast cancer mortality and the accuracy of various mammography techniques have been widely studied. However, the quality and findings of existing systematic reviews and meta-analyses require comprehensive evaluation.

Methods: A systematic literature search was conducted in the Cochrane Library, EMBASE, and PubMed for systematic reviews published up until December 20, 2022. A total of 28 systematic reviews with meta-analyses were included. Two reviewers independently extracted data and assessed methodological quality using the Risk Of Bias In Systematic Reviews (ROBIS) tool.

Results: Of the 28 systematic reviews included, only 17.9% were rated as low risk of bias. The pooled estimates for breast cancer mortality reduction due to mammography screening ranged from 0.51 (95% CI 0.46-0.55) to 1.04 (95% CI 0.84-1.27). The results were influenced by study design, age, and follow-up duration, with an overall trend indicating that mammography screening reduces breast cancer mortality. Sensitivity of mammography techniques ranged from 55 to 91%, and specificity from 84 to 97%. Digital breast tomosynthesis combined with synthetic contrast-enhanced spectral mammography, digital mammography, and film mammography demonstrated relatively high cancer detection rates and low false positives.

Conclusion: Mammography screening appears effective in reducing breast cancer mortality. The accuracy of various mammography techniques is generally reliable, with certain combinations showing high detection rates. However, the methodological quality of most included reviews was at high risk of bias, indicating a need for higher-quality studies in the future.